|
MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY
|
Facility
|
IP
|
$118,810.60
|
|
|
Service Code
|
APR-DRG 1604
|
| Min. Negotiated Rate |
$105,534.99 |
| Max. Negotiated Rate |
$118,810.60 |
| Rate for Payer: Anthem Medicaid |
$113,767.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$113,767.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113,767.70
|
| Rate for Payer: Dean Health Medicaid |
$113,767.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$105,534.99
|
| Rate for Payer: Managed Health Services Medicaid |
$118,810.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$113,767.70
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$113,767.70
|
| Rate for Payer: United Healthcare Medicaid |
$113,767.70
|
|
|
MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY
|
Facility
|
IP
|
$41,211.06
|
|
|
Service Code
|
APR-DRG 1602
|
| Min. Negotiated Rate |
$36,606.23 |
| Max. Negotiated Rate |
$41,211.06 |
| Rate for Payer: Anthem Medicaid |
$39,461.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$39,461.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39,461.86
|
| Rate for Payer: Dean Health Medicaid |
$39,461.86
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36,606.23
|
| Rate for Payer: Managed Health Services Medicaid |
$41,211.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$39,461.86
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$39,461.86
|
| Rate for Payer: United Healthcare Medicaid |
$39,461.86
|
|
|
MAJOR CHEST AND RESPIRATORY TRAUMA
|
Facility
|
IP
|
$19,728.70
|
|
|
Service Code
|
APR-DRG 1354
|
| Min. Negotiated Rate |
$17,524.26 |
| Max. Negotiated Rate |
$19,728.70 |
| Rate for Payer: Anthem Medicaid |
$18,891.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$18,891.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18,891.31
|
| Rate for Payer: Dean Health Medicaid |
$18,891.31
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17,524.26
|
| Rate for Payer: Managed Health Services Medicaid |
$19,728.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,891.31
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18,891.31
|
| Rate for Payer: United Healthcare Medicaid |
$18,891.31
|
|
|
MAJOR CHEST AND RESPIRATORY TRAUMA
|
Facility
|
IP
|
$11,135.75
|
|
|
Service Code
|
APR-DRG 1353
|
| Min. Negotiated Rate |
$9,891.47 |
| Max. Negotiated Rate |
$11,135.75 |
| Rate for Payer: Anthem Medicaid |
$10,663.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,663.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,663.10
|
| Rate for Payer: Dean Health Medicaid |
$10,663.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,891.47
|
| Rate for Payer: Managed Health Services Medicaid |
$11,135.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,663.10
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,663.10
|
| Rate for Payer: United Healthcare Medicaid |
$10,663.10
|
|
|
MAJOR CHEST AND RESPIRATORY TRAUMA
|
Facility
|
IP
|
$7,628.43
|
|
|
Service Code
|
APR-DRG 1352
|
| Min. Negotiated Rate |
$6,776.05 |
| Max. Negotiated Rate |
$7,628.43 |
| Rate for Payer: Anthem Medicaid |
$7,304.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,304.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,304.64
|
| Rate for Payer: Dean Health Medicaid |
$7,304.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,776.05
|
| Rate for Payer: Managed Health Services Medicaid |
$7,628.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,304.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,304.64
|
| Rate for Payer: United Healthcare Medicaid |
$7,304.64
|
|
|
MAJOR CHEST AND RESPIRATORY TRAUMA
|
Facility
|
IP
|
$6,050.13
|
|
|
Service Code
|
APR-DRG 1351
|
| Min. Negotiated Rate |
$5,374.11 |
| Max. Negotiated Rate |
$6,050.13 |
| Rate for Payer: Anthem Medicaid |
$5,793.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,793.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,793.34
|
| Rate for Payer: Dean Health Medicaid |
$5,793.34
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,374.11
|
| Rate for Payer: Managed Health Services Medicaid |
$6,050.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,793.34
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,793.34
|
| Rate for Payer: United Healthcare Medicaid |
$5,793.34
|
|
|
MAJOR CHEST AND RESPIRATORY TRAUMA
|
Facility
|
OP
|
$87.80
|
|
|
Service Code
|
EAPG 00580
|
| Min. Negotiated Rate |
$84.42 |
| Max. Negotiated Rate |
$87.80 |
| Rate for Payer: Anthem Medicaid |
$84.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$84.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.42
|
| Rate for Payer: Dean Health Medicaid |
$84.42
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$84.42
|
| Rate for Payer: Managed Health Services Medicaid |
$87.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$84.42
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$84.42
|
| Rate for Payer: United Healthcare Medicaid |
$84.42
|
|
|
MAJOR CHEST PROCEDURES WITH CC
|
Facility
|
IP
|
$70,850.00
|
|
|
Service Code
|
MSDRG 164
|
| Min. Negotiated Rate |
$19,836.07 |
| Max. Negotiated Rate |
$70,850.00 |
| Rate for Payer: Aetna Managed Medicare |
$19,836.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55,071.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42,211.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40,104.14
|
| Rate for Payer: Anthem Medicare Advantage |
$19,836.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,836.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,836.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,836.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44,519.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,836.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51,722.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,836.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,836.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,836.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,836.07
