|
MAJOR STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES
|
Facility
|
IP
|
$13,503.20
|
|
|
Service Code
|
APR-DRG 2201
|
| Min. Negotiated Rate |
$11,994.38 |
| Max. Negotiated Rate |
$13,503.20 |
| Rate for Payer: Anthem Medicaid |
$12,930.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,930.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,930.06
|
| Rate for Payer: Dean Health Medicaid |
$12,930.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,994.38
|
| Rate for Payer: Managed Health Services Medicaid |
$13,503.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,930.06
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,930.06
|
| Rate for Payer: United Healthcare Medicaid |
$12,930.06
|
|
|
MAJOR THUMB OR JOINT PROCEDURES
|
Facility
|
IP
|
$40,773.20
|
|
|
Service Code
|
MSDRG 506
|
| Min. Negotiated Rate |
$10,839.22 |
| Max. Negotiated Rate |
$40,773.20 |
| Rate for Payer: Aetna Managed Medicare |
$10,839.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,174.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,062.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,060.59
|
| Rate for Payer: Anthem Medicare Advantage |
$10,839.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,839.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,839.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,839.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,159.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,839.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,661.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,839.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,839.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,839.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,839.22
|
| Rate for Payer: NAPHCARE Commercial |
$16,258.83
|
| Rate for Payer: Quartz Medicare Advantage |
$10,839.22
|
| Rate for Payer: The Alliance Commercial |
$40,773.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,839.22
|
| Rate for Payer: United Healthcare PPO |
$23,091.88
|
| Rate for Payer: Wellcare Medicare |
$10,839.22
|
|
|
Malaria Smear
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
633784
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$168.95 |
| Rate for Payer: Aetna Commercial |
$168.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.94
|
| Rate for Payer: Aetna Managed Medicare |
$6.23
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$6.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.23
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$168.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.23
|
| Rate for Payer: Health EOS Commercial |
$161.83
|
| Rate for Payer: HFN Commercial |
$168.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.23
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: NAPHCARE Commercial |
$9.34
|
| Rate for Payer: Preferred Network Access Commercial |
$168.95
|
| Rate for Payer: Quartz Beloit One Network |
$78.25
|
| Rate for Payer: Quartz Commercial |
$101.37
|
| Rate for Payer: Quartz Medicare Advantage |
$6.23
|
| Rate for Payer: The Alliance Commercial |
$24.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.23
|
| Rate for Payer: WEA Trust Commercial |
$97.81
|
| Rate for Payer: WPS Commercial |
$27.41
|
|
|
Malaria Smear
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
633784
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.14 |
| Max. Negotiated Rate |
$163.61 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.26
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$163.61
|
| Rate for Payer: Health EOS Commercial |
$158.28
|
| Rate for Payer: HFN Commercial |
$163.61
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: Preferred Network Access Commercial |
$163.61
|
| Rate for Payer: Quartz Beloit One Network |
$87.14
|
| Rate for Payer: Quartz Commercial |
$106.70
|
| Rate for Payer: WEA Trust Commercial |
$97.81
|
| Rate for Payer: WPS Commercial |
$131.72
|
|
|
Malaria Smear
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
633784
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$163.61 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.94
|
| Rate for Payer: Aetna Managed Medicare |
$6.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.34
|
| Rate for Payer: Anthem Medicare Advantage |
$6.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.23
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$163.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.23
|
| Rate for Payer: Health EOS Commercial |
$158.28
|
| Rate for Payer: HFN Commercial |
$163.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.23
