Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

ZIPRASIDONE 40 MG CAPSULE [29779]

Facility

$1.60

Service Code	NDC 6050525296
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$1.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.96
Rate for Payer: Aetna of CA Government/Medicare	$0.96
Rate for Payer: Cash Price	$0.72
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.28
Rate for Payer: Health Smart Auto/Commercial	$0.96
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$0.96
Rate for Payer: LLUH Dept of Risk Management WC	$0.88
Rate for Payer: Multiplan Commercial	$1.20

ZIPRASIDONE 40 MG CAPSULE [29779]

Facility

$5.79

Service Code	NDC 0904627008
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$4.63
Rate for Payer: Cash Price	$2.61
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.63
Rate for Payer: Health Smart Auto/Commercial	$3.47
Rate for Payer: LLUH Dept of Risk Management WC	$3.18
Rate for Payer: Multiplan Commercial	$4.34

ZIPRASIDONE 40 MG CAPSULE [29779]

Facility

$5.79

Service Code	NDC 0904627008
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$4.63
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.47
Rate for Payer: Aetna of CA Government/Medicare	$3.47
Rate for Payer: Cash Price	$2.61
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.63
Rate for Payer: Health Smart Auto/Commercial	$3.47
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$3.47
Rate for Payer: LLUH Dept of Risk Management WC	$3.18
Rate for Payer: Multiplan Commercial	$4.34

ZIPRASIDONE 60 MG CAPSULE [29780]

Facility

$1.12

Service Code	NDC 6800145206
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.90
Rate for Payer: Cash Price	$0.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.90
Rate for Payer: Health Smart Auto/Commercial	$0.67
Rate for Payer: LLUH Dept of Risk Management WC	$0.62
Rate for Payer: Multiplan Commercial	$0.84

ZIPRASIDONE 60 MG CAPSULE [29780]

Facility

$1.12

Service Code	NDC 6800145206
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.67
Rate for Payer: Aetna of CA Government/Medicare	$0.67
Rate for Payer: Cash Price	$0.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.90
Rate for Payer: Health Smart Auto/Commercial	$0.67
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$0.67
Rate for Payer: LLUH Dept of Risk Management WC	$0.62
Rate for Payer: Multiplan Commercial	$0.84

ZIPRASIDONE 60 MG CAPSULE [29780]

Facility

$0.70

Service Code	NDC 5511125860
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.56
Rate for Payer: Cash Price	$0.32
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.56
Rate for Payer: Health Smart Auto/Commercial	$0.42
Rate for Payer: LLUH Dept of Risk Management WC	$0.39
Rate for Payer: Multiplan Commercial	$0.53

ZIPRASIDONE 60 MG CAPSULE [29780]

Facility

$0.70

Service Code	NDC 5511125860
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.42
Rate for Payer: Aetna of CA Government/Medicare	$0.42
Rate for Payer: Cash Price	$0.32
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.56
Rate for Payer: Health Smart Auto/Commercial	$0.42
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$0.42
Rate for Payer: LLUH Dept of Risk Management WC	$0.39
Rate for Payer: Multiplan Commercial	$0.53

ZIPRASIDONE 80 MG CAPSULE [29781]

Facility

$3.32

Service Code	NDC 6808410609
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$2.66
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.99
Rate for Payer: Aetna of CA Government/Medicare	$1.99
Rate for Payer: Cash Price	$1.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.66
Rate for Payer: Health Smart Auto/Commercial	$1.99
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$1.99
Rate for Payer: LLUH Dept of Risk Management WC	$1.83
Rate for Payer: Multiplan Commercial	$2.49

ZIPRASIDONE 80 MG CAPSULE [29781]

Facility

$3.32

Service Code	NDC 6808410611
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$2.66
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.99
Rate for Payer: Aetna of CA Government/Medicare	$1.99
Rate for Payer: Cash Price	$1.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.66
Rate for Payer: Health Smart Auto/Commercial	$1.99
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$1.99
Rate for Payer: LLUH Dept of Risk Management WC	$1.83
Rate for Payer: Multiplan Commercial	$2.49

ZIPRASIDONE 80 MG CAPSULE [29781]

Facility

$3.32

Service Code	NDC 6808410609
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$2.66
Rate for Payer: Cash Price	$1.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.66
Rate for Payer: Health Smart Auto/Commercial	$1.99
Rate for Payer: LLUH Dept of Risk Management WC	$1.83
Rate for Payer: Multiplan Commercial	$2.49

ZIPRASIDONE 80 MG CAPSULE [29781]

Facility

$1.80

Service Code	NDC 6050525316
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$1.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.08
Rate for Payer: Aetna of CA Government/Medicare	$1.08
Rate for Payer: Cash Price	$0.81
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.44
Rate for Payer: Health Smart Auto/Commercial	$1.08
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$1.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.99
Rate for Payer: Multiplan Commercial	$1.35

