|
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 |
$7,420.48 |
| Max. Negotiated Rate |
$20,895.68 |
| Rate for Payer: Aetna Managed Medicare |
$7,420.48
|
| 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 |
$7,420.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,420.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,420.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,420.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,360.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,420.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,082.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,420.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,420.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,420.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,420.48
|
| Rate for Payer: NAPHCARE Commercial |
$11,130.72
|
| Rate for Payer: Quartz Medicare Advantage |
$7,420.48
|
| Rate for Payer: The Alliance Commercial |
$20,895.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,420.48
|
| Rate for Payer: United Healthcare PPO |
$11,741.71
|
| Rate for Payer: Wellcare Medicare |
$7,420.48
|
|
|
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 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
|
$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
|
$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 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: The Alliance Commercial |
$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: 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
|
$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
|
|
|
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 HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT
|
Facility
|
IP
|
$92,399.84
|
|
|
Service Code
|
MSDRG 469
|
| Min. Negotiated Rate |
$23,735.61 |
| Max. Negotiated Rate |
$92,399.84 |
| Rate for Payer: Aetna Managed Medicare |
$23,735.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66,182.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50,727.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48,194.88
|
| Rate for Payer: Anthem Medicare Advantage |
$23,735.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,735.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,735.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,735.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53,500.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,735.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67,528.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,735.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,735.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,735.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,735.61
|
| Rate for Payer: NAPHCARE Commercial |
$35,603.41
|
| Rate for Payer: Quartz Medicare Advantage |
$23,735.61
|
| Rate for Payer: The Alliance Commercial |
$92,399.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,735.61
|
| Rate for Payer: United Healthcare PPO |
$52,571.68
|
| Rate for Payer: Wellcare Medicare |
$23,735.61
|
|
|
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC
|
Facility
|
IP
|
$52,360.88
|
|
|
Service Code
|
MSDRG 470
|
| Min. Negotiated Rate |
$15,278.68 |
| Max. Negotiated Rate |
$52,360.88 |
| Rate for Payer: Aetna Managed Medicare |
$15,278.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42,087.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32,259.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,648.52
|
| Rate for Payer: Anthem Medicare Advantage |
$15,278.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,278.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,278.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,278.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34,022.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,278.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,160.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,278.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,278.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,278.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,278.68
|
| Rate for Payer: NAPHCARE Commercial |
$22,918.02
|
| Rate for Payer: Quartz Medicare Advantage |
$15,278.68
|
| Rate for Payer: The Alliance Commercial |
$52,360.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,278.68
|
| Rate for Payer: United Healthcare PPO |
$29,708.73
|
| Rate for Payer: Wellcare Medicare |
$15,278.68
|
|
|
Major Joint 20610 - Admin Intra-articular Injection Charge
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
3475534
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$311.88 |
| Max. Negotiated Rate |
$585.56 |
| Rate for Payer: Aetna Commercial |
$572.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$547.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$337.33
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna Commercial |
$585.56
|
| Rate for Payer: Health EOS Commercial |
$566.47
|
| Rate for Payer: HFN Commercial |
$585.56
|
| Rate for Payer: Multiplan Commercial |
$509.18
|
| Rate for Payer: Preferred Network Access Commercial |
$585.56
|
| Rate for Payer: Quartz Beloit One Network |
$311.88
|
| Rate for Payer: Quartz Commercial |
$381.89
|
| Rate for Payer: WEA Trust Commercial |
$350.06
|
| Rate for Payer: WPS Commercial |
$471.42
|
|
|
Major Joint 20610 - Admin Intra-articular Injection Charge
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
3475534
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$305.51 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$572.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$547.37
|
| Rate for Payer: Aetna Managed Medicare |
$323.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$413.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$318.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$305.51
|
| Rate for Payer: Anthem Medicare Advantage |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$337.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$323.03
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna Commercial |
$585.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$323.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$323.03
|
| Rate for Payer: Health EOS Commercial |
$566.47
|
| Rate for Payer: HFN Commercial |
$585.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,201.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$323.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$323.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$323.03
|
| Rate for Payer: Multiplan Commercial |
$509.18
|
| Rate for Payer: NAPHCARE Commercial |
$484.55
|
| Rate for Payer: Preferred Network Access Commercial |
$585.56
|
| Rate for Payer: Quartz Beloit One Network |
$311.88
|
| Rate for Payer: Quartz Commercial |
$413.71
|
| Rate for Payer: Quartz Medicare Advantage |
$323.03
|
| Rate for Payer: The Alliance Commercial |
$1,292.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$323.03
|
| Rate for Payer: WEA Trust Commercial |
$350.06
|
| Rate for Payer: Wellcare Medicare |
$323.03
|
| Rate for Payer: WPS Commercial |
$471.42
|
|
|
Major Joint 20610 - Admin Intra-articular Injection Charge
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
3475534
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.79 |
| Max. Negotiated Rate |
$217.36 |
| Rate for Payer: Aetna Commercial |
$217.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.77
|
| Rate for Payer: Aetna Managed Medicare |
$37.79
|
| Rate for Payer: Anthem Medicare Advantage |
$37.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.79
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$217.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.79
|
| Rate for Payer: Health EOS Commercial |
$208.21
|
| Rate for Payer: HFN Commercial |
$217.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$156.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.79
|
| Rate for Payer: Multiplan Commercial |
$183.04
|
| Rate for Payer: NAPHCARE Commercial |
$56.69
|
| Rate for Payer: Preferred Network Access Commercial |
$217.36
|
| Rate for Payer: Quartz Beloit One Network |
$100.67
|
| Rate for Payer: Quartz Commercial |
$130.42
|
| Rate for Payer: Quartz Medicare Advantage |
$37.79
|
| Rate for Payer: The Alliance Commercial |
$160.62
|
| Rate for Payer: United Healthcare Medicaid |
$67.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.79
|
| Rate for Payer: WEA Trust Commercial |
$125.84
|
| Rate for Payer: WPS Commercial |
$170.07
|
|
|
Major joint or bursa w/ultrasound guidance 20611
|
Professional
|
Both
|
$1,188.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
4494833
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.32 |
| Max. Negotiated Rate |
$1,173.74 |
| Rate for Payer: Aetna Commercial |
$1,173.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.55
|
| Rate for Payer: Aetna Managed Medicare |
$48.32
|
| Rate for Payer: Anthem Medicare Advantage |
$48.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$48.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$48.32
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,173.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.32
|
| Rate for Payer: Health EOS Commercial |
$1,124.32
|
| Rate for Payer: HFN Commercial |
$1,173.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$208.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$208.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$48.32
|
| Rate for Payer: Multiplan Commercial |
$988.42
|
| Rate for Payer: NAPHCARE Commercial |
$72.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.74
|
| Rate for Payer: Quartz Beloit One Network |
$543.63
|
| Rate for Payer: Quartz Commercial |
$704.25
|
| Rate for Payer: Quartz Medicare Advantage |
$48.32
|
| Rate for Payer: The Alliance Commercial |
$205.35
|
| Rate for Payer: United Healthcare Medicaid |
$72.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.32
|
| Rate for Payer: WEA Trust Commercial |
$679.54
|
| Rate for Payer: WPS Commercial |
$217.43
|
|