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: NAPHCARE Commercial |
$9.34
|
| Rate for Payer: Preferred Network Access Commercial |
$163.61
|
| Rate for Payer: Quartz Beloit One Network |
$87.14
|
| Rate for Payer: Quartz Commercial |
$115.60
|
| Rate for Payer: Quartz Medicare Advantage |
$6.23
|
| Rate for Payer: The Alliance Commercial |
$24.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.23
|
| Rate for Payer: United Healthcare PPO |
$133.38
|
| Rate for Payer: WEA Trust Commercial |
$97.81
|
| Rate for Payer: Wellcare Medicare |
$6.23
|
| Rate for Payer: WPS Commercial |
$131.72
|
|
|
MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY
|
Facility
|
IP
|
$4,822.57
|
|
|
Service Code
|
APR-DRG 5011
|
| Min. Negotiated Rate |
$4,283.71 |
| Max. Negotiated Rate |
$4,822.57 |
| Rate for Payer: Anthem Medicaid |
$4,617.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,617.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,617.88
|
| Rate for Payer: Dean Health Medicaid |
$4,617.88
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,283.71
|
| Rate for Payer: Managed Health Services Medicaid |
$4,822.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,617.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,617.88
|
| Rate for Payer: United Healthcare Medicaid |
$4,617.88
|
|
|
MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY
|
Facility
|
IP
|
$6,137.82
|
|
|
Service Code
|
APR-DRG 5012
|
| 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
|
|
|
MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY
|
Facility
|
IP
|
$18,764.18
|
|
|
Service Code
|
APR-DRG 5014
|
| Min. Negotiated Rate |
$16,667.52 |
| Max. Negotiated Rate |
$18,764.18 |
| Rate for Payer: Anthem Medicaid |
$17,967.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,967.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,967.74
|
| Rate for Payer: Dean Health Medicaid |
$17,967.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,667.52
|
| Rate for Payer: Managed Health Services Medicaid |
$18,764.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,967.74
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,967.74
|
| Rate for Payer: United Healthcare Medicaid |
$17,967.74
|
|
|
MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY
|
Facility
|
IP
|
$9,119.04
|
|
|
Service Code
|
APR-DRG 5013
|
| Min. Negotiated Rate |
$8,100.10 |
| Max. Negotiated Rate |
$9,119.04 |
| Rate for Payer: Anthem Medicaid |
$8,731.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,731.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,731.99
|
| Rate for Payer: Dean Health Medicaid |
$8,731.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,100.10
|
| Rate for Payer: Managed Health Services Medicaid |
$9,119.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,731.99
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,731.99
|
| Rate for Payer: United Healthcare Medicaid |
$8,731.99
|
|
|
MALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
OP
|
$99.58
|
|
|
Service Code
|
EAPG 00744
|
| Min. Negotiated Rate |
$95.75 |
| Max. Negotiated Rate |
$99.58 |
| Rate for Payer: Anthem Medicaid |
$95.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$95.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$95.75
|
| Rate for Payer: Dean Health Medicaid |
$95.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$95.75
|
| Rate for Payer: Managed Health Services Medicaid |
$99.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$95.75
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$95.75
|
| Rate for Payer: United Healthcare Medicaid |
$95.75
|
|
|
MALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
OP
|
$90.41
|
|
|
Service Code
|
EAPG 00740
|
| Min. Negotiated Rate |
$86.93 |
| Max. Negotiated Rate |
$90.41 |
| Rate for Payer: Anthem Medicaid |
$86.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$86.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.93
|
| Rate for Payer: Dean Health Medicaid |
$86.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$86.93
|
| Rate for Payer: Managed Health Services Medicaid |
$90.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$86.93
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$86.93
|
| Rate for Payer: United Healthcare Medicaid |
$86.93
|
|
|
MALFUNCTION, REACTION AND COMPLICATION OF GASTROINTESTINAL DEVICE OR PROCEDURE
|
Facility
|
IP
|
$11,223.44
|
|
|
Service Code
|
APR-DRG 2523
|
| Min. Negotiated Rate |
$9,969.36 |
| Max. Negotiated Rate |
$11,223.44 |
| Rate for Payer: Anthem Medicaid |
$10,747.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,747.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,747.06
|