ZIPRASIDONE 80 MG CAPSULE [29781]

Facility

$1.80

Service Code	NDC 6050525316
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$1.44
Rate for Payer: Cash Price	$0.81
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.44
Rate for Payer: Health Smart Auto/Commercial	$1.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.99
Rate for Payer: Multiplan Commercial	$1.35

ZIPRASIDONE 80 MG CAPSULE [29781]

Facility

$3.32

Service Code	NDC 6808410611
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$2.66
Rate for Payer: Cash Price	$1.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.66
Rate for Payer: Health Smart Auto/Commercial	$1.99
Rate for Payer: LLUH Dept of Risk Management WC	$1.83
Rate for Payer: Multiplan Commercial	$2.49

ZIV-AFLIBERCEPT 100 MG/4 ML (25 MG/ML) INTRAVENOUS SOLUTION [197072]

Facility

$480.00

Service Code	HCPCS J9400
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$384.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$288.00
Rate for Payer: Aetna of CA Government/Medicare	$288.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$384.00
Rate for Payer: Health Smart Auto/Commercial	$288.00
Rate for Payer: Intervalley Health Plan Commercial	$8.61
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$288.00
Rate for Payer: LLUH Dept of Risk Management WC	$264.00
Rate for Payer: Multiplan Commercial	$360.00

ZIV-AFLIBERCEPT 100 MG/4 ML (25 MG/ML) INTRAVENOUS SOLUTION [197072]

Facility

$480.00

Service Code	HCPCS J9400
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$264.00
Max. Negotiated Rate	$384.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$384.00
Rate for Payer: Health Smart Auto/Commercial	$288.00
Rate for Payer: LLUH Dept of Risk Management WC	$264.00
Rate for Payer: Multiplan Commercial	$360.00

ZIV-AFLIBERCEPT 200 MG/8 ML (25 MG/ML) INTRAVENOUS SOLUTION [197073]

Facility

$480.00

Service Code	HCPCS J9400
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$264.00
Max. Negotiated Rate	$384.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$384.00
Rate for Payer: Health Smart Auto/Commercial	$288.00
Rate for Payer: LLUH Dept of Risk Management WC	$264.00
Rate for Payer: Multiplan Commercial	$360.00

ZIV-AFLIBERCEPT 200 MG/8 ML (25 MG/ML) INTRAVENOUS SOLUTION [197073]

Facility

$480.00

Service Code	HCPCS J9400
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$384.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$288.00
Rate for Payer: Aetna of CA Government/Medicare	$288.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$384.00
Rate for Payer: Health Smart Auto/Commercial	$288.00
Rate for Payer: Intervalley Health Plan Commercial	$8.61
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$288.00
Rate for Payer: LLUH Dept of Risk Management WC	$264.00
Rate for Payer: Multiplan Commercial	$360.00

ZOLBETUXIMAB-CLZB 100 MG INTRAVENOUS SOLUTION [243165]

Facility

$1,939.20

Service Code	HCPCS J1326
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1,066.56
Max. Negotiated Rate	$1,551.36
Rate for Payer: Cash Price	$872.64
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,551.36
Rate for Payer: Health Smart Auto/Commercial	$1,163.52
Rate for Payer: LLUH Dept of Risk Management WC	$1,066.56
Rate for Payer: Multiplan Commercial	$1,454.40

ZOLBETUXIMAB-CLZB 100 MG INTRAVENOUS SOLUTION [243165]

Facility

$1,939.20

Service Code	HCPCS J1326
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$33.65
Max. Negotiated Rate	$1,551.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,163.52
Rate for Payer: Aetna of CA Government/Medicare	$1,163.52
Rate for Payer: Cash Price	$872.64
Rate for Payer: Cash Price	$872.64
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,551.36
Rate for Payer: Health Smart Auto/Commercial	$1,163.52
Rate for Payer: Intervalley Health Plan Commercial	$33.65
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$1,163.52
Rate for Payer: LLUH Dept of Risk Management WC	$1,066.56
Rate for Payer: Multiplan Commercial	$1,454.40

ZOLEDRONIC ACID 4 MG/100 ML-MANNITOL-0.9 % NACL INTRAVENOUS PIGGYBACK [201638]

Facility

$2.16

Service Code	HCPCS J3489
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.73
Rate for Payer: Cash Price	$0.97
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.73
Rate for Payer: Health Smart Auto/Commercial	$1.30
Rate for Payer: LLUH Dept of Risk Management WC	$1.19
Rate for Payer: Multiplan Commercial	$1.62

