|
NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE
|
Facility
|
IP
|
$198,865.27
|
|
|
Service Code
|
APR-DRG 6314
|
| Min. Negotiated Rate |
$176,644.54 |
| Max. Negotiated Rate |
$198,865.27 |
| Rate for Payer: Anthem Medicaid |
$190,424.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$190,424.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$190,424.46
|
| Rate for Payer: Dean Health Medicaid |
$190,424.46
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$176,644.54
|
| Rate for Payer: Managed Health Services Medicaid |
$198,865.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$190,424.46
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$190,424.46
|
| Rate for Payer: United Healthcare Medicaid |
$190,424.46
|
|
|
NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE
|
Facility
|
IP
|
$33,670.31
|
|
|
Service Code
|
APR-DRG 6312
|
| Min. Negotiated Rate |
$29,908.07 |
| Max. Negotiated Rate |
$33,670.31 |
| Rate for Payer: Anthem Medicaid |
$32,241.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$32,241.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32,241.18
|
| Rate for Payer: Dean Health Medicaid |
$32,241.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$29,908.07
|
| Rate for Payer: Managed Health Services Medicaid |
$33,670.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,241.18
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$32,241.18
|
| Rate for Payer: United Healthcare Medicaid |
$32,241.18
|
|
|
NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE
|
Facility
|
IP
|
$58,484.63
|
|
|
Service Code
|
APR-DRG 6313
|
| Min. Negotiated Rate |
$51,949.70 |
| Max. Negotiated Rate |
$58,484.63 |
| Rate for Payer: Anthem Medicaid |
$56,002.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$56,002.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56,002.25
|
| Rate for Payer: Dean Health Medicaid |
$56,002.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$51,949.70
|
| Rate for Payer: Managed Health Services Medicaid |
$58,484.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$56,002.25
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$56,002.25
|
| Rate for Payer: United Healthcare Medicaid |
$56,002.25
|
|
|
NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION
|
Facility
|
IP
|
$18,325.77
|
|
|
Service Code
|
APR-DRG 6393
|
| Min. Negotiated Rate |
$16,278.09 |
| Max. Negotiated Rate |
$18,325.77 |
| Rate for Payer: Anthem Medicaid |
$17,547.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,547.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,547.93
|
| Rate for Payer: Dean Health Medicaid |
$17,547.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,278.09
|
| Rate for Payer: Managed Health Services Medicaid |
$18,325.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,547.93
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,547.93
|
| Rate for Payer: United Healthcare Medicaid |
$17,547.93
|
|
|
NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION
|
Facility
|
IP
|
$27,532.49
|
|
|
Service Code
|
APR-DRG 6394
|
| Min. Negotiated Rate |
$24,456.08 |
| Max. Negotiated Rate |
$27,532.49 |
| Rate for Payer: Anthem Medicaid |
$26,363.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$26,363.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26,363.88
|
| Rate for Payer: Dean Health Medicaid |
$26,363.88
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24,456.08
|
| Rate for Payer: Managed Health Services Medicaid |
$27,532.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,363.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26,363.88
|
| Rate for Payer: United Healthcare Medicaid |
$26,363.88
|
|
|
NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION
|
Facility
|
IP
|
$3,244.27
|
|
|
Service Code
|
APR-DRG 6391
|
| Min. Negotiated Rate |
$2,881.77 |
| Max. Negotiated Rate |
$3,244.27 |
| Rate for Payer: Anthem Medicaid |
$3,106.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,106.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,106.57
|
| Rate for Payer: Dean Health Medicaid |
$3,106.57
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$2,881.77
|
| Rate for Payer: Managed Health Services Medicaid |
$3,244.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,106.57
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,106.57
|
| Rate for Payer: United Healthcare Medicaid |
$3,106.57
|
|
|
NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION
|
Facility
|
IP
|
$6,225.50
|
|
|
Service Code
|
APR-DRG 6392
|
| Min. Negotiated Rate |
$5,529.88 |
| Max. Negotiated Rate |
$6,225.50 |
| Rate for Payer: Anthem Medicaid |
$5,961.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,961.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,961.26
|
| Rate for Payer: Dean Health Medicaid |
$5,961.26
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,529.88
