|
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
|
|
|
METHYLPREDNISOLONE 4 MG TABLETS IN A DOSE PACK [4991]
|
Facility
|
OP
|
$1.37
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.82
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.22
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.82
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.22
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.10
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.30
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.22
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
|
|
METHYLPREDNISOLONE 4 MG TABLETS IN A DOSE PACK [4991]
|
Facility
|
IP
|
$1.37
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Cash Price |
$0.20
|
| 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 |
$1.10
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.22
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$1.03
|
|
|
METHYLPREDNISOLONE 500 MG INJ WRAP FOR CNR USE ONLY [4081203]
|
Facility
|
IP
|
$29.14
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cash Price |
$31.27
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$45.49
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$23.31
|
| Rate for Payer: Health Smart Auto/Commercial |
$17.48
|
| Rate for Payer: Health Smart Auto/Commercial |
$34.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.27
|
| Rate for Payer: Multiplan Commercial |
$42.65
|
| Rate for Payer: Multiplan Commercial |
$21.86
|
|
|
METHYLPREDNISOLONE 500 MG INJ WRAP FOR CNR USE ONLY [4081203]
|
Facility
|
OP
|
$29.14
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$17.48
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$34.12
|
| Rate for Payer: Aetna of CA Government/Medicare |
$17.48
|
| Rate for Payer: Aetna of CA Government/Medicare |
$34.12
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cash Price |
$31.27
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$23.31
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$45.49
|
| Rate for Payer: Health Smart Auto/Commercial |
$17.48
|
| Rate for Payer: Health Smart Auto/Commercial |
$34.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$17.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$34.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.03
|
| Rate for Payer: Multiplan Commercial |
$21.86
|
| Rate for Payer: Multiplan Commercial |
$42.65
|
|
|
METHYLPREDNISOLONE 8 MG TABLET [10576]
|
Facility
|
IP
|
$1.73
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.54
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.38
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.04
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$1.45
|
|
|
METHYLPREDNISOLONE 8 MG TABLET [10576]
|
Facility
|
OP
|
$1.93
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.16
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.04
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.16
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.04
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.54
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.38
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.04
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$1.45
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
|
|
METHYLPREDNISOLONE ACETATE 20 MG/ML SUSPENSION FOR INJECTION [4994]
|
Facility
|
OP
|
$8.53
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.12
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.12
|
| Rate for Payer: Cash Price |
$4.69
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$6.82
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.69
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
|
|
METHYLPREDNISOLONE ACETATE 20 MG/ML SUSPENSION FOR INJECTION [4994]
|
Facility
|
IP
|
$8.53
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Cash Price |
$4.69
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$6.82
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.69
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
|
|
METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION [4995]
|
Facility
|
OP
|
$13.64
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$10.91 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$8.18
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$6.94
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$8.18
|
| Rate for Payer: Aetna of CA Government/Medicare |
$6.94
|
| Rate for Payer: Aetna of CA Government/Medicare |
$8.18
|
| Rate for Payer: Aetna of CA Government/Medicare |
$8.18
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$6.36
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$10.91
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$9.26
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$10.90
|
| Rate for Payer: Health Smart Auto/Commercial |
$8.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$8.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$8.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$8.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$6.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$10.22
|
| Rate for Payer: Multiplan Commercial |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$10.23
|
|
|
METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION [4995]
|
Facility
|
IP
|
$11.57
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$9.26 |
| Rate for Payer: Cash Price |
$6.36
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$10.91
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$9.26
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$10.90
|
| Rate for Payer: Health Smart Auto/Commercial |
$8.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$8.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$6.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$10.23
|
| Rate for Payer: Multiplan Commercial |
$10.22
|
| Rate for Payer: Multiplan Commercial |
$8.68
|
|
|
METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION [4996]
|
Facility
|
IP
|
$23.67
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$18.93
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$18.94
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$15.66
|
| Rate for Payer: Health Smart Auto/Commercial |
$11.75
|
| Rate for Payer: Health Smart Auto/Commercial |
$14.20
|
| Rate for Payer: Health Smart Auto/Commercial |
$14.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$14.69
|
| Rate for Payer: Multiplan Commercial |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$17.75
|
|
|
METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION [4996]
|
Facility
|
OP
|
$23.67
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$14.20
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$11.75
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$14.20
|
| Rate for Payer: Aetna of CA Government/Medicare |
$11.75
|
| Rate for Payer: Aetna of CA Government/Medicare |
$14.20
|
| Rate for Payer: Aetna of CA Government/Medicare |
$14.20
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$18.94
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$15.66
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$18.93
|
| Rate for Payer: Health Smart Auto/Commercial |
$11.75
|
| Rate for Payer: Health Smart Auto/Commercial |
$14.20
|
| Rate for Payer: Health Smart Auto/Commercial |
$14.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$14.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$11.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$14.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.02
|
| Rate for Payer: Multiplan Commercial |
$14.69
|
| Rate for Payer: Multiplan Commercial |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$17.75
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION [10577]
|
Facility
|
IP
|
$30.42
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.73 |
| Max. Negotiated Rate |
$24.34 |
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Cash Price |
$27.65
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: Cash Price |
$22.59
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$32.85
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$40.22
