Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

METHYLPHENIDATE 5 MG TABLET [4988]

Facility

IP

$2.46

Service Code	NDC 68084-805-21
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.97
Rate for Payer: Cash Price	$1.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.97
Rate for Payer: Health Smart Auto/Commercial	$1.48
Rate for Payer: LLUH Dept of Risk Management WC	$1.35
Rate for Payer: Multiplan Commercial	$1.84

METHYLPHENIDATE 5 MG TABLET [4988]

Facility

IP

$0.12

Service Code	NDC 0115-1800-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Commercial	$0.09

METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]

Facility

IP

$9.34

Service Code	NDC 9999-7068-51
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$7.47
Rate for Payer: Cash Price	$5.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.47
Rate for Payer: Health Smart Auto/Commercial	$5.60
Rate for Payer: LLUH Dept of Risk Management WC	$5.14
Rate for Payer: Multiplan Commercial	$7.00

METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]

Facility

OP

$6.22

Service Code	NDC 62175-310-37
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$4.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.73
Rate for Payer: Aetna of CA Government/Medicare	$3.73
Rate for Payer: Cash Price	$3.42
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.98
Rate for Payer: Health Smart Auto/Commercial	$3.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.73
Rate for Payer: LLUH Dept of Risk Management WC	$3.42
Rate for Payer: Multiplan Commercial	$4.67

METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]

Facility

IP

$15.48

Service Code	NDC 50458-585-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$8.51
Max. Negotiated Rate	$12.38
Rate for Payer: Cash Price	$8.51
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$12.38
Rate for Payer: Health Smart Auto/Commercial	$9.29
Rate for Payer: LLUH Dept of Risk Management WC	$8.51
Rate for Payer: Multiplan Commercial	$11.61

METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]

Facility

IP

$6.22

Service Code	NDC 62175-310-37
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$4.98
Rate for Payer: Cash Price	$3.42
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.98
Rate for Payer: Health Smart Auto/Commercial	$3.73
Rate for Payer: LLUH Dept of Risk Management WC	$3.42
Rate for Payer: Multiplan Commercial	$4.67

METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]

Facility

OP

$9.34

Service Code	NDC 9999-7068-51
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$7.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.60
Rate for Payer: Aetna of CA Government/Medicare	$5.60
Rate for Payer: Cash Price	$5.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.47
Rate for Payer: Health Smart Auto/Commercial	$5.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.60
Rate for Payer: LLUH Dept of Risk Management WC	$5.14
Rate for Payer: Multiplan Commercial	$7.00

METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR [28750]

Facility

OP

$15.48

Service Code	NDC 50458-585-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$8.51
Max. Negotiated Rate	$12.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.29
Rate for Payer: Aetna of CA Government/Medicare	$9.29
Rate for Payer: Cash Price	$8.51
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$12.38
Rate for Payer: Health Smart Auto/Commercial	$9.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.29
Rate for Payer: LLUH Dept of Risk Management WC	$8.51
Rate for Payer: Multiplan Commercial	$11.61

METHYLPHENIDATE ER 20 MG TABLET,EXTENDED RELEASE [4989]

Facility

OP

$2.02

Service Code	NDC 10702-076-06
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.62
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.21
Rate for Payer: Aetna of CA Government/Medicare	$1.21
Rate for Payer: Cash Price	$1.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.62
Rate for Payer: Health Smart Auto/Commercial	$1.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.21
Rate for Payer: LLUH Dept of Risk Management WC	$1.11
Rate for Payer: Multiplan Commercial	$1.51

METHYLPHENIDATE ER 20 MG TABLET,EXTENDED RELEASE [4989]

Facility

IP

$2.02

Service Code	NDC 10702-076-06
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.62
Rate for Payer: Cash Price	$1.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.62
Rate for Payer: Health Smart Auto/Commercial	$1.21
Rate for Payer: LLUH Dept of Risk Management WC	$1.11
Rate for Payer: Multiplan Commercial	$1.51

METHYLPHENIDATE ER 27 MG TABLET,EXTENDED RELEASE 24 HR [32654]