| Rate for Payer: Dean Health Medicaid |
$10,747.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,969.36
|
| Rate for Payer: Managed Health Services Medicaid |
$11,223.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,747.06
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,747.06
|
| Rate for Payer: United Healthcare Medicaid |
$10,747.06
|
|
|
MALFUNCTION, REACTION AND COMPLICATION OF GASTROINTESTINAL DEVICE OR PROCEDURE
|
Facility
|
IP
|
$20,956.26
|
|
|
Service Code
|
APR-DRG 2524
|
| Min. Negotiated Rate |
$18,614.66 |
| Max. Negotiated Rate |
$20,956.26 |
| Rate for Payer: Anthem Medicaid |
$20,066.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,066.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,066.77
|
| Rate for Payer: Dean Health Medicaid |
$20,066.77
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,614.66
|
| Rate for Payer: Managed Health Services Medicaid |
$20,956.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,066.77
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,066.77
|
| Rate for Payer: United Healthcare Medicaid |
$20,066.77
|
|
|
MALFUNCTION, REACTION AND COMPLICATION OF GASTROINTESTINAL DEVICE OR PROCEDURE
|
Facility
|
IP
|
$5,699.40
|
|
|
Service Code
|
APR-DRG 2521
|
| Min. Negotiated Rate |
$5,062.56 |
| Max. Negotiated Rate |
$5,699.40 |
| Rate for Payer: Anthem Medicaid |
$5,457.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,457.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,457.49
|
| Rate for Payer: Dean Health Medicaid |
$5,457.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,062.56
|
| Rate for Payer: Managed Health Services Medicaid |
$5,699.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,457.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,457.49
|
| Rate for Payer: United Healthcare Medicaid |
$5,457.49
|
|
|
MALFUNCTION, REACTION AND COMPLICATION OF GASTROINTESTINAL DEVICE OR PROCEDURE
|
Facility
|
IP
|
$7,453.06
|
|
|
Service Code
|
APR-DRG 2522
|
| Min. Negotiated Rate |
$6,620.28 |
| Max. Negotiated Rate |
$7,453.06 |
| Rate for Payer: Anthem Medicaid |
$7,136.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,136.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,136.72
|
| Rate for Payer: Dean Health Medicaid |
$7,136.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,620.28
|
| Rate for Payer: Managed Health Services Medicaid |
$7,453.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,136.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,136.72
|
| Rate for Payer: United Healthcare Medicaid |
$7,136.72
|
|
|
MALFUNCTION, REACTION AND COMPLICATION OF GI DEVICE OR PROCEDURE
|
Facility
|
OP
|
$115.31
|
|
|
Service Code
|
EAPG 00629
|
| Min. Negotiated Rate |
$110.87 |
| Max. Negotiated Rate |
$115.31 |
| Rate for Payer: Anthem Medicaid |
$110.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$110.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.87
|
| Rate for Payer: Dean Health Medicaid |
$110.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$110.87
|
| Rate for Payer: Managed Health Services Medicaid |
$115.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$110.87
|
| Rate for Payer: United Healthcare Medicaid |
$110.87
|
|
|
MALFUNCTION, REACTION, COMPLICATION OF CARDIAC OR VASCULAR DEVICE OR PROCEDURE
|
Facility
|
IP
|
$7,803.80
|
|
|
Service Code
|
APR-DRG 2062
|
| 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
|
|
|
MALFUNCTION, REACTION, COMPLICATION OF CARDIAC OR VASCULAR DEVICE OR PROCEDURE
|
Facility
|
IP
|
$6,488.55
|
|
|
Service Code
|
APR-DRG 2061
|
| Min. Negotiated Rate |
$5,763.53 |
| Max. Negotiated Rate |
$6,488.55 |
| Rate for Payer: Anthem Medicaid |
$6,213.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,213.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,213.14
|
| Rate for Payer: Dean Health Medicaid |
$6,213.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,763.53
|
| Rate for Payer: Managed Health Services Medicaid |
$6,488.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,213.14
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,213.14
|
| Rate for Payer: United Healthcare Medicaid |
$6,213.14
|
|
|
MALFUNCTION, REACTION, COMPLICATION OF CARDIAC OR VASCULAR DEVICE OR PROCEDURE
|
Facility
|
IP
|
$11,749.54
|
|
|
Service Code
|
APR-DRG 2063
|
| Min. Negotiated Rate |
$10,436.67 |
| Max. Negotiated Rate |
$11,749.54 |
| Rate for Payer: Anthem Medicaid |
$11,250.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,250.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,250.83
|
| Rate for Payer: Dean Health Medicaid |
$11,250.83
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,436.67
