Commercial Workers Compensation: disclosed hospital rates

iDirect answer

Based on the published hospital price files, Commercial Workers Compensation appears in disclosed negotiated rates across 2 hospitals and 135 services. This is public hospital price transparency data, not a guaranteed estimate of your bill.

Actual patient responsibility may vary based on your insurance plan, deductible, coinsurance, network status, diagnosis, setting, bundled services, clinical circumstances, and hospital billing practices.

135 prices shown.

Service	Hospital	Code	List price	Cash price	Negotiated range	Allowed (median)
00009-0003-02 - methylPREDNISolone 500 mg Pres Fre Outpatient	Decatur Memorial Hospital	J2919 HCPCS	$429	$429	$104 – $429	—
00187-4303-05 - amobarbital 0.5 gm Inj Outpatient	Springfield Memorial Hospital	J0300 HCPCS	$3,332	$3,332	$750 – $3,332	—
00187-4303-05 - amobarbital 0.5 gm Inj Outpatient	Decatur Memorial Hospital	J0300 HCPCS	$3,332	$3,332	$810 – $3,332	—
13533-0800-20 - immune globulin intravenous and su Outpatient	Springfield Memorial Hospital	J1561 HCPCS	$3,839	$3,839	$864 – $3,839	—
13533-0800-20 - immune globulin intravenous and su Outpatient	Decatur Memorial Hospital	J1561 HCPCS	$3,839	$3,839	$933 – $3,839	—
18860-0720-10 - ziconotide 100 mcg/mL Sol Outpatient	Decatur Memorial Hospital	J2278 HCPCS	$4,966	$4,966	$1,207 – $4,966	—
50242-0070-01 - obinutuzumab 25 mg/mL Sol Outpatient	Decatur Memorial Hospital	J9301 HCPCS	$622	$622	$151 – $622	—
55566-2300-00 - desmopressin 4 mcg/mL Inj Outpatient	Springfield Memorial Hospital	J2597 HCPCS	$195	$195	$43.90 – $195	—
55566-2300-00 - desmopressin 4 mcg/mL Inj Outpatient	Decatur Memorial Hospital	J2597 HCPCS	$195	$195	$47.42 – $195	—
59676-0610-01 - trabectedin 1 mg PWD Outpatient	Decatur Memorial Hospital	J9352 HCPCS	$22,286	$22,286	$3,121 – $22,286	—
61364-0181-03 - peramivir 10 mg/mL 20mL vial Outpatient	Springfield Memorial Hospital	J2547 HCPCS	$1,267	$1,267	$285 – $1,267	—
61364-0181-03 - peramivir 10 mg/mL 20mL vial Outpatient	Decatur Memorial Hospital	J2547 HCPCS	$1,267	$1,267	$308 – $1,267	—
63323-0593-03 - glucagon 1 mg Inj Outpatient	Springfield Memorial Hospital	J1611 HCPCS	$451	$451	$101 – $451	—
63323-0593-03 - glucagon 1 mg Inj Outpatient	Decatur Memorial Hospital	J1611 HCPCS	$451	$451	$109 – $451	—
63323-0594-03 - glucagon 1 mg Inj Outpatient	Decatur Memorial Hospital	J1611 HCPCS	$451	$451	$109 – $451	—
63833-0617-02 - antihemophilic factor-von Willebra Outpatient	Decatur Memorial Hospital	J7187 HCPCS	$5.05	$5.05	$1.23 – $5.05	—
66220-0160-10 - conivaptan 20 mg/100 mL-D5 Sol Outpatient	Springfield Memorial Hospital	C9488 HCPCS	$4,051	$4,051	$911 – $4,051	—
66220-0160-10 - conivaptan 20 mg/100 mL-D5 Sol Outpatient	Decatur Memorial Hospital	C9488 HCPCS	$4,051	$4,051	$856 – $4,051	—
67457-0366-10 - ibutilide 0.1 mg/mL Sol Outpatient	Decatur Memorial Hospital	J1742 HCPCS	$612	$612	$149 – $612	—
67919-0030-01 - ceftolozane-tazobactam 1 g-0.5 g P Outpatient	Springfield Memorial Hospital	J0695 HCPCS	$638	$638	$143 – $638	—
67919-0030-01 - ceftolozane-tazobactam 1 g-0.5 g P Outpatient	Decatur Memorial Hospital	J0695 HCPCS	$638	$638	$155 – $638	—
ATOS PUNCTURE PRVX VEGA 20F 10MM Outpatient	Decatur Memorial Hospital	L8501 HCPCS	$3,722	$3,722	$135 – $3,722	—
ATOS PUNCTURE PRVX VEGA 20F 12.5MM Outpatient	Decatur Memorial Hospital	L8501 HCPCS	$3,722	$3,722	$135 – $3,722	—
ATOS PUNCTURE PRVX VEGA 20F 8MM Outpatient	Decatur Memorial Hospital	L8501 HCPCS	$3,722	$3,722	$135 – $3,722	—
BASEPLATE HA ADAPTER 25MM Outpatient	Springfield Memorial Hospital	C1776 HCPCS	$12,938	$12,938	$2,911 – $12,938	—