Facility

OP

$15.87

Service Code	NDC 50458-588-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$8.73
Max. Negotiated Rate	$12.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.52
Rate for Payer: Aetna of CA Government/Medicare	$9.52
Rate for Payer: Cash Price	$8.73
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$12.70
Rate for Payer: Health Smart Auto/Commercial	$9.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.52
Rate for Payer: LLUH Dept of Risk Management WC	$8.73
Rate for Payer: Multiplan Commercial	$11.90

METHYLPHENIDATE ER 27 MG TABLET,EXTENDED RELEASE 24 HR [32654]

Facility

IP

$15.87

Service Code	NDC 50458-588-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$8.73
Max. Negotiated Rate	$12.70
Rate for Payer: Cash Price	$8.73
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$12.70
Rate for Payer: Health Smart Auto/Commercial	$9.52
Rate for Payer: LLUH Dept of Risk Management WC	$8.73
Rate for Payer: Multiplan Commercial	$11.90

METHYLPHENIDATE ER 36 MG TABLET,EXTENDED RELEASE 24 HR [28751]

Facility

OP

$16.37

Service Code	NDC 50458-586-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$13.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.82
Rate for Payer: Aetna of CA Government/Medicare	$9.82
Rate for Payer: Cash Price	$9.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$13.10
Rate for Payer: Health Smart Auto/Commercial	$9.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.82
Rate for Payer: LLUH Dept of Risk Management WC	$9.00
Rate for Payer: Multiplan Commercial	$12.28

METHYLPHENIDATE ER 36 MG TABLET,EXTENDED RELEASE 24 HR [28751]

Facility

IP

$16.37

Service Code	NDC 50458-586-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$13.10
Rate for Payer: Cash Price	$9.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$13.10
Rate for Payer: Health Smart Auto/Commercial	$9.82
Rate for Payer: LLUH Dept of Risk Management WC	$9.00
Rate for Payer: Multiplan Commercial	$12.28

METHYLPHENIDATE LA 20 MG BIPHASIC 50-50 CAPSULE,EXTENDED RELEASE [33198]

Facility

IP

$15.14

Service Code	NDC 0078-0370-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$8.33
Max. Negotiated Rate	$12.11
Rate for Payer: Cash Price	$8.33
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$12.11
Rate for Payer: Health Smart Auto/Commercial	$9.08
Rate for Payer: LLUH Dept of Risk Management WC	$8.33
Rate for Payer: Multiplan Commercial	$11.36

METHYLPHENIDATE LA 20 MG BIPHASIC 50-50 CAPSULE,EXTENDED RELEASE [33198]

Facility

OP

$15.14

Service Code	NDC 0078-0370-05
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$8.33
Max. Negotiated Rate	$12.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.08
Rate for Payer: Aetna of CA Government/Medicare	$9.08
Rate for Payer: Cash Price	$8.33
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$12.11
Rate for Payer: Health Smart Auto/Commercial	$9.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.08
Rate for Payer: LLUH Dept of Risk Management WC	$8.33
Rate for Payer: Multiplan Commercial	$11.36

METHYLPREDNISOLONE 125 MG INJ. [4081205]

Facility

OP

$12.50

Service Code	HCPCS J2919
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.39
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.65
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.47
Rate for Payer: Aetna of CA Government/Medicare	$5.47
Rate for Payer: Aetna of CA Government/Medicare	$8.39
Rate for Payer: Aetna of CA Government/Medicare	$7.50
Rate for Payer: Aetna of CA Government/Medicare	$4.65
Rate for Payer: Cash Price	$6.88
Rate for Payer: Cash Price	$5.02
Rate for Payer: Cash Price	$7.69
Rate for Payer: Cash Price	$4.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$11.18
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.30
Rate for Payer: Health Smart Auto/Commercial	$5.47
Rate for Payer: Health Smart Auto/Commercial	$4.65
Rate for Payer: Health Smart Auto/Commercial	$8.39
Rate for Payer: Health Smart Auto/Commercial	$7.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.50
Rate for Payer: LLUH Dept of Risk Management WC	$5.02
Rate for Payer: LLUH Dept of Risk Management WC	$6.88
Rate for Payer: LLUH Dept of Risk Management WC	$4.26
Rate for Payer: LLUH Dept of Risk Management WC	$7.69
Rate for Payer: Multiplan Commercial	$10.48
Rate for Payer: Multiplan Commercial	$5.81
Rate for Payer: Multiplan Commercial	$6.84
Rate for Payer: Multiplan Commercial	$9.38