|
| Rate for Payer: NAPHCARE Commercial |
$29,754.10
|
| Rate for Payer: Quartz Medicare Advantage |
$19,836.07
|
| Rate for Payer: The Alliance Commercial |
$70,850.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,836.07
|
| Rate for Payer: United Healthcare PPO |
$40,266.32
|
| Rate for Payer: Wellcare Medicare |
$19,836.07
|
|
|
MAJOR CHEST PROCEDURES WITH MCC
|
Facility
|
IP
|
$130,661.44
|
|
|
Service Code
|
MSDRG 163
|
| Min. Negotiated Rate |
$34,829.29 |
| Max. Negotiated Rate |
$130,661.44 |
| Rate for Payer: Aetna Managed Medicare |
$34,829.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$97,789.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74,954.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71,211.86
|
| Rate for Payer: Anthem Medicare Advantage |
$34,829.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34,829.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34,829.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$34,829.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79,051.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$34,829.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95,591.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34,829.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34,829.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$34,829.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$34,829.29
|
| Rate for Payer: NAPHCARE Commercial |
$52,243.93
|
| Rate for Payer: Quartz Medicare Advantage |
$34,829.29
|
| Rate for Payer: The Alliance Commercial |
$130,661.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34,829.29
|
| Rate for Payer: United Healthcare PPO |
$74,419.45
|
| Rate for Payer: Wellcare Medicare |
$34,829.29
|
|
|
MAJOR CHEST PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$52,214.24
|
|
|
Service Code
|
MSDRG 165
|
| Min. Negotiated Rate |
$15,166.10 |
| Max. Negotiated Rate |
$52,214.24 |
| Rate for Payer: Aetna Managed Medicare |
$15,166.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41,766.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32,013.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,414.95
|
| Rate for Payer: Anthem Medicare Advantage |
$15,166.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,166.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,166.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,166.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,763.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,166.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,053.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,166.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,166.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,166.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,166.10
|
| Rate for Payer: NAPHCARE Commercial |
$22,749.15
|
| Rate for Payer: Quartz Medicare Advantage |
$15,166.10
|
| Rate for Payer: The Alliance Commercial |
$52,214.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,166.10
|
| Rate for Payer: United Healthcare PPO |
$29,625.06
|
| Rate for Payer: Wellcare Medicare |
$15,166.10
|
|
|
MAJOR CHEST TRAUMA WITH CC
|
Facility
|
IP
|
$29,417.44
|
|
|
Service Code
|
MSDRG 184
|
| Min. Negotiated Rate |
$8,655.87 |
| Max. Negotiated Rate |
$29,417.44 |
| Rate for Payer: Aetna Managed Medicare |
$8,655.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,217.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,796.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,907.61
|
| Rate for Payer: Anthem Medicare Advantage |
$8,655.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,655.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,655.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,655.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,769.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,655.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,332.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,655.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,655.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,655.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,655.87
|
| Rate for Payer: NAPHCARE Commercial |
$12,983.80
|
| Rate for Payer: Quartz Medicare Advantage |
$8,655.87
|
| Rate for Payer: The Alliance Commercial |
$29,417.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,655.87
|
| Rate for Payer: United Healthcare PPO |
$16,607.65
|
| Rate for Payer: Wellcare Medicare |
$8,655.87
|
|
|
MAJOR CHEST TRAUMA WITH MCC
|
Facility
|
IP
|
$43,867.20
|
|
|
Service Code
|
MSDRG 183
|
| Min. Negotiated Rate |
$12,223.06 |
| Max. Negotiated Rate |
$43,867.20 |
| Rate for Payer: Aetna Managed Medicare |
$12,223.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,381.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,586.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,308.76
|
| Rate for Payer: Anthem Medicare Advantage |
$12,223.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,223.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,223.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,223.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,984.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,223.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,930.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,223.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,223.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,223.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,223.06
|
| Rate for Payer: NAPHCARE Commercial |
$18,334.59
|
| Rate for Payer: Quartz Medicare Advantage |
$12,223.06
|
| Rate for Payer: The Alliance Commercial |
