Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

$0.40

Service Code	NDC 11523-4112-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.32
Rate for Payer: Cash Price	$0.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.22
Rate for Payer: Multiplan Commercial	$0.30

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

$0.40

Service Code	NDC 11523-4112-1
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.24
Rate for Payer: Aetna of CA Government/Medicare	$0.24
Rate for Payer: Cash Price	$0.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.22
Rate for Payer: Multiplan Commercial	$0.30

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

$0.10

Service Code	NDC 8770189900
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Cash Price	$0.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Commercial	$0.08

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

$0.49

Service Code	NDC 11523-1167-6
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.39
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.29
Rate for Payer: Aetna of CA Government/Medicare	$0.29
Rate for Payer: Cash Price	$0.27
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.39
Rate for Payer: Health Smart Auto/Commercial	$0.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.29
Rate for Payer: LLUH Dept of Risk Management WC	$0.27
Rate for Payer: Multiplan Commercial	$0.37

OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [5944]

Facility

$4.14

Service Code	HCPCS J2590
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$3.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.48
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.01
Rate for Payer: Aetna of CA Government/Medicare	$0.74
Rate for Payer: Aetna of CA Government/Medicare	$1.01
Rate for Payer: Aetna of CA Government/Medicare	$2.48
Rate for Payer: Cash Price	$0.92
Rate for Payer: Cash Price	$0.68
Rate for Payer: Cash Price	$2.28
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.98
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.34
Rate for Payer: Health Smart Auto/Commercial	$2.48
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: Health Smart Auto/Commercial	$0.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.74
Rate for Payer: LLUH Dept of Risk Management WC	$0.68
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: LLUH Dept of Risk Management WC	$2.28
Rate for Payer: Multiplan Commercial	$1.26
Rate for Payer: Multiplan Commercial	$0.92
Rate for Payer: Multiplan Commercial	$3.10

OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [5944]

Facility

$1.23

Service Code	HCPCS J2590
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.98
Rate for Payer: Cash Price	$0.68
Rate for Payer: Cash Price	$2.28
Rate for Payer: Cash Price	$0.92
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.98
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.34
Rate for Payer: Health Smart Auto/Commercial	$2.48
Rate for Payer: Health Smart Auto/Commercial	$1.01
Rate for Payer: Health Smart Auto/Commercial	$0.74
Rate for Payer: LLUH Dept of Risk Management WC	$2.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.68
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: Multiplan Commercial	$3.10
Rate for Payer: Multiplan Commercial	$1.26
Rate for Payer: Multiplan Commercial	$0.92

OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [117335]

Facility

$0.07

Service Code	HCPCS J2590
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.04
Rate for Payer: Aetna of CA Government/Medicare	$0.04
Rate for Payer: Cash Price	$0.04
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Commercial	$0.05

OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [117335]

Facility

$0.07

Service Code	HCPCS J2590
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.04
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Commercial	$0.05

OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE IV (TITRATABLE) [4085635]

Facility

$0.07

Service Code	HCPCS J2590
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.04
Rate for Payer: Aetna of CA Government/Medicare	$0.04
Rate for Payer: Cash Price	$0.04
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Commercial	$0.05

OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE IV (TITRATABLE) [4085635]

Facility

$0.07

Service Code	HCPCS J2590
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.04
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Commercial	$0.05

PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [10843]

Facility

$1.44

Service Code	HCPCS J9267
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.86
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.44
Rate for Payer: Aetna of CA Government/Medicare	$1.44
Rate for Payer: Aetna of CA Government/Medicare	$1.03
Rate for Payer: Aetna of CA Government/Medicare	$0.86
Rate for Payer: Aetna of CA Government/Medicare	$1.22
Rate for Payer: Cash Price	$0.79
Rate for Payer: Cash Price	$1.32
Rate for Payer: Cash Price	$0.94
Rate for Payer: Cash Price	$1.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.37
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.62
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.92
Rate for Payer: Health Smart Auto/Commercial	$1.44
Rate for Payer: Health Smart Auto/Commercial	$1.22
Rate for Payer: Health Smart Auto/Commercial	$1.03
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.86
Rate for Payer: LLUH Dept of Risk Management WC	$1.32
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: LLUH Dept of Risk Management WC	$1.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.94
Rate for Payer: Multiplan Commercial	$1.28
Rate for Payer: Multiplan Commercial	$1.52
Rate for Payer: Multiplan Commercial	$1.80
Rate for Payer: Multiplan Commercial	$1.08

PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [10843]

Facility

$2.40

Service Code	HCPCS J9267
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.92
Rate for Payer: Cash Price	$1.32
Rate for Payer: Cash Price	$1.11
Rate for Payer: Cash Price	$0.79
Rate for Payer: Cash Price	$0.94
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.92
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.37
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.62
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.15
Rate for Payer: Health Smart Auto/Commercial	$1.03
Rate for Payer: Health Smart Auto/Commercial	$0.86
Rate for Payer: Health Smart Auto/Commercial	$1.44
Rate for Payer: Health Smart Auto/Commercial	$1.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.94
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: LLUH Dept of Risk Management WC	$1.32
Rate for Payer: LLUH Dept of Risk Management WC	$1.12
Rate for Payer: Multiplan Commercial	$1.80
Rate for Payer: Multiplan Commercial	$1.08
Rate for Payer: Multiplan Commercial	$1.28
Rate for Payer: Multiplan Commercial	$1.52

PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]

Facility

$4.32

Service Code	HCPCS J2469
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.59
Rate for Payer: Aetna of CA Government/Medicare	$2.59
Rate for Payer: Cash Price	$2.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.46
Rate for Payer: Health Smart Auto/Commercial	$2.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.59
Rate for Payer: LLUH Dept of Risk Management WC	$2.38
Rate for Payer: Multiplan Commercial	$3.24

PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]

Facility

$4.32

Service Code	HCPCS J2469
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.46
Rate for Payer: Cash Price	$2.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.46
Rate for Payer: Health Smart Auto/Commercial	$2.59
Rate for Payer: LLUH Dept of Risk Management WC	$2.38
Rate for Payer: Multiplan Commercial	$3.24

PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION. [40836591]

Facility

$12.00

Service Code	HCPCS J2469
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.60
Rate for Payer: Cash Price	$6.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$9.60
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Commercial	$9.00

PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION. [40836591]

Facility

$12.00

Service Code	HCPCS J2469
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.20
Rate for Payer: Aetna of CA Government/Medicare	$7.20
Rate for Payer: Cash Price	$6.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$9.60
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Commercial	$9.00

PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SYRINGE [222773]

Facility

$12.00

Service Code	HCPCS J2469
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.60
Rate for Payer: Cash Price	$6.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$9.60
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Commercial	$9.00

PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SYRINGE [222773]

Facility

$12.00

Service Code	HCPCS J2469
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.20
Rate for Payer: Aetna of CA Government/Medicare	$7.20
Rate for Payer: Cash Price	$6.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$9.60
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Commercial	$9.00

PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION [32589]

Facility

$1.73

Service Code	HCPCS J2430
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$1.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.94
Rate for Payer: Aetna of CA Government/Medicare	$1.94
Rate for Payer: Aetna of CA Government/Medicare	$1.04
Rate for Payer: Cash Price	$1.78
Rate for Payer: Cash Price	$0.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.59
Rate for Payer: Health Smart Auto/Commercial	$1.04
Rate for Payer: Health Smart Auto/Commercial	$1.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.94
Rate for Payer: LLUH Dept of Risk Management WC	$0.95
Rate for Payer: LLUH Dept of Risk Management WC	$1.78
Rate for Payer: Multiplan Commercial	$2.43
Rate for Payer: Multiplan Commercial	$1.30

PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION [32589]

Facility

$3.24

Service Code	HCPCS J2430
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$2.59
Rate for Payer: Cash Price	$1.78
Rate for Payer: Cash Price	$0.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.59
Rate for Payer: Health Smart Auto/Commercial	$1.94
Rate for Payer: Health Smart Auto/Commercial	$1.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.95
Rate for Payer: LLUH Dept of Risk Management WC	$1.78
Rate for Payer: Multiplan Commercial	$1.30
Rate for Payer: Multiplan Commercial	$2.43

PAMIDRONATE 30 MG INTRAVENOUS SOLUTION [10845]

Facility

$22.55

Service Code	HCPCS J2430
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$18.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.53
Rate for Payer: Aetna of CA Government/Medicare	$13.53
Rate for Payer: Cash Price	$12.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$18.04
Rate for Payer: Health Smart Auto/Commercial	$13.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.53
Rate for Payer: LLUH Dept of Risk Management WC	$12.40
Rate for Payer: Multiplan Commercial	$16.91

PAMIDRONATE 30 MG INTRAVENOUS SOLUTION [10845]

Facility

$22.55

Service Code	HCPCS J2430
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$18.04
Rate for Payer: Cash Price	$12.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$18.04
Rate for Payer: Health Smart Auto/Commercial	$13.53
Rate for Payer: LLUH Dept of Risk Management WC	$12.40
Rate for Payer: Multiplan Commercial	$16.91

PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION [33886]

Facility

$5.45

Service Code	HCPCS J2430
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$4.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.27
Rate for Payer: Aetna of CA Government/Medicare	$3.27
Rate for Payer: Cash Price	$3.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.36
Rate for Payer: Health Smart Auto/Commercial	$3.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.27
Rate for Payer: LLUH Dept of Risk Management WC	$3.00
Rate for Payer: Multiplan Commercial	$4.09

PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION [33886]

Facility

$5.45

Service Code	HCPCS J2430
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$4.36
Rate for Payer: Cash Price	$3.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.36
Rate for Payer: Health Smart Auto/Commercial	$3.27
Rate for Payer: LLUH Dept of Risk Management WC	$3.00
Rate for Payer: Multiplan Commercial	$4.09

PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION [32855]

Facility

$11.23

Service Code	HCPCS J2430
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$8.98
Rate for Payer: Cash Price	$6.17
Rate for Payer: Cash Price	$6.97
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.98
Rate for Payer: Health Smart Auto/Commercial	$6.74
Rate for Payer: Health Smart Auto/Commercial	$7.60
Rate for Payer: LLUH Dept of Risk Management WC	$6.18
Rate for Payer: LLUH Dept of Risk Management WC	$6.97
Rate for Payer: Multiplan Commercial	$8.42
Rate for Payer: Multiplan Commercial	$9.50

Know your out-of-pocket cost for care.

All Charges