|
Methylphenidate, Serum
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
CPT 80360
|
| Hospital Charge Code |
3439532
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.72 |
| Max. Negotiated Rate |
$696.00 |
| Rate for Payer: Aetna Commercial |
$156.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$149.64
|
| Rate for Payer: Aetna Managed Medicare |
$48.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$113.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$87.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$83.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.22
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$160.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.37
|
| Rate for Payer: Health EOS Commercial |
$154.86
|
| Rate for Payer: HFN Commercial |
$160.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.50
|
| Rate for Payer: Multiplan Commercial |
$139.20
|
| Rate for Payer: NAPHCARE Commercial |
$104.40
|
| Rate for Payer: Preferred Network Access Commercial |
$160.08
|
| Rate for Payer: Quartz Beloit One Network |
$85.26
|
| Rate for Payer: Quartz Commercial |
$113.10
|
| Rate for Payer: Quartz Medicare Advantage |
$104.40
|
| Rate for Payer: The Alliance Commercial |
$696.00
|
| Rate for Payer: United Healthcare PPO |
$130.50
|
| Rate for Payer: WEA Trust Commercial |
$95.70
|
| Rate for Payer: WPS Commercial |
$128.88
|
|
|
Methylprednisolone 20 Mg inj Acetate J1020
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS J1020
|
| Hospital Charge Code |
3407531
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$292.00 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.78
|
| Rate for Payer: Aetna Managed Medicare |
$20.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.69
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$67.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.85
|
| Rate for Payer: Health EOS Commercial |
$64.97
|
| Rate for Payer: HFN Commercial |
$67.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.75
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: NAPHCARE Commercial |
$43.80
|
| Rate for Payer: Preferred Network Access Commercial |
$67.16
|
| Rate for Payer: Quartz Beloit One Network |
$35.77
|
| Rate for Payer: Quartz Commercial |
$47.45
|
| Rate for Payer: Quartz Medicare Advantage |
$43.80
|
| Rate for Payer: The Alliance Commercial |
$292.00
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
Methylprednisolone 20 Mg inj Acetate J1020
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS J1020
|
| Hospital Charge Code |
3407531
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Aetna Commercial |
$69.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.78
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.80
|
| Rate for Payer: Health EOS Commercial |
$66.43
|
| Rate for Payer: HFN Commercial |
$69.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.69
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: Preferred Network Access Commercial |
$69.35
|
| Rate for Payer: Quartz Beloit One Network |
$32.12
|
| Rate for Payer: Quartz Commercial |
$41.61
|
| Rate for Payer: The Alliance Commercial |
$36.50
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
Methylprednisolone 20 Mg inj Acetate J1020
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS J1020
|
| Hospital Charge Code |
3407531
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$67.16 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.69
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$67.16
|
| Rate for Payer: Health EOS Commercial |
$64.97
|
| Rate for Payer: HFN Commercial |
$67.16
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: NAPHCARE Commercial |
$43.80
|
| Rate for Payer: Preferred Network Access Commercial |
$67.16
|
| Rate for Payer: Quartz Beloit One Network |
$35.77
|
| Rate for Payer: Quartz Commercial |
$43.80
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
Methylprednisolone 40 mg inj Acetate J1030 man
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS J1030
|
| Hospital Charge Code |
3373510
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.89 |
| Max. Negotiated Rate |
$56.12 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.33
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Health EOS Commercial |
$54.29
|
| Rate for Payer: HFN Commercial |
$56.12
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.60
|
| Rate for Payer: Preferred Network Access Commercial |
$56.12
|
| Rate for Payer: Quartz Beloit One Network |
$29.89
|
| Rate for Payer: Quartz Commercial |
$36.60
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
Methylprednisolone 40 mg inj Acetate J1030 man
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS J1030
|
| Hospital Charge Code |
3373510
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.46
|
| Rate for Payer: Aetna Managed Medicare |
$17.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.33
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.14
|
| Rate for Payer: Health EOS Commercial |
$54.29
|
| Rate for Payer: HFN Commercial |
$56.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.75
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.60
|
| Rate for Payer: Preferred Network Access Commercial |
$56.12
|
| Rate for Payer: Quartz Beloit One Network |
$29.89
|
| Rate for Payer: Quartz Commercial |
$39.65
|
| Rate for Payer: Quartz Medicare Advantage |
$36.60
|
| Rate for Payer: The Alliance Commercial |
$244.00
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
Methylprednisolone 40 mg inj Acetate J1030 man
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS J1030
|
| Hospital Charge Code |
3373510
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Aetna Commercial |
$57.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.46
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$57.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.60
|
| Rate for Payer: Health EOS Commercial |
$55.51
|
| Rate for Payer: HFN Commercial |
$57.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.38
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: Preferred Network Access Commercial |
$57.95
|
| Rate for Payer: Quartz Beloit One Network |
$26.84
|
| Rate for Payer: Quartz Commercial |
$34.77
|
| Rate for Payer: The Alliance Commercial |
$30.50
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