$43,867.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,223.06
|
| Rate for Payer: United Healthcare PPO |
$24,858.58
|
| Rate for Payer: Wellcare Medicare |
$12,223.06
|
|
|
MAJOR CHEST TRAUMA WITHOUT CC/MCC
|
Facility
|
IP
|
$21,227.44
|
|
|
Service Code
|
MSDRG 185
|
| Min. Negotiated Rate |
$6,529.95 |
| Max. Negotiated Rate |
$21,227.44 |
| Rate for Payer: Aetna Managed Medicare |
$6,529.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,160.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,153.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,496.79
|
| Rate for Payer: Anthem Medicare Advantage |
$6,529.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,529.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,529.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,529.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,872.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,529.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,325.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,529.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,529.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,529.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,529.95
|
| Rate for Payer: NAPHCARE Commercial |
$9,794.93
|
| Rate for Payer: Quartz Medicare Advantage |
$6,529.95
|
| Rate for Payer: The Alliance Commercial |
$21,227.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,529.95
|
| Rate for Payer: United Healthcare PPO |
$11,931.17
|
| Rate for Payer: Wellcare Medicare |
$6,529.95
|
|
|
MAJOR CRANIAL OR FACIAL BONE PROCEDURES
|
Facility
|
IP
|
$47,085.82
|
|
|
Service Code
|
APR-DRG 0894
|
| Min. Negotiated Rate |
$41,824.57 |
| Max. Negotiated Rate |
$47,085.82 |
| Rate for Payer: Anthem Medicaid |
$45,087.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$45,087.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45,087.27
|
| Rate for Payer: Dean Health Medicaid |
$45,087.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$41,824.57
|
| Rate for Payer: Managed Health Services Medicaid |
$47,085.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$45,087.27
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$45,087.27
|
| Rate for Payer: United Healthcare Medicaid |
$45,087.27
|
|
|
MAJOR CRANIAL OR FACIAL BONE PROCEDURES
|
Facility
|
IP
|
$15,695.27
|
|
|
Service Code
|
APR-DRG 0891
|
| Min. Negotiated Rate |
$13,941.52 |
| Max. Negotiated Rate |
$15,695.27 |
| Rate for Payer: Anthem Medicaid |
$15,029.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$15,029.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,029.09
|
| Rate for Payer: Dean Health Medicaid |
$15,029.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,941.52
|
| Rate for Payer: Managed Health Services Medicaid |
$15,695.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,029.09
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15,029.09
|
| Rate for Payer: United Healthcare Medicaid |
$15,029.09
|
|
|
MAJOR CRANIAL OR FACIAL BONE PROCEDURES
|
Facility
|
IP
|
$35,160.92
|
|
|
Service Code
|
APR-DRG 0893
|
| Min. Negotiated Rate |
$31,232.13 |
| Max. Negotiated Rate |
$35,160.92 |
| Rate for Payer: Anthem Medicaid |
$33,668.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$33,668.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33,668.52
|
| Rate for Payer: Dean Health Medicaid |
$33,668.52
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$31,232.13
|
| Rate for Payer: Managed Health Services Medicaid |
$35,160.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,668.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$33,668.52
|
| Rate for Payer: United Healthcare Medicaid |
$33,668.52
|
|
|
MAJOR CRANIAL OR FACIAL BONE PROCEDURES
|
Facility
|
IP
|
$20,517.85
|
|
|
Service Code
|
APR-DRG 0892
|
| 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
|
|
|
MAJOR DEPRESSIVE DIAGNOSES AND OTHER OR UNSPECIFIED PSYCHOSES
|
Facility
|
OP
|
$31.99
|
|
|
Service Code
|
EAPG 00821
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$31.99 |
| Rate for Payer: Anthem Medicaid |
$30.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$30.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.76
|
| Rate for Payer: Dean Health Medicaid |
$30.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30.76
|
| Rate for Payer: Managed Health Services Medicaid |
$31.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$30.76
|
| Rate for Payer: United Healthcare Medicaid |
$30.76
|
|
|
Major Dressing Change
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
3026414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$149.26 |
| Rate for Payer: Aetna Commercial |
$146.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.53
|
| Rate for Payer: Aetna Managed Medicare |
$45.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$77.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.99
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$149.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.79
|
| Rate for Payer: Health EOS Commercial |
$144.39
|
| Rate for Payer: HFN Commercial |
$149.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$121.68
|
| Rate for Payer: Multiplan Commercial |
$129.79
|
| Rate for Payer: NAPHCARE Commercial |
$97.34
|
| Rate for Payer: Preferred Network Access Commercial |
$149.26
|
| Rate for Payer: Quartz Beloit One Network |
$79.50
|
| Rate for Payer: Quartz Commercial |
$105.46
|
| Rate for Payer: Quartz Medicare Advantage |
$97.34
|
| Rate for Payer: The Alliance Commercial |
$122.47
|
| Rate for Payer: WEA Trust Commercial |
$89.23
|
| Rate for Payer: WPS Commercial |
$120.17
|
|
|
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
|
$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
|
$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
|
$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
|
|