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$24.34
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$42.22
|
| Rate for Payer: Health Smart Auto/Commercial |
$18.25
|
| Rate for Payer: Health Smart Auto/Commercial |
$24.64
|
| Rate for Payer: Health Smart Auto/Commercial |
$30.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$31.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.58
|
| Rate for Payer: Multiplan Commercial |
$39.59
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: Multiplan Commercial |
$30.80
|
| Rate for Payer: Multiplan Commercial |
$22.82
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION [10577]
|
Facility
|
OP
|
$41.06
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.58 |
| Max. Negotiated Rate |
$32.85 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$24.64
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$18.25
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$30.16
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$31.67
|
| Rate for Payer: Aetna of CA Government/Medicare |
$24.64
|
| Rate for Payer: Aetna of CA Government/Medicare |
$31.67
|
| Rate for Payer: Aetna of CA Government/Medicare |
$18.25
|
| Rate for Payer: Aetna of CA Government/Medicare |
$30.16
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Cash Price |
$27.65
|
| Rate for Payer: Cash Price |
$22.59
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$40.22
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$24.34
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$32.85
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$42.22
|
| Rate for Payer: Health Smart Auto/Commercial |
$31.67
|
| Rate for Payer: Health Smart Auto/Commercial |
$18.25
|
| Rate for Payer: Health Smart Auto/Commercial |
$30.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$24.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$24.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$18.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$30.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$31.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.03
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: Multiplan Commercial |
$22.82
|
| Rate for Payer: Multiplan Commercial |
$30.80
|
| Rate for Payer: Multiplan Commercial |
$39.59
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION [10578]
|
Facility
|
IP
|
$13.98
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$11.18 |
| Rate for Payer: Cash Price |
$7.69
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$11.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$8.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.69
|
| Rate for Payer: Multiplan Commercial |
$10.48
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION [10578]
|
Facility
|
OP
|
$13.98
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$11.18 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$8.39
|
| Rate for Payer: Aetna of CA Government/Medicare |
$8.39
|
| Rate for Payer: Cash Price |
$7.69
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$11.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$8.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$8.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.69
|
| Rate for Payer: Multiplan Commercial |
$10.48
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 2 GRAM INTRAVENOUS SOLUTION [10579]
|
Facility
|
OP
|
$130.63
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.85 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$78.38
|
| Rate for Payer: Aetna of CA Government/Medicare |
$78.38
|
| Rate for Payer: Cash Price |
$71.85
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$104.50
|
| Rate for Payer: Health Smart Auto/Commercial |
$78.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$78.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.85
|
| Rate for Payer: Multiplan Commercial |
$97.97
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 2 GRAM INTRAVENOUS SOLUTION [10579]
|
Facility
|
IP
|
$130.63
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.85 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Cash Price |
$71.85
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$104.50
|
| Rate for Payer: Health Smart Auto/Commercial |
$78.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.85
|
| Rate for Payer: Multiplan Commercial |
$97.97
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG SOLUTION FOR INJECTION [10580]
|
Facility
|
IP
|
$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: Cash Price |
$4.01
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$5.84
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$5.47
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG SOLUTION FOR INJECTION [10580]
|
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 Government/Medicare |
$4.38
|
| Rate for Payer: Cash Price |
$4.01
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$5.84
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.38
|
| 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: Multiplan Commercial |
$5.47
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION [10581]
|
Facility
|
IP
|
$29.14
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cash Price |
$14.52
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$22.19
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$23.31
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$21.12
|
| Rate for Payer: Health Smart Auto/Commercial |
$15.84
|
| Rate for Payer: Health Smart Auto/Commercial |
$16.64
|
| Rate for Payer: Health Smart Auto/Commercial |
$17.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.26
|
| Rate for Payer: Multiplan Commercial |
$19.80
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Multiplan Commercial |
$21.86
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION [10581]
|
Facility
|
OP
|
$29.14
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$17.48
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$15.84
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$16.64
|
| Rate for Payer: Aetna of CA Government/Medicare |
$15.84
|
| Rate for Payer: Aetna of CA Government/Medicare |
$17.48
|
| Rate for Payer: Aetna of CA Government/Medicare |
$16.64
|
| Rate for Payer: Cash Price |
$14.52
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$23.31
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$21.12
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$22.19
|
| Rate for Payer: Health Smart Auto/Commercial |
$15.84
|
| Rate for Payer: Health Smart Auto/Commercial |
$16.64
|
| Rate for Payer: Health Smart Auto/Commercial |
$17.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$16.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$15.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$17.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.03
|
| Rate for Payer: Multiplan Commercial |
$19.80
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Multiplan Commercial |
$21.86
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 1,000 MG/8 ML INTRAVENOUS SOLUTION [120963]
|
Facility
|
IP
|
$82.70
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.48 |
| Max. Negotiated Rate |
$66.16 |
| Rate for Payer: Cash Price |
$45.49
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$66.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$49.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.48
|
| Rate for Payer: Multiplan Commercial |
$62.02
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 1,000 MG/8 ML INTRAVENOUS SOLUTION [120963]
|
Facility
|
OP
|
$82.70
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.48 |
| Max. Negotiated Rate |
$66.16 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$49.62
|
| Rate for Payer: Aetna of CA Government/Medicare |
$49.62
|
| Rate for Payer: Cash Price |
$45.49
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$66.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$49.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$49.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.48
|
| Rate for Payer: Multiplan Commercial |
$62.02
|
|