Methylprednisolone 80 mg/1 mL (MED)
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
HCPCS J1040
|
| Hospital Charge Code |
6065692
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.33 |
| Max. Negotiated Rate |
$199.64 |
| Rate for Payer: Aetna Commercial |
$195.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.01
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$199.64
|
| Rate for Payer: Health EOS Commercial |
$193.13
|
| Rate for Payer: HFN Commercial |
$199.64
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: NAPHCARE Commercial |
$130.20
|
| Rate for Payer: Preferred Network Access Commercial |
$199.64
|
| Rate for Payer: Quartz Beloit One Network |
$106.33
|
| Rate for Payer: Quartz Commercial |
$130.20
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: WPS Commercial |
$160.73
|
|
|
Methylprednisolone 80 mg/1 mL (MED)
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
HCPCS J1040
|
| Hospital Charge Code |
6065692
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$868.00 |
| Rate for Payer: Aetna Commercial |
$195.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.62
|
| Rate for Payer: Aetna Managed Medicare |
$60.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$108.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.01
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$199.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.43
|
| Rate for Payer: Health EOS Commercial |
$193.13
|
| Rate for Payer: HFN Commercial |
$199.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$162.75
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: NAPHCARE Commercial |
$130.20
|
| Rate for Payer: Preferred Network Access Commercial |
$199.64
|
| Rate for Payer: Quartz Beloit One Network |
$106.33
|
| Rate for Payer: Quartz Commercial |
$141.05
|
| Rate for Payer: Quartz Medicare Advantage |
$130.20
|
| Rate for Payer: The Alliance Commercial |
$868.00
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: WPS Commercial |
$160.73
|
|
|
Methylprednisolone 80 mg inj Acetate J1040 man
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS J1040
|
| Hospital Charge Code |
3373518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$61.64 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.20
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$40.20
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Methylprednisolone 80 mg inj Acetate J1040 man
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS J1040
|
| Hospital Charge Code |
3373518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Aetna Commercial |
$63.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$63.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.20
|
| Rate for Payer: Health EOS Commercial |
$60.97
|
| Rate for Payer: HFN Commercial |
$63.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.68
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Preferred Network Access Commercial |
$63.65
|
| Rate for Payer: Quartz Beloit One Network |
$29.48
|
| Rate for Payer: Quartz Commercial |
$38.19
|
| Rate for Payer: The Alliance Commercial |
$33.50
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Methylprednisolone 80 mg inj Acetate J1040 man
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS J1040
|
| Hospital Charge Code |
3373518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.76 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Aetna Managed Medicare |
$18.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.49
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.25
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.20
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$43.55
|
| Rate for Payer: Quartz Medicare Advantage |
$40.20
|
| Rate for Payer: The Alliance Commercial |
$268.00
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Methylprednisolone Acetate 20 Mg Charge
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J1020
|
| Hospital Charge Code |
2958848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$11.04 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.36
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Health EOS Commercial |
$10.68
|
| Rate for Payer: HFN Commercial |
$11.04
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11.04
|
| Rate for Payer: Quartz Beloit One Network |
$5.88
|
| Rate for Payer: Quartz Commercial |
$7.20
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
|
Methylprednisolone Acetate 20 Mg Charge
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS J1020
|
| Hospital Charge Code |
2958848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Aetna Commercial |
$11.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.20
|
| Rate for Payer: Health EOS Commercial |
$10.92
|
| Rate for Payer: HFN Commercial |
$11.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.69
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11.40
|
| Rate for Payer: Quartz Beloit One Network |
$5.28
|
| Rate for Payer: Quartz Commercial |
$6.84
|
| Rate for Payer: The Alliance Commercial |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
|
Methylprednisolone Acetate 20 Mg Charge
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J1020
|
| Hospital Charge Code |
2958848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Aetna Managed Medicare |
$3.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.36
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.72
|
| Rate for Payer: Health EOS Commercial |
$10.68
|
| Rate for Payer: HFN Commercial |
$11.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11.04
|
| Rate for Payer: Quartz Beloit One Network |
$5.88
|
| Rate for Payer: Quartz Commercial |
$7.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7.20
|
| Rate for Payer: The Alliance Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
|
Methylprednisolone Acetate 40mg/1ml [Med]
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS J1030
|
| Hospital Charge Code |
2974963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$292.00 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.78
|
| Rate for Payer: Aetna Managed Medicare |
$20.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.69
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$67.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.85
|
| Rate for Payer: Health EOS Commercial |
$64.97
|
| Rate for Payer: HFN Commercial |
