|
METHYLPREDNISOLONE 500 MG INJ WRAP FOR CNR USE ONLY [4081203]
|
Facility
|
OP
|
$29.14
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX4081203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.03 |
| Max. Negotiated Rate |
$21.86 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$17.48
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$31.88
|
| Rate for Payer: Aetna of CA Government/Medicare |
$17.48
|
| Rate for Payer: Aetna of CA Government/Medicare |
$31.88
|
| Rate for Payer: Cash Price |
$23.91
|
| Rate for Payer: Cash Price |
$13.11
|
| Rate for Payer: Health Smart Auto/Commercial |
$31.88
|
| Rate for Payer: Health Smart Auto/Commercial |
$17.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$17.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$31.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.03
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$21.86
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$39.86
|
|
|
METHYLPREDNISOLONE 8 MG TABLET [10576]
|
Facility
|
OP
|
$1.73
|
|
|
Service Code
|
CPT J7509
|
| Hospital Charge Code |
1710983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.04
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.16
|
| 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 |
$0.78
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.30
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.45
|
|
|
METHYLPREDNISOLONE 8 MG TABLET [10576]
|
Facility
|
IP
|
$1.73
|
|
|
Service Code
|
CPT J7509
|
| Hospital Charge Code |
1710983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.54
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.16
|
| 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 |
$1.06
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.30
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.45
|
|
|
METHYLPREDNISOLONE ACETATE 20 MG/ML SUSPENSION FOR INJECTION [4994]
|
Facility
|
IP
|
$8.53
|
|
|
Service Code
|
CPT J1020
|
| Hospital Charge Code |
NDG4994
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS |
$6.40
|
|
|
METHYLPREDNISOLONE ACETATE 20 MG/ML SUSPENSION FOR INJECTION [4994]
|
Facility
|
OP
|
$8.53
|
|
|
Service Code
|
CPT J1020
|
| Hospital Charge Code |
NDG4994
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$6.40 |
| 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 |
$3.84
|
| 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 Beech St/Commercial/PHCS |
$6.40
|
|
|
METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION [4995]
|
Facility
|
IP
|
$8.58
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
1720226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$6.86 |
| Rate for Payer: Cash Price |
$3.86
|
| Rate for Payer: Cash Price |
$5.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.86
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.15
|
| Rate for Payer: Health Smart Auto/Commercial |
$7.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.44
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$8.87
|
|
|
METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION [4995]
|
Facility
|
OP
|
$13.63
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
1720218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$10.22 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$8.18
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$8.18
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$6.26
|
| Rate for Payer: Aetna of CA Government/Medicare |
$8.18
|
| Rate for Payer: Aetna of CA Government/Medicare |
$8.18
|
| Rate for Payer: Aetna of CA Government/Medicare |
$6.26
|
| Rate for Payer: Cash Price |
$6.14
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cash Price |
$6.13
|
| Rate for Payer: Health Smart Auto/Commercial |
$8.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$6.26
|
| Rate for Payer: Health Smart Auto/Commercial |
$8.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$6.26
|
| 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: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.74
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$10.23
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$10.22
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.83
|
|
|
METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION [4995]
|
Facility
|
IP
|
$11.84
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
NDG4995
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$9.47 |
| Rate for Payer: Cash Price |
$5.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.47
|
| Rate for Payer: Health Smart Auto/Commercial |
$7.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$8.88
|
|
|
METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION [4995]
|
Facility
|
OP
|
$8.58
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
1720226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.15
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$7.10
|
| Rate for Payer: Aetna of CA Government/Medicare |
$7.10
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.15
|
| Rate for Payer: Cash Price |
$5.32
|
| Rate for Payer: Cash Price |
$3.86
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.15
|
| Rate for Payer: Health Smart Auto/Commercial |
$7.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$7.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$8.87
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.44
|
|
|
METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION [4995]
|
Facility
|
IP
|
$13.63
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
1720218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Cash Price |
$6.13
|
| Rate for Payer: Cash Price |
$6.14
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.35
|
| Rate for Payer: Cigna of CA 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 |
$6.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.74
|
| 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 Beech St/Commercial/PHCS |
$7.83
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$10.22
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$10.23
|
|
|
METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION [4995]
|
Facility
|
OP
|
$11.84
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
NDG4995
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$8.88 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$7.10
|
| Rate for Payer: Aetna of CA Government/Medicare |
$7.10
|
| Rate for Payer: Cash Price |
$5.33
|
| Rate for Payer: Health Smart Auto/Commercial |
$7.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$7.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$8.88
|
|
|
METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION [4996]
|
Facility
|
IP
|
$19.58
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
1720010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$15.66 |
| Rate for Payer: Cash Price |
$8.81
|
| Rate for Payer: Cash Price |
$10.65
|
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: Cash Price |
$10.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.93
|
| Rate for Payer: Health Smart Auto/Commercial |
$14.20
|
| Rate for Payer: Health Smart Auto/Commercial |
$14.20
|
| Rate for Payer: Health Smart Auto/Commercial |
$11.75
|
| Rate for Payer: Health Smart Auto/Commercial |
$10.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.02
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$14.68
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$17.75
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$17.74
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$12.87
|
|
|
METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION [4996]
|
Facility
|
OP
|
$23.67
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
1720010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$17.75 |
| 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 |
$10.30
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$14.20
|
| Rate for Payer: Aetna of CA Government/Medicare |
$14.20
|
| Rate for Payer: Aetna of CA Government/Medicare |
$10.30