METHYLPREDNISOLONE 125 MG INJ. [4081205]

Facility

IP

$9.12

Service Code	HCPCS J2919
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$7.30
Rate for Payer: Cash Price	$5.02
Rate for Payer: Cash Price	$4.26
Rate for Payer: Cash Price	$6.88
Rate for Payer: Cash Price	$7.69
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$11.18
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.00
Rate for Payer: Health Smart Auto/Commercial	$8.39
Rate for Payer: Health Smart Auto/Commercial	$7.50
Rate for Payer: Health Smart Auto/Commercial	$5.47
Rate for Payer: Health Smart Auto/Commercial	$4.65
Rate for Payer: LLUH Dept of Risk Management WC	$7.69
Rate for Payer: LLUH Dept of Risk Management WC	$6.88
Rate for Payer: LLUH Dept of Risk Management WC	$5.02
Rate for Payer: LLUH Dept of Risk Management WC	$4.26
Rate for Payer: Multiplan Commercial	$6.84
Rate for Payer: Multiplan Commercial	$9.38
Rate for Payer: Multiplan Commercial	$10.48
Rate for Payer: Multiplan Commercial	$5.81

METHYLPREDNISOLONE 16 MG TABLET [4992]

Facility

OP

$3.40

Service Code	HCPCS J7509
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$2.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.79
Rate for Payer: Aetna of CA Government/Medicare	$2.04
Rate for Payer: Aetna of CA Government/Medicare	$1.79
Rate for Payer: Cash Price	$1.87
Rate for Payer: Cash Price	$1.64
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.72
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.38
Rate for Payer: Health Smart Auto/Commercial	$1.79
Rate for Payer: Health Smart Auto/Commercial	$2.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.79
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.04
Rate for Payer: LLUH Dept of Risk Management WC	$1.87
Rate for Payer: LLUH Dept of Risk Management WC	$1.64
Rate for Payer: Multiplan Commercial	$2.55
Rate for Payer: Multiplan Commercial	$2.23

METHYLPREDNISOLONE 16 MG TABLET [4992]

Facility

IP

$3.40

Service Code	HCPCS J7509
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$2.72
Rate for Payer: Cash Price	$1.87
Rate for Payer: Cash Price	$1.64
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.72
Rate for Payer: Health Smart Auto/Commercial	$1.79
Rate for Payer: Health Smart Auto/Commercial	$2.04
Rate for Payer: LLUH Dept of Risk Management WC	$1.87
Rate for Payer: LLUH Dept of Risk Management WC	$1.64
Rate for Payer: Multiplan Commercial	$2.23
Rate for Payer: Multiplan Commercial	$2.55

METHYLPREDNISOLONE 32 MG TABLET [10575]

Facility

IP

$4.44

Service Code	HCPCS J7509
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$3.55
Rate for Payer: Cash Price	$2.44
Rate for Payer: Cash Price	$2.73
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.97
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.55
Rate for Payer: Health Smart Auto/Commercial	$2.66
Rate for Payer: Health Smart Auto/Commercial	$2.98
Rate for Payer: LLUH Dept of Risk Management WC	$2.44
Rate for Payer: LLUH Dept of Risk Management WC	$2.73
Rate for Payer: Multiplan Commercial	$3.72
Rate for Payer: Multiplan Commercial	$3.33

METHYLPREDNISOLONE 32 MG TABLET [10575]