$67.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.75
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: NAPHCARE Commercial |
$43.80
|
| Rate for Payer: Preferred Network Access Commercial |
$67.16
|
| Rate for Payer: Quartz Beloit One Network |
$35.77
|
| Rate for Payer: Quartz Commercial |
$47.45
|
| Rate for Payer: Quartz Medicare Advantage |
$43.80
|
| Rate for Payer: The Alliance Commercial |
$292.00
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
Methylprednisolone Acetate 40mg/1ml [Med]
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS J1030
|
| Hospital Charge Code |
2974963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$67.16 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.69
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$67.16
|
| Rate for Payer: Health EOS Commercial |
$64.97
|
| Rate for Payer: HFN Commercial |
$67.16
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: NAPHCARE Commercial |
$43.80
|
| Rate for Payer: Preferred Network Access Commercial |
$67.16
|
| Rate for Payer: Quartz Beloit One Network |
$35.77
|
| Rate for Payer: Quartz Commercial |
$43.80
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
Methylprednisolone Acetate 40 Mg Charge
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
HCPCS J1030
|
| Hospital Charge Code |
2983577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9.46
|
| Rate for Payer: Aetna Managed Medicare |
$3.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.83
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$10.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.16
|
| Rate for Payer: Health EOS Commercial |
$9.79
|
| Rate for Payer: HFN Commercial |
$10.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.25
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: NAPHCARE Commercial |
$6.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10.12
|
| Rate for Payer: Quartz Beloit One Network |
$5.39
|
| Rate for Payer: Quartz Commercial |
$7.15
|
| Rate for Payer: Quartz Medicare Advantage |
$6.60
|
| Rate for Payer: The Alliance Commercial |
$44.00
|
| Rate for Payer: WEA Trust Commercial |
$6.05
|
| Rate for Payer: WPS Commercial |
$8.15
|
|
|
Methylprednisolone Acetate 40 Mg Charge
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
HCPCS J1030
|
| Hospital Charge Code |
2983577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.83
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$10.12
|
| Rate for Payer: Health EOS Commercial |
$9.79
|
| Rate for Payer: HFN Commercial |
$10.12
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: NAPHCARE Commercial |
$6.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10.12
|
| Rate for Payer: Quartz Beloit One Network |
$5.39
|
| Rate for Payer: Quartz Commercial |
$6.60
|
| Rate for Payer: WEA Trust Commercial |
$6.05
|
| Rate for Payer: WPS Commercial |
$8.15
|
|
|
Methylprednisolone Acetate 40 Mg Charge
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS J1030
|
| Hospital Charge Code |
2983577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Aetna Commercial |
$10.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9.46
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$10.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.60
|
| Rate for Payer: Health EOS Commercial |
$10.01
|
| Rate for Payer: HFN Commercial |
$10.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.38
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10.45
|
| Rate for Payer: Quartz Beloit One Network |
$4.84
|
| Rate for Payer: Quartz Commercial |
$6.27
|
| Rate for Payer: The Alliance Commercial |
$5.50
|
| Rate for Payer: WEA Trust Commercial |
$6.05
|
| Rate for Payer: WPS Commercial |
$8.15
|
|
|
Methylprednisolone Acetate 80 Mg Charge
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J1040
|
| Hospital Charge Code |
2983536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Aetna Managed Medicare |
$3.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.36
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.72
|
| Rate for Payer: Health EOS Commercial |
$10.68
|
| Rate for Payer: HFN Commercial |
$11.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11.04
|
| Rate for Payer: Quartz Beloit One Network |
$5.88
|
| Rate for Payer: Quartz Commercial |
$7.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7.20
|
| Rate for Payer: The Alliance Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
|
Methylprednisolone Acetate 80 Mg Charge
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J1040
|
| Hospital Charge Code |
2983536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$11.04 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.36
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Health EOS Commercial |
$10.68
|
| Rate for Payer: HFN Commercial |
$11.04
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11.04
|
| Rate for Payer: Quartz Beloit One Network |
$5.88
|
| Rate for Payer: Quartz Commercial |
$7.20
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
|
Methylprednisolone Acetate 80 Mg Charge
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS J1040
|
| Hospital Charge Code |
2983536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$15.68 |
| Rate for Payer: Aetna Commercial |
$11.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.20
|
| Rate for Payer: Health EOS Commercial |
$10.92
|
| Rate for Payer: HFN Commercial |
$11.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.68
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11.40
|
| Rate for Payer: Quartz Beloit One Network |
$5.28
|
| Rate for Payer: Quartz Commercial |
$6.84
|
| Rate for Payer: The Alliance Commercial |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
|
Methylprednisolone Inj <125 mg J2930
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
3921375
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Managed Medicare |
$2.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.48
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$5.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4.80
|
| Rate for Payer: The Alliance Commercial |
$32.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
Methylprednisolone Inj <125 mg J2930
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
3921375
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$4.80
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