|
| Rate for Payer: Managed Health Services Medicaid |
$6,225.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,961.26
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,961.26
|
| Rate for Payer: United Healthcare Medicaid |
$5,961.26
|
|
|
NEONATE BIRTH WEIGHT > 2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION
|
Facility
|
IP
|
$20,605.53
|
|
|
Service Code
|
APR-DRG 6343
|
| Min. Negotiated Rate |
$18,303.12 |
| Max. Negotiated Rate |
$20,605.53 |
| Rate for Payer: Anthem Medicaid |
$19,730.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$19,730.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19,730.93
|
| Rate for Payer: Dean Health Medicaid |
$19,730.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,303.12
|
| Rate for Payer: Managed Health Services Medicaid |
$20,605.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,730.93
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19,730.93
|
| Rate for Payer: United Healthcare Medicaid |
$19,730.93
|
|
|
NEONATE BIRTH WEIGHT > 2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION
|
Facility
|
IP
|
$10,346.61
|
|
|
Service Code
|
APR-DRG 6342
|
| Min. Negotiated Rate |
$9,190.50 |
| Max. Negotiated Rate |
$10,346.61 |
| Rate for Payer: Anthem Medicaid |
$9,907.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,907.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,907.45
|
| Rate for Payer: Dean Health Medicaid |
$9,907.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,190.50
|
| Rate for Payer: Managed Health Services Medicaid |
$10,346.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,907.45
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,907.45
|
| Rate for Payer: United Healthcare Medicaid |
$9,907.45
|
|
|
NEONATE BIRTH WEIGHT > 2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION
|
Facility
|
IP
|
$6,313.18
|
|
|
Service Code
|
APR-DRG 6341
|
| Min. Negotiated Rate |
$5,607.76 |
| Max. Negotiated Rate |
$6,313.18 |
| Rate for Payer: Anthem Medicaid |
$6,045.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,045.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,045.22
|
| Rate for Payer: Dean Health Medicaid |
$6,045.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,607.76
|
| Rate for Payer: Managed Health Services Medicaid |
$6,313.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,045.22
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,045.22
|
| Rate for Payer: United Healthcare Medicaid |
$6,045.22
|
|
|
NEONATE BIRTH WEIGHT > 2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION
|
Facility
|
IP
|
$39,457.39
|
|
|
Service Code
|
APR-DRG 6344
|
| Min. Negotiated Rate |
$35,048.52 |
| Max. Negotiated Rate |
$39,457.39 |
| Rate for Payer: Anthem Medicaid |
$37,782.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$37,782.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37,782.63
|
| Rate for Payer: Dean Health Medicaid |
$37,782.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$35,048.52
|
| Rate for Payer: Managed Health Services Medicaid |
$39,457.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$37,782.63
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$37,782.63
|
| Rate for Payer: United Healthcare Medicaid |
$37,782.63
|
|
|
NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
|
IP
|
$26,743.35
|
|
|
Service Code
|
APR-DRG 5911
|
| Min. Negotiated Rate |
$23,755.11 |
| Max. Negotiated Rate |
$26,743.35 |
| Rate for Payer: Anthem Medicaid |
$25,608.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$25,608.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25,608.23
|
| Rate for Payer: Dean Health Medicaid |
$25,608.23
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$23,755.11
|
| Rate for Payer: Managed Health Services Medicaid |
$26,743.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,608.23
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$25,608.23
|
| Rate for Payer: United Healthcare Medicaid |
$25,608.23
|
|
|
NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
|
IP
|
$125,912.93
|
|
|
Service Code
|
APR-DRG 5912
|
| Min. Negotiated Rate |
$111,843.72 |
| Max. Negotiated Rate |
$125,912.93 |
| Rate for Payer: Anthem Medicaid |
$120,568.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$120,568.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120,568.57
|
| Rate for Payer: Dean Health Medicaid |
$120,568.57
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$111,843.72
|
| Rate for Payer: Managed Health Services Medicaid |
$125,912.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$120,568.57
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$120,568.57
|
| Rate for Payer: United Healthcare Medicaid |
$120,568.57
|
|
|
NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
|
IP
|
$194,568.80
|
|
|
Service Code
|
APR-DRG 5914
|
| Min. Negotiated Rate |
$172,828.15 |