|
| Rate for Payer: Managed Health Services Medicaid |
$11,749.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,250.83
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,250.83
|
| Rate for Payer: United Healthcare Medicaid |
$11,250.83
|
|
|
MALFUNCTION, REACTION, COMPLICATION OF CARDIAC OR VASCULAR DEVICE OR PROCEDURE
|
Facility
|
IP
|
$20,517.85
|
|
|
Service Code
|
APR-DRG 2064
|
| Min. Negotiated Rate |
$18,225.23 |
| Max. Negotiated Rate |
$20,517.85 |
| Rate for Payer: Anthem Medicaid |
$19,646.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$19,646.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19,646.97
|
| Rate for Payer: Dean Health Medicaid |
$19,646.97
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,225.23
|
| Rate for Payer: Managed Health Services Medicaid |
$20,517.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,646.97
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19,646.97
|
| Rate for Payer: United Healthcare Medicaid |
$19,646.97
|
|
|
MALFUNCTION, REACTION, COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE
|
Facility
|
IP
|
$6,488.55
|
|
|
Service Code
|
APR-DRG 4662
|
| Min. Negotiated Rate |
$5,763.53 |
| Max. Negotiated Rate |
$6,488.55 |
| Rate for Payer: Anthem Medicaid |
$6,213.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,213.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,213.14
|
| Rate for Payer: Dean Health Medicaid |
$6,213.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,763.53
|
| Rate for Payer: Managed Health Services Medicaid |
$6,488.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,213.14
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,213.14
|
| Rate for Payer: United Healthcare Medicaid |
$6,213.14
|
|
|
MALFUNCTION, REACTION, COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE
|
Facility
|
IP
|
$10,258.92
|
|
|
Service Code
|
APR-DRG 4663
|
| Min. Negotiated Rate |
$9,112.62 |
| Max. Negotiated Rate |
$10,258.92 |
| Rate for Payer: Anthem Medicaid |
$9,823.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,823.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,823.48
|
| Rate for Payer: Dean Health Medicaid |
$9,823.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,112.62
|
| Rate for Payer: Managed Health Services Medicaid |
$10,258.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,823.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,823.48
|
| Rate for Payer: United Healthcare Medicaid |
$9,823.48
|
|
|
MALFUNCTION, REACTION, COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE
|
Facility
|
IP
|
$17,273.57
|
|
|
Service Code
|
APR-DRG 4664
|
| Min. Negotiated Rate |
$15,343.46 |
| Max. Negotiated Rate |
$17,273.57 |
| Rate for Payer: Anthem Medicaid |
$16,540.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,540.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,540.40
|
| Rate for Payer: Dean Health Medicaid |
$16,540.40
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,343.46
|
| Rate for Payer: Managed Health Services Medicaid |
$17,273.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,540.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,540.40
|
| Rate for Payer: United Healthcare Medicaid |
$16,540.40
|
|
|
MALFUNCTION, REACTION, COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE
|
Facility
|
IP
|
$5,085.62
|
|
|
Service Code
|
APR-DRG 4661
|
| Min. Negotiated Rate |
$4,517.36 |
| Max. Negotiated Rate |
$5,085.62 |
| Rate for Payer: Anthem Medicaid |
$4,869.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,869.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,869.76
|
| Rate for Payer: Dean Health Medicaid |
$4,869.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,517.36
|
| Rate for Payer: Managed Health Services Medicaid |
$5,085.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,869.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,869.76
|
| Rate for Payer: United Healthcare Medicaid |
$4,869.76
|
|
|
MALFUNCTION, REACTION, COMPLICATION OF NEUROLOGICAL DEVICE OR PROC
|
Facility
|
OP
|
$91.72
|
|
|
Service Code
|
EAPG 00537
|
| Min. Negotiated Rate |
$88.19 |
| Max. Negotiated Rate |
$91.72 |
| Rate for Payer: Anthem Medicaid |
$88.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$88.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.19
|
| Rate for Payer: Dean Health Medicaid |
$88.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$88.19
|
| Rate for Payer: Managed Health Services Medicaid |
$91.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$88.19
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$88.19
|
| Rate for Payer: United Healthcare Medicaid |
$88.19
|
|