|
| Rate for Payer: Aetna of CA Government/Medicare |
$11.75
|
| Rate for Payer: Aetna of CA Government/Medicare |
$14.20
|
| Rate for Payer: Cash Price |
$8.81
|
| Rate for Payer: Cash Price |
$10.65
|
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: Cash Price |
$10.65
|
| Rate for Payer: Health Smart Auto/Commercial |
$10.30
|
| 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 |
$11.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$14.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$10.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$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: LLUH Dept of Risk Management WC |
$9.44
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$12.87
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$17.74
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$17.75
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$14.68
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION [10577]
|
Facility
|
IP
|
$41.06
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
1720344
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.58 |
| Max. Negotiated Rate |
$32.85 |
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cash Price |
$23.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.22
|
| 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 |
$22.58
|
| 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: Multiplan Beech St/Commercial/PHCS |
$39.58
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$30.80
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$37.70
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION [10577]
|
Facility
|
OP
|
$52.78
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
1720344
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.03 |
| Max. Negotiated Rate |
$39.58 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$31.67
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$24.64
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$30.16
|
| Rate for Payer: Aetna of CA Government/Medicare |
$30.16
|
| Rate for Payer: Aetna of CA Government/Medicare |
$24.64
|
| Rate for Payer: Aetna of CA Government/Medicare |
$31.67
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cash Price |
$23.75
|
| Rate for Payer: Health Smart Auto/Commercial |
$31.67
|
| 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 |
$30.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$31.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$24.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.65
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$39.58
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$37.70
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$30.80
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION [10578]
|
Facility
|
OP
|
$13.98
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX10578
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$10.48 |
| 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 |
$6.29
|
| 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 Beech St/Commercial/PHCS |
$10.48
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION [10578]
|
Facility
|
IP
|
$13.98
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX10578
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$11.18 |
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS |
$10.48
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 2 GRAM INTRAVENOUS SOLUTION [10579]
|
Facility
|
OP
|
$113.10
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX10579
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.20 |
| Max. Negotiated Rate |
$84.82 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$67.86
|
| Rate for Payer: Aetna of CA Government/Medicare |
$67.86
|
| Rate for Payer: Cash Price |
$50.90
|
| Rate for Payer: Health Smart Auto/Commercial |
$67.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$67.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.20
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$84.82
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 2 GRAM INTRAVENOUS SOLUTION [10579]
|
Facility
|
IP
|
$113.10
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX10579
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.20 |
| Max. Negotiated Rate |
$90.48 |
| Rate for Payer: Cash Price |
$50.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$90.48
|
| Rate for Payer: Health Smart Auto/Commercial |
$67.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.20
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$84.82
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG SOLUTION FOR INJECTION [10580]
|
Facility
|
IP
|
$7.30
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
ERX10580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$5.84 |
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.84
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$5.48
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG SOLUTION FOR INJECTION [10580]
|
Facility
|
OP
|
$7.30
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
ERX10580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$5.48 |
| 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 |
$3.29
|
| 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 |
$4.02
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$5.48
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION [10581]
|
Facility
|
OP
|
$29.14
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
1720342
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.03 |
| Max. Negotiated Rate |
$21.86 |
| 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 |
$13.11
|
| Rate for Payer: Cash Price |
$12.48
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Health Smart Auto/Commercial |
$15.84
|
| Rate for Payer: Health Smart Auto/Commercial |
$17.48
|
| Rate for Payer: Health Smart Auto/Commercial |
$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 |
$16.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$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 Beech St/Commercial/PHCS |
$20.80
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$19.80
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$21.86
|
|
|
METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION [10581]
|
Facility
|
IP
|
$29.14
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
1720342
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Cash Price |
$13.11
|
| Rate for Payer: Cash Price |
$12.48
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.19
|
| Rate for Payer: Health Smart Auto/Commercial |
$16.64
|
| Rate for Payer: Health Smart Auto/Commercial |
$15.84
|
| 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 |
$15.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.52
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$21.86
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$20.80
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$19.80
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 1,000 MG/8 ML INTRAVENOUS SOLUTION [120963]
|
Facility
|
IP
|
$77.29
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX120963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$61.83 |
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.83
|
| Rate for Payer: Health Smart Auto/Commercial |
$46.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.51
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$57.97
|
|
|
METHYLPREDNISOLONE SOD SUCC (PF) 1,000 MG/8 ML INTRAVENOUS SOLUTION [120963]
|
Facility
|
OP
|
$77.29
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
ERX120963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$57.97 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$46.37
|
| Rate for Payer: Aetna of CA Government/Medicare |
$46.37
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Health Smart Auto/Commercial |
$46.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$46.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.51
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$57.97
|
|