| Max. Negotiated Rate |
$194,568.80 |
| Rate for Payer: Anthem Medicaid |
$186,310.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$186,310.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$186,310.35
|
| Rate for Payer: Dean Health Medicaid |
$186,310.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$172,828.15
|
| Rate for Payer: Managed Health Services Medicaid |
$194,568.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$186,310.35
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$186,310.35
|
| Rate for Payer: United Healthcare Medicaid |
$186,310.35
|
|
|
NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
|
IP
|
$146,781.51
|
|
|
Service Code
|
APR-DRG 5913
|
| Min. Negotiated Rate |
$130,380.49 |
| Max. Negotiated Rate |
$146,781.51 |
| Rate for Payer: Anthem Medicaid |
$140,551.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$140,551.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$140,551.38
|
| Rate for Payer: Dean Health Medicaid |
$140,551.38
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$130,380.49
|
| Rate for Payer: Managed Health Services Medicaid |
$146,781.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$140,551.38
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$140,551.38
|
| Rate for Payer: United Healthcare Medicaid |
$140,551.38
|
|
|
NEONATE BIRTH WEIGHT < 500 GRAMS, OR BIRTH WEIGHT 500-999 GRAMS AND GESTATIONAL AGE <24 WEEKS, OR BIRTH WEIGHT 500-749 GRAMS WITH MAJOR ANOMALY OR WITHOUT LIFE SUSTAINING INTERVENTION
|
Facility
|
IP
|
$138,363.93
|
|
|
Service Code
|
APR-DRG 5891
|
| Min. Negotiated Rate |
$122,903.48 |
| Max. Negotiated Rate |
$138,363.93 |
| Rate for Payer: Anthem Medicaid |
$132,491.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$132,491.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$132,491.09
|
| Rate for Payer: Dean Health Medicaid |
$132,491.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$122,903.48
|
| Rate for Payer: Managed Health Services Medicaid |
$138,363.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$132,491.09
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$132,491.09
|
| Rate for Payer: United Healthcare Medicaid |
$132,491.09
|
|
|
NEONATE BIRTH WEIGHT < 500 GRAMS, OR BIRTH WEIGHT 500-999 GRAMS AND GESTATIONAL AGE <24 WEEKS, OR BIRTH WEIGHT 500-749 GRAMS WITH MAJOR ANOMALY OR WITHOUT LIFE SUSTAINING INTERVENTION
|
Facility
|
IP
|
$138,363.93
|
|
|
Service Code
|
APR-DRG 5893
|
| Min. Negotiated Rate |
$122,903.48 |
| Max. Negotiated Rate |
$138,363.93 |
| Rate for Payer: Anthem Medicaid |
$132,491.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$132,491.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$132,491.09
|
| Rate for Payer: Dean Health Medicaid |
$132,491.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$122,903.48
|
| Rate for Payer: Managed Health Services Medicaid |
$138,363.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$132,491.09
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$132,491.09
|
| Rate for Payer: United Healthcare Medicaid |
$132,491.09
|
|
|
NEONATE BIRTH WEIGHT < 500 GRAMS, OR BIRTH WEIGHT 500-999 GRAMS AND GESTATIONAL AGE <24 WEEKS, OR BIRTH WEIGHT 500-749 GRAMS WITH MAJOR ANOMALY OR WITHOUT LIFE SUSTAINING INTERVENTION
|
Facility
|
IP
|
$138,363.93
|
|
|
Service Code
|
APR-DRG 5892
|
| Min. Negotiated Rate |
$122,903.48 |
| Max. Negotiated Rate |
$138,363.93 |
| Rate for Payer: Anthem Medicaid |
$132,491.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$132,491.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$132,491.09
|
| Rate for Payer: Dean Health Medicaid |
$132,491.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$122,903.48
|
| Rate for Payer: Managed Health Services Medicaid |
$138,363.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$132,491.09
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$132,491.09
|
| Rate for Payer: United Healthcare Medicaid |
$132,491.09
|
|
|
NEONATE BIRTH WEIGHT < 500 GRAMS, OR BIRTH WEIGHT 500-999 GRAMS AND GESTATIONAL AGE <24 WEEKS, OR BIRTH WEIGHT 500-749 GRAMS WITH MAJOR ANOMALY OR WITHOUT LIFE SUSTAINING INTERVENTION
|
Facility
|
IP
|
$2,893.54
|
|
|
Service Code
|
APR-DRG 5894
|
| Min. Negotiated Rate |
$2,570.22 |
| Max. Negotiated Rate |
$2,893.54 |
| Rate for Payer: Anthem Medicaid |
$2,770.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$2,770.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,770.73
|
| Rate for Payer: Dean Health Medicaid |
$2,770.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$2,570.22
|
| Rate for Payer: Managed Health Services Medicaid |
$2,893.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,770.73
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2,770.73
|
| Rate for Payer: United Healthcare Medicaid |
$2,770.73
|
|
|
NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
|
IP
