|
Major Dressing Change
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
3026414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.50 |
| Max. Negotiated Rate |
$149.26 |
| Rate for Payer: Aetna Commercial |
$146.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.99
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$149.26
|
| Rate for Payer: Health EOS Commercial |
$144.39
|
| Rate for Payer: HFN Commercial |
$149.26
|
| Rate for Payer: Multiplan Commercial |
$129.79
|
| Rate for Payer: Preferred Network Access Commercial |
$149.26
|
| Rate for Payer: Quartz Beloit One Network |
$79.50
|
| Rate for Payer: Quartz Commercial |
$97.34
|
| Rate for Payer: WEA Trust Commercial |
$89.23
|
| Rate for Payer: WPS Commercial |
$120.17
|
|
|
MAJOR ESOPHAGEAL DISORDERS
|
Facility
|
IP
|
$7,365.38
|
|
|
Service Code
|
APR-DRG 2422
|
| Min. Negotiated Rate |
$6,542.39 |
| Max. Negotiated Rate |
$7,365.38 |
| Rate for Payer: Anthem Medicaid |
$7,052.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,052.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,052.76
|
| Rate for Payer: Dean Health Medicaid |
$7,052.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,542.39
|
| Rate for Payer: Managed Health Services Medicaid |
$7,365.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,052.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,052.76
|
| Rate for Payer: United Healthcare Medicaid |
$7,052.76
|
|
|
MAJOR ESOPHAGEAL DISORDERS
|
Facility
|
IP
|
$21,482.36
|
|
|
Service Code
|
APR-DRG 2424
|
| Min. Negotiated Rate |
$19,081.97 |
| Max. Negotiated Rate |
$21,482.36 |
| Rate for Payer: Anthem Medicaid |
$20,570.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,570.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,570.54
|
| Rate for Payer: Dean Health Medicaid |
$20,570.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,081.97
|
| Rate for Payer: Managed Health Services Medicaid |
$21,482.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,570.54
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,570.54
|
| Rate for Payer: United Healthcare Medicaid |
$20,570.54
|
|
|
MAJOR ESOPHAGEAL DISORDERS
|
Facility
|
IP
|
$5,787.08
|
|
|
Service Code
|
APR-DRG 2421
|
| Min. Negotiated Rate |
$5,140.45 |
| Max. Negotiated Rate |
$5,787.08 |
| Rate for Payer: Anthem Medicaid |
$5,541.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,541.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,541.45
|
| Rate for Payer: Dean Health Medicaid |
$5,541.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,140.45
|
| Rate for Payer: Managed Health Services Medicaid |
$5,787.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,541.45
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,541.45
|
| Rate for Payer: United Healthcare Medicaid |
$5,541.45
|
|
|
MAJOR ESOPHAGEAL DISORDERS
|
Facility
|
IP
|
$11,048.07
|
|
|
Service Code
|
APR-DRG 2423
|
| Min. Negotiated Rate |
$9,813.59 |
| Max. Negotiated Rate |
$11,048.07 |
| Rate for Payer: Anthem Medicaid |
$10,579.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,579.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,579.14
|
| Rate for Payer: Dean Health Medicaid |
$10,579.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,813.59
|
| Rate for Payer: Managed Health Services Medicaid |
$11,048.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,579.14
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,579.14
|
| Rate for Payer: United Healthcare Medicaid |
$10,579.14
|
|
|
MAJOR ESOPHAGEAL DISORDERS WITH CC
|
Facility
|
IP
|
$27,658.80
|
|
|
Service Code
|
MSDRG 369
|
| Min. Negotiated Rate |
$8,166.51 |
| Max. Negotiated Rate |
$27,658.80 |
| Rate for Payer: Aetna Managed Medicare |
$8,166.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,823.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,727.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,892.30
|
| Rate for Payer: Anthem Medicare Advantage |
$8,166.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,166.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,166.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,166.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,641.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,166.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,042.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,166.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,166.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,166.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,166.51
|
| Rate for Payer: NAPHCARE Commercial |
$12,249.76
|
| Rate for Payer: Quartz Medicare Advantage |
$8,166.51
|
| Rate for Payer: The Alliance Commercial |
$27,658.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,166.51
|
| Rate for Payer: United Healthcare PPO |
$15,603.52
|
| Rate for Payer: Wellcare Medicare |
$8,166.51
|
|
|
MAJOR ESOPHAGEAL DISORDERS WITH MCC
|
Facility
|
IP
|
$46,009.60
|
|
|
Service Code
|
MSDRG 368
|
| Min. Negotiated Rate |
$12,697.85 |
| Max. Negotiated Rate |
$46,009.60 |
| Rate for Payer: Aetna Managed Medicare |