ZOLEDRONIC ACID 4 MG/100 ML-MANNITOL-0.9 % NACL INTRAVENOUS PIGGYBACK [201638]

Facility

$2.16

Service Code	HCPCS J3489
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.73
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.30
Rate for Payer: Aetna of CA Government/Medicare	$1.30
Rate for Payer: Cash Price	$0.97
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.73
Rate for Payer: Health Smart Auto/Commercial	$1.30
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$1.30
Rate for Payer: LLUH Dept of Risk Management WC	$1.19
Rate for Payer: Multiplan Commercial	$1.62

ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION [35640]

Facility

$43.20

Service Code	HCPCS J3489
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$23.76
Max. Negotiated Rate	$34.56
Rate for Payer: Cash Price	$19.44
Rate for Payer: Cash Price	$8.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$34.56
Rate for Payer: Health Smart Auto/Commercial	$10.80
Rate for Payer: Health Smart Auto/Commercial	$25.92
Rate for Payer: LLUH Dept of Risk Management WC	$9.90
Rate for Payer: LLUH Dept of Risk Management WC	$23.76
Rate for Payer: Multiplan Commercial	$32.40
Rate for Payer: Multiplan Commercial	$13.50

ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION [35640]

Facility

$18.00

Service Code	HCPCS J3489
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$25.92
Rate for Payer: Aetna of CA Government/Medicare	$10.80
Rate for Payer: Aetna of CA Government/Medicare	$25.92
Rate for Payer: Cash Price	$8.10
Rate for Payer: Cash Price	$19.44
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$34.56
Rate for Payer: Health Smart Auto/Commercial	$25.92
Rate for Payer: Health Smart Auto/Commercial	$10.80
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$10.80
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$25.92
Rate for Payer: LLUH Dept of Risk Management WC	$9.90
Rate for Payer: LLUH Dept of Risk Management WC	$23.76
Rate for Payer: Multiplan Commercial	$13.50
Rate for Payer: Multiplan Commercial	$32.40

ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK [81434]

Facility

$3.60

Service Code	HCPCS J3489
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$2.88
Rate for Payer: Cash Price	$1.62
Rate for Payer: Cash Price	$0.59
Rate for Payer: Cash Price	$1.89
Rate for Payer: Cash Price	$1.27
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.88
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.04
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.36
Rate for Payer: Health Smart Auto/Commercial	$0.78
Rate for Payer: Health Smart Auto/Commercial	$1.69
Rate for Payer: Health Smart Auto/Commercial	$2.16
Rate for Payer: Health Smart Auto/Commercial	$2.52
Rate for Payer: LLUH Dept of Risk Management WC	$1.55
Rate for Payer: LLUH Dept of Risk Management WC	$1.98
Rate for Payer: LLUH Dept of Risk Management WC	$0.72
Rate for Payer: LLUH Dept of Risk Management WC	$2.31
Rate for Payer: Multiplan Commercial	$2.12
Rate for Payer: Multiplan Commercial	$3.15
Rate for Payer: Multiplan Commercial	$2.70
Rate for Payer: Multiplan Commercial	$0.98

ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK [81434]

Facility

$1.30

Service Code	HCPCS J3489
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$1.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.69
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.52
Rate for Payer: Aetna of CA Government/Medicare	$2.52
Rate for Payer: Aetna of CA Government/Medicare	$1.69
Rate for Payer: Aetna of CA Government/Medicare	$0.78
Rate for Payer: Aetna of CA Government/Medicare	$2.16
Rate for Payer: Cash Price	$0.59
Rate for Payer: Cash Price	$1.89
Rate for Payer: Cash Price	$1.27
Rate for Payer: Cash Price	$1.62
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.04
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.88
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.36
Rate for Payer: Health Smart Auto/Commercial	$2.52
Rate for Payer: Health Smart Auto/Commercial	$2.16
Rate for Payer: Health Smart Auto/Commercial	$1.69
Rate for Payer: Health Smart Auto/Commercial	$0.78
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$2.52
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$2.16
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$1.69
Rate for Payer: Kaiser Foundation Hospitals Commercial/Medi-Cal/Medicare Advantage	$0.78
Rate for Payer: LLUH Dept of Risk Management WC	$2.31
Rate for Payer: LLUH Dept of Risk Management WC	$0.72
Rate for Payer: LLUH Dept of Risk Management WC	$1.98
Rate for Payer: LLUH Dept of Risk Management WC	$1.55
Rate for Payer: Multiplan Commercial	$2.12
Rate for Payer: Multiplan Commercial	$2.70
Rate for Payer: Multiplan Commercial	$3.15
Rate for Payer: Multiplan Commercial	$0.98

Know your out-of-pocket cost for care.

All Charges