|
$76,635.03
|
|
|
Service Code
|
APR-DRG 5931
|
| Min. Negotiated Rate |
$68,072.01 |
| Max. Negotiated Rate |
$76,635.03 |
| Rate for Payer: Anthem Medicaid |
$73,382.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$73,382.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73,382.26
|
| Rate for Payer: Dean Health Medicaid |
$73,382.26
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$68,072.01
|
| Rate for Payer: Managed Health Services Medicaid |
$76,635.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$73,382.26
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$73,382.26
|
| Rate for Payer: United Healthcare Medicaid |
$73,382.26
|
|
|
NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
|
IP
|
$125,123.78
|
|
|
Service Code
|
APR-DRG 5933
|
| Min. Negotiated Rate |
$111,142.75 |
| Max. Negotiated Rate |
$125,123.78 |
| Rate for Payer: Anthem Medicaid |
$119,812.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$119,812.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$119,812.92
|
| Rate for Payer: Dean Health Medicaid |
$119,812.92
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$111,142.75
|
| Rate for Payer: Managed Health Services Medicaid |
$125,123.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$119,812.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$119,812.92
|
| Rate for Payer: United Healthcare Medicaid |
$119,812.92
|
|
|
NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
|
IP
|
$171,069.73
|
|
|
Service Code
|
APR-DRG 5934
|
| Min. Negotiated Rate |
$151,954.81 |
| Max. Negotiated Rate |
$171,069.73 |
| Rate for Payer: Anthem Medicaid |
$163,808.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$163,808.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163,808.69
|
| Rate for Payer: Dean Health Medicaid |
$163,808.69
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$151,954.81
|
| Rate for Payer: Managed Health Services Medicaid |
$171,069.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$163,808.69
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$163,808.69
|
| Rate for Payer: United Healthcare Medicaid |
$163,808.69
|
|
|
NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE
|
Facility
|
IP
|
$100,660.20
|
|
|
Service Code
|
APR-DRG 5932
|
| Min. Negotiated Rate |
$89,412.67 |
| Max. Negotiated Rate |
$100,660.20 |
| Rate for Payer: Anthem Medicaid |
$96,387.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$96,387.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96,387.69
|
| Rate for Payer: Dean Health Medicaid |
$96,387.69
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$89,412.67
|
| Rate for Payer: Managed Health Services Medicaid |
$100,660.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$96,387.69
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$96,387.69
|
| Rate for Payer: United Healthcare Medicaid |
$96,387.69
|
|
|
NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY
|
Facility
|
IP
|
$50,638.64
|
|
|
Service Code
|
MSDRG 789
|
| Min. Negotiated Rate |
$1,664.00 |
| Max. Negotiated Rate |
$50,638.64 |
| Rate for Payer: Aetna Managed Medicare |
$14,308.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,702.48
|
| Rate for Payer: Anthem Medicare Advantage |
$14,308.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,308.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,308.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,308.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,787.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,308.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,016.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,308.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,308.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,308.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,308.39
|
| Rate for Payer: NAPHCARE Commercial |
$21,462.59
|
| Rate for Payer: Quartz Medicare Advantage |
$14,308.39
|
| Rate for Payer: The Alliance Commercial |
$50,638.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,308.39
|
| Rate for Payer: United Healthcare PPO |
$1,664.00
|
| Rate for Payer: Wellcare Medicare |
$14,308.39
|
|
|
NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE
|
Facility
|
IP
|
$876.83
|
|
|
Service Code
|
APR-DRG 5811
|
| Min. Negotiated Rate |
$778.86 |
| Max. Negotiated Rate |
$876.83 |
| Rate for Payer: Anthem Medicaid |
$839.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$839.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$839.61
|
| Rate for Payer: Dean Health Medicaid |
$839.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$778.86
|
| Rate for Payer: Managed Health Services Medicaid |
$876.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$839.61
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$839.61
|
| Rate for Payer: United Healthcare Medicaid |
$839.61
|
|