$12,697.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34,733.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,623.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,293.89
|
| Rate for Payer: Anthem Medicare Advantage |
$12,697.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,697.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,697.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,697.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,078.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,697.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,502.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,697.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,697.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,697.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,697.85
|
| Rate for Payer: NAPHCARE Commercial |
$19,046.77
|
| Rate for Payer: Quartz Medicare Advantage |
$12,697.85
|
| Rate for Payer: The Alliance Commercial |
$46,009.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,697.85
|
| Rate for Payer: United Healthcare PPO |
$26,082.17
|
| Rate for Payer: Wellcare Medicare |
$12,697.85
|
|
|
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$20,895.68
|
|
|
Service Code
|
MSDRG 370
|
| Min. Negotiated Rate |
$6,076.99 |
| Max. Negotiated Rate |
$20,895.68 |
| Rate for Payer: Aetna Managed Medicare |
$6,076.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,290.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,720.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,135.10
|
| Rate for Payer: Anthem Medicare Advantage |
$6,076.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,076.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,076.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,076.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,360.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,076.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,082.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,076.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,076.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,076.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,076.99
|
| Rate for Payer: NAPHCARE Commercial |
$9,115.49
|
| Rate for Payer: Quartz Medicare Advantage |
$6,076.99
|
| Rate for Payer: The Alliance Commercial |
$20,895.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,076.99
|
| Rate for Payer: United Healthcare PPO |
$11,741.71
|
| Rate for Payer: Wellcare Medicare |
$6,076.99
|
|
|
MAJOR GASTROINTESTINAL AND PERITONEAL INFECTIONS
|
Facility
|
IP
|
$6,751.60
|
|
|
Service Code
|
APR-DRG 2482
|
| Min. Negotiated Rate |
$5,997.19 |
| Max. Negotiated Rate |
$6,751.60 |
| Rate for Payer: Anthem Medicaid |
$6,465.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,465.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,465.03
|
| Rate for Payer: Dean Health Medicaid |
$6,465.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,997.19
|
| Rate for Payer: Managed Health Services Medicaid |
$6,751.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,465.03
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,465.03
|
| Rate for Payer: United Healthcare Medicaid |
$6,465.03
|
|
|
MAJOR GASTROINTESTINAL AND PERITONEAL INFECTIONS
|
Facility
|
IP
|
$17,799.67
|
|
|
Service Code
|
APR-DRG 2484
|
| Min. Negotiated Rate |
$15,810.78 |
| Max. Negotiated Rate |
$17,799.67 |
| Rate for Payer: Anthem Medicaid |
$17,044.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,044.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,044.16
|
| Rate for Payer: Dean Health Medicaid |
$17,044.16
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,810.78
|
| Rate for Payer: Managed Health Services Medicaid |
$17,799.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,044.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,044.16
|
| Rate for Payer: United Healthcare Medicaid |
$17,044.16
|
|
|
MAJOR GASTROINTESTINAL AND PERITONEAL INFECTIONS
|
Facility
|
IP
|
$10,171.24
|
|
|
Service Code
|
APR-DRG 2483
|
| Min. Negotiated Rate |
$9,034.73 |
| Max. Negotiated Rate |
$10,171.24 |
| Rate for Payer: Anthem Medicaid |
$9,739.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,739.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,739.52
|
| Rate for Payer: Dean Health Medicaid |
$9,739.52
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,034.73
|
| Rate for Payer: Managed Health Services Medicaid |
$10,171.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,739.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,739.52
|
| Rate for Payer: United Healthcare Medicaid |
$9,739.52
|
|
|
MAJOR GASTROINTESTINAL AND PERITONEAL INFECTIONS
|
Facility
|
IP
|
$4,910.25
|
|
|
Service Code
|
APR-DRG 2481
|
| Min. Negotiated Rate |
$4,361.59 |
| Max. Negotiated Rate |
$4,910.25 |
| Rate for Payer: Anthem Medicaid |
$4,701.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,701.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,701.84
|
| Rate for Payer: Dean Health Medicaid |
$4,701.84
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,361.59
|
| Rate for Payer: Managed Health Services Medicaid |
$4,910.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,701.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,701.84