Facility

OP

$4.96

Service Code	HCPCS J7509
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$3.97
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.66
Rate for Payer: Aetna of CA Government/Medicare	$2.98
Rate for Payer: Aetna of CA Government/Medicare	$2.66
Rate for Payer: Cash Price	$2.44
Rate for Payer: Cash Price	$2.73
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.97
Rate for Payer: Health Smart Auto/Commercial	$2.98
Rate for Payer: Health Smart Auto/Commercial	$2.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.66
Rate for Payer: LLUH Dept of Risk Management WC	$2.44
Rate for Payer: LLUH Dept of Risk Management WC	$2.73
Rate for Payer: Multiplan Commercial	$3.33
Rate for Payer: Multiplan Commercial	$3.72

METHYLPREDNISOLONE 40 MG INJ. [4081204]

Facility

IP

$4.90

Service Code	HCPCS J2919
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$3.92
Rate for Payer: Cash Price	$2.69
Rate for Payer: Cash Price	$4.01
Rate for Payer: Cash Price	$4.27
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.21
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.92
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.84
Rate for Payer: Health Smart Auto/Commercial	$2.94
Rate for Payer: Health Smart Auto/Commercial	$4.38
Rate for Payer: Health Smart Auto/Commercial	$4.66
Rate for Payer: LLUH Dept of Risk Management WC	$2.69
Rate for Payer: LLUH Dept of Risk Management WC	$4.01
Rate for Payer: LLUH Dept of Risk Management WC	$4.27
Rate for Payer: Multiplan Commercial	$3.67
Rate for Payer: Multiplan Commercial	$5.82
Rate for Payer: Multiplan Commercial	$5.47

METHYLPREDNISOLONE 40 MG INJ. [4081204]

Facility

OP

$7.30

Service Code	HCPCS J2919
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$5.84
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.66
Rate for Payer: Aetna of CA Government/Medicare	$2.94
Rate for Payer: Aetna of CA Government/Medicare	$4.66
Rate for Payer: Aetna of CA Government/Medicare	$4.38
Rate for Payer: Cash Price	$4.27
Rate for Payer: Cash Price	$2.69
Rate for Payer: Cash Price	$4.01
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3.92
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.84
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.21
Rate for Payer: Health Smart Auto/Commercial	$4.66
Rate for Payer: Health Smart Auto/Commercial	$4.38
Rate for Payer: Health Smart Auto/Commercial	$2.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.38
Rate for Payer: LLUH Dept of Risk Management WC	$4.01
Rate for Payer: LLUH Dept of Risk Management WC	$2.69
Rate for Payer: LLUH Dept of Risk Management WC	$4.27
Rate for Payer: Multiplan Commercial	$3.67
Rate for Payer: Multiplan Commercial	$5.82
Rate for Payer: Multiplan Commercial	$5.47

METHYLPREDNISOLONE 4 MG TABLET [4993]

Facility

OP

$1.03

Service Code	HCPCS J7509
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.62
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.34
Rate for Payer: Aetna of CA Government/Medicare	$0.62
Rate for Payer: Aetna of CA Government/Medicare	$1.34
Rate for Payer: Aetna of CA Government/Medicare	$0.23
Rate for Payer: Aetna of CA Government/Medicare	$1.20
Rate for Payer: Cash Price	$0.21
Rate for Payer: Cash Price	$1.10
Rate for Payer: Cash Price	$0.57
Rate for Payer: Cash Price	$1.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.82
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.78
Rate for Payer: Health Smart Auto/Commercial	$1.34
Rate for Payer: Health Smart Auto/Commercial	$0.23
Rate for Payer: Health Smart Auto/Commercial	$1.20
Rate for Payer: Health Smart Auto/Commercial	$0.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.34
Rate for Payer: LLUH Dept of Risk Management WC	$0.57
Rate for Payer: LLUH Dept of Risk Management WC	$1.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.21
Rate for Payer: LLUH Dept of Risk Management WC	$1.23
Rate for Payer: Multiplan Commercial	$1.50
Rate for Payer: Multiplan Commercial	$0.29
Rate for Payer: Multiplan Commercial	$0.77
Rate for Payer: Multiplan Commercial	$1.67

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