|
| Rate for Payer: United Healthcare Medicaid |
$4,701.84
|
|
|
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC
|
Facility
|
IP
|
$29,152.24
|
|
|
Service Code
|
MSDRG 372
|
| Min. Negotiated Rate |
$8,325.80 |
| Max. Negotiated Rate |
$29,152.24 |
| Rate for Payer: Aetna Managed Medicare |
$8,325.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,277.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,075.45
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,222.79
|
| Rate for Payer: Anthem Medicare Advantage |
$8,325.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,325.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,325.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,325.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,008.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,325.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,137.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,325.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,325.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,325.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,325.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,488.70
|
| Rate for Payer: Quartz Medicare Advantage |
$8,325.80
|
| Rate for Payer: The Alliance Commercial |
$29,152.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,325.80
|
| Rate for Payer: United Healthcare PPO |
$16,456.09
|
| Rate for Payer: Wellcare Medicare |
$8,325.80
|
|
|
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC
|
Facility
|
IP
|
$48,656.40
|
|
|
Service Code
|
MSDRG 371
|
| Min. Negotiated Rate |
$14,085.53 |
| Max. Negotiated Rate |
$48,656.40 |
| Rate for Payer: Aetna Managed Medicare |
$14,085.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38,687.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,653.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,173.00
|
| Rate for Payer: Anthem Medicare Advantage |
$14,085.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,085.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,085.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,085.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,274.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,085.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,443.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,085.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,085.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,085.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,085.53
|
| Rate for Payer: NAPHCARE Commercial |
$21,128.30
|
| Rate for Payer: Quartz Medicare Advantage |
$14,085.53
|
| Rate for Payer: The Alliance Commercial |
$48,656.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,085.53
|
| Rate for Payer: United Healthcare PPO |
$27,593.10
|
| Rate for Payer: Wellcare Medicare |
$14,085.53
|
|
|
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$20,143.76
|
|
|
Service Code
|
MSDRG 373
|
| Min. Negotiated Rate |
$6,077.34 |
| Max. Negotiated Rate |
$20,143.76 |
| Rate for Payer: Aetna Managed Medicare |
$6,077.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,871.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,165.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,557.75
|
| Rate for Payer: Anthem Medicare Advantage |
$6,077.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,077.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,077.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,077.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,830.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,077.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,530.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,077.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,077.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,077.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,077.34
|
| Rate for Payer: NAPHCARE Commercial |
$9,116.02
|
| Rate for Payer: Quartz Medicare Advantage |
$6,077.34
|
| Rate for Payer: The Alliance Commercial |
$20,143.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,077.34
|
| Rate for Payer: United Healthcare PPO |
$11,312.28
|
| Rate for Payer: Wellcare Medicare |
$6,077.34
|
|
|
MAJOR HEAD AND NECK PROCEDURES WITH CC
|
Facility
|
IP
|
$57,614.96
|
|
|
Service Code
|
MSDRG 141
|
| Min. Negotiated Rate |
$17,210.09 |
| Max. Negotiated Rate |
$57,614.96 |
| Rate for Payer: Aetna Managed Medicare |
$17,210.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47,589.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36,477.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34,655.76
|
| Rate for Payer: Anthem Medicare Advantage |
$17,210.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,210.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,210.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,210.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38,471.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,210.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42,014.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,210.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,210.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,210.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,210.09
|
| Rate for Payer: NAPHCARE Commercial |
$25,815.13
|
| Rate for Payer: Quartz Medicare Advantage |
$17,210.09
|
| Rate for Payer: The Alliance Commercial |
$57,614.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,210.09
|
| Rate for Payer: United Healthcare PPO |
$32,708.50
|
| Rate for Payer: Wellcare Medicare |
$17,210.09
|
|
|
MAJOR HEAD AND NECK PROCEDURES WITH MCC
|
Facility
|
IP
|
$104,795.60
|
|
|
Service Code
|
MSDRG 140
|
| Min. Negotiated Rate |
$33,171.29 |
| Max. Negotiated Rate |
$104,795.60 |
| Rate for Payer: Aetna Managed Medicare |
$33,171.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93,065.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$71,333.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67,771.86
|
| Rate for Payer: Anthem Medicare Advantage |
$33,171.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33,171.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33,171.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$33,171.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75,232.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$33,171.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76,619.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33,171.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33,171.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$33,171.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$33,171.29
|
| Rate for Payer: NAPHCARE Commercial |
$49,756.93
|
| Rate for Payer: Quartz Medicare Advantage |
$33,171.29
|
| Rate for Payer: The Alliance Commercial |
$104,795.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33,171.29
|
| Rate for Payer: United Healthcare PPO |
$59,649.55
|
| Rate for Payer: Wellcare Medicare |
$33,171.29
|
|
|
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$43,051.84
|
|
|
Service Code
|
MSDRG 142
|
| Min. Negotiated Rate |
$12,732.32 |
| Max. Negotiated Rate |
$43,051.84 |
| Rate for Payer: Aetna Managed Medicare |
$12,732.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34,832.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,698.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,365.39
|
| Rate for Payer: Anthem Medicare Advantage |
$12,732.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,732.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,732.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,732.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,157.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,732.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,332.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,732.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,732.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,732.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,732.32
|
| Rate for Payer: NAPHCARE Commercial |
$19,098.49
|
| Rate for Payer: Quartz Medicare Advantage |
$12,732.32
|
| Rate for Payer: The Alliance Commercial |
$43,051.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,732.32
|
| Rate for Payer: United Healthcare PPO |
$24,392.84
|
| Rate for Payer: Wellcare Medicare |
$12,732.32
|
|
|
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC
|
Facility
|
IP
|
$33,634.64
|
|
|
Service Code
|
MSDRG 809
|
| Min. Negotiated Rate |
$10,201.29 |
| Max. Negotiated Rate |
$33,634.64 |
| Rate for Payer: Aetna Managed Medicare |
$10,201.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,620.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,171.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,114.04
|
| Rate for Payer: Anthem Medicare Advantage |
$10,201.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,201.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,201.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,201.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,328.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,201.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,425.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,201.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,201.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,201.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,201.29
|
| Rate for Payer: NAPHCARE Commercial |
$15,301.93
|
| Rate for Payer: Quartz Medicare Advantage |
$10,201.29
|
| Rate for Payer: The Alliance Commercial |
$33,634.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,201.29
|
| Rate for Payer: United Healthcare PPO |
$19,015.36
|
| Rate for Payer: Wellcare Medicare |
$10,201.29
|
|
|
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC
|
Facility
|
IP
|
$60,887.84
|
|
|
Service Code
|
MSDRG 808
|
| Min. Negotiated Rate |
$17,415.31 |
| Max. Negotiated Rate |
$60,887.84 |
| Rate for Payer: Aetna Managed Medicare |
$17,415.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48,174.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36,925.45
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35,081.59
|
| Rate for Payer: Anthem Medicare Advantage |
$17,415.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,415.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,415.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,415.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38,943.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,415.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44,415.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,415.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,415.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,415.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,415.31
|
| Rate for Payer: NAPHCARE Commercial |
$26,122.96
|
| Rate for Payer: Quartz Medicare Advantage |
$17,415.31
|
| Rate for Payer: The Alliance Commercial |
$60,887.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,415.31
|
| Rate for Payer: United Healthcare PPO |
$34,577.83
|
| Rate for Payer: Wellcare Medicare |
$17,415.31
|
|
|
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$28,107.04
|
|
|
Service Code
|
MSDRG 810
|
| Min. Negotiated Rate |
$8,521.85 |
| Max. Negotiated Rate |
$28,107.04 |
| Rate for Payer: Aetna Managed Medicare |
$8,521.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,835.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,503.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,629.55
|
| Rate for Payer: Anthem Medicare Advantage |
$8,521.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,521.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,521.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,521.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,460.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,521.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,371.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,521.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,521.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,521.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,521.85
|
| Rate for Payer: NAPHCARE Commercial |
$12,782.78
|
| Rate for Payer: Quartz Medicare Advantage |
$8,521.85
|
| Rate for Payer: The Alliance Commercial |
$28,107.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,521.85
|
| Rate for Payer: United Healthcare PPO |
$15,859.28
|
| Rate for Payer: Wellcare Medicare |
$8,521.85
|
|
|
MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION
|
Facility
|
IP
|
$7,803.80
|
|
|
Service Code
|
APR-DRG 6602
|
| Min. Negotiated Rate |
$6,931.82 |
| Max. Negotiated Rate |
$7,803.80 |
| Rate for Payer: Anthem Medicaid |
$7,472.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,472.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,472.56
|
| Rate for Payer: Dean Health Medicaid |
$7,472.56
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,931.82
|
| Rate for Payer: Managed Health Services Medicaid |
$7,803.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,472.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,472.56
|
| Rate for Payer: United Healthcare Medicaid |
$7,472.56
|
|
|
MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION
|
Facility
|
IP
|
$23,323.70
|
|
|
Service Code
|
APR-DRG 6604
|
| Min. Negotiated Rate |
$20,717.57 |
| Max. Negotiated Rate |
$23,323.70 |
| Rate for Payer: Anthem Medicaid |
$22,333.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,333.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,333.73
|
| Rate for Payer: Dean Health Medicaid |
$22,333.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,717.57
|
| Rate for Payer: Managed Health Services Medicaid |
$23,323.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,333.73
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,333.73
|
| Rate for Payer: United Healthcare Medicaid |
$22,333.73
|
|
|
MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION
|
Facility
|
IP
|
$6,137.82
|
|
|
Service Code
|
APR-DRG 6601
|
| Min. Negotiated Rate |
$5,451.99 |
| Max. Negotiated Rate |
$6,137.82 |
| Rate for Payer: Anthem Medicaid |
$5,877.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,877.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,877.30
|
| Rate for Payer: Dean Health Medicaid |
$5,877.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,451.99
|
| Rate for Payer: Managed Health Services Medicaid |
$6,137.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,877.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,877.30
|
| Rate for Payer: United Healthcare Medicaid |
$5,877.30
|
|
|
MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION
|
Facility
|
IP
|
$12,275.63
|
|
|
Service Code
|
APR-DRG 6603
|
| Min. Negotiated Rate |
$10,903.98 |
| Max. Negotiated Rate |
$12,275.63 |
| Rate for Payer: Anthem Medicaid |
$11,754.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,754.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,754.60
|
| Rate for Payer: Dean Health Medicaid |
$11,754.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,903.98
|
| Rate for Payer: Managed Health Services Medicaid |
$12,275.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,754.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,754.60
|
| Rate for Payer: United Healthcare Medicaid |
$11,754.60
|
|
