|
OT Evaluation Low Charge
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
5247100
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$92.96 |
| Max. Negotiated Rate |
$1,328.00 |
| Rate for Payer: Aetna Commercial |
$298.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$285.52
|
| Rate for Payer: Aetna Managed Medicare |
$92.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.96
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.79
|
| Rate for Payer: Health EOS Commercial |
$295.48
|
| Rate for Payer: HFN Commercial |
$305.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: NAPHCARE Commercial |
$199.20
|
| Rate for Payer: Preferred Network Access Commercial |
$305.44
|
| Rate for Payer: Quartz Beloit One Network |
$162.68
|
| Rate for Payer: Quartz Commercial |
$215.80
|
| Rate for Payer: Quartz Medicare Advantage |
$199.20
|
| Rate for Payer: The Alliance Commercial |
$1,328.00
|
| Rate for Payer: United Healthcare PPO |
$249.00
|
| Rate for Payer: WEA Trust Commercial |
$182.60
|
| Rate for Payer: WPS Commercial |
$245.91
|
|
|
OT Evaluation Moderate Complexity
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
5250657
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$320.95 |
| Max. Negotiated Rate |
$602.60 |
| Rate for Payer: Aetna Commercial |
$589.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.15
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$602.60
|
| Rate for Payer: Health EOS Commercial |
$582.95
|
| Rate for Payer: HFN Commercial |
$602.60
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: NAPHCARE Commercial |
$393.00
|
| Rate for Payer: Preferred Network Access Commercial |
$602.60
|
| Rate for Payer: Quartz Beloit One Network |
$320.95
|
| Rate for Payer: Quartz Commercial |
$393.00
|
| Rate for Payer: WEA Trust Commercial |
$360.25
|
| Rate for Payer: WPS Commercial |
$485.16
|
|
|
OT Evaluation Moderate Complexity
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
5250657
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$2,620.00 |
| Rate for Payer: Aetna Commercial |
$589.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.30
|
| Rate for Payer: Aetna Managed Medicare |
$183.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.15
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$602.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$366.54
|
| Rate for Payer: Health EOS Commercial |
$582.95
|
| Rate for Payer: HFN Commercial |
$602.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: NAPHCARE Commercial |
$393.00
|
| Rate for Payer: Preferred Network Access Commercial |
$602.60
|
| Rate for Payer: Quartz Beloit One Network |
$320.95
|
| Rate for Payer: Quartz Commercial |
$425.75
|
| Rate for Payer: Quartz Medicare Advantage |
$393.00
|
| Rate for Payer: The Alliance Commercial |
$2,620.00
|
| Rate for Payer: United Healthcare PPO |
$491.25
|
| Rate for Payer: WEA Trust Commercial |
$360.25
|
| Rate for Payer: WPS Commercial |
$485.16
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$38,368.00
|
|
|
Service Code
|
MSDRG 818
|
| Min. Negotiated Rate |
$13,801.30 |
| Max. Negotiated Rate |
$38,368.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,801.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,546.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,814.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,875.26
|
| Rate for Payer: Anthem Medicare Advantage |
$13,801.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,801.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,801.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,801.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,843.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,801.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,875.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,801.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,801.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,801.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,801.30
|
| Rate for Payer: NAPHCARE Commercial |
$20,701.95
|
| Rate for Payer: Quartz Medicare Advantage |
$13,801.30
|
| Rate for Payer: The Alliance Commercial |
$38,368.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,801.30
|
| Rate for Payer: United Healthcare PPO |
$17,808.83
|
| Rate for Payer: Wellcare Medicare |
$13,801.30
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$75,208.00
|
|
|
Service Code
|
MSDRG 817
|
| Min. Negotiated Rate |
$27,053.17 |
| Max. Negotiated Rate |
$75,208.00 |
| Rate for Payer: Aetna Managed Medicare |
$27,053.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47,414.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36,343.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34,528.28
|
| Rate for Payer: Anthem Medicare Advantage |
$27,053.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,053.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,053.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,053.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38,329.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,053.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43,972.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,053.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,053.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,053.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,053.17
|
| Rate for Payer: NAPHCARE Commercial |
$40,579.76
|
| Rate for Payer: Quartz Medicare Advantage |
$27,053.17
|
| Rate for Payer: The Alliance Commercial |
$75,208.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,053.17
|
| Rate for Payer: United Healthcare PPO |
$34,233.16
|
| Rate for Payer: Wellcare Medicare |
$27,053.17
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$24,439.00
|
|
|
Service Code
|
MSDRG 819
|
| Min. Negotiated Rate |
$8,791.10 |
| Max. Negotiated Rate |
$24,439.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,791.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,091.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,633.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,902.98
|
| Rate for Payer: Anthem Medicare Advantage |
$8,791.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,791.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,791.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,791.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,433.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,791.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,690.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,791.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,791.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,791.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,791.10
|
| Rate for Payer: NAPHCARE Commercial |
$13,186.65
|
| Rate for Payer: Quartz Medicare Advantage |
$8,791.10
|
| Rate for Payer: The Alliance Commercial |
$24,439.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,791.10
|
| Rate for Payer: United Healthcare PPO |
$13,772.20
|
| Rate for Payer: Wellcare Medicare |
$8,791.10
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$19,933.00
|
|
|
Service Code
|
MSDRG 832
|
| Min. Negotiated Rate |
$7,170.10 |
| Max. Negotiated Rate |
$19,933.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,170.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,525.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,899.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,305.72
|
| Rate for Payer: Anthem Medicare Advantage |
$7,170.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,170.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,170.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,170.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,550.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,170.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,385.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,170.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,170.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,170.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,170.10
|
| Rate for Payer: NAPHCARE Commercial |
$10,755.15
|
| Rate for Payer: Quartz Medicare Advantage |
$7,170.10
|
| Rate for Payer: The Alliance Commercial |
$19,933.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,170.10
|
| Rate for Payer: United Healthcare PPO |
$11,199.02
|
| Rate for Payer: Wellcare Medicare |
$7,170.10
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$28,908.00
|
|
|
Service Code
|
MSDRG 831
|
| Min. Negotiated Rate |
$10,398.67 |
| Max. Negotiated Rate |
$28,908.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,398.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,189.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,241.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,430.78
|
| Rate for Payer: Anthem Medicare Advantage |
$10,398.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,398.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,398.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,398.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,129.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,398.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,691.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,398.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,398.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,398.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,398.67
|
| Rate for Payer: NAPHCARE Commercial |
$15,598.00
|
| Rate for Payer: Quartz Medicare Advantage |
$10,398.67
|
| Rate for Payer: The Alliance Commercial |
$28,908.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,398.67
|
| Rate for Payer: United Healthcare PPO |
$15,329.77
|
| Rate for Payer: Wellcare Medicare |
$10,398.67
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$13,927.00
|
|
|
Service Code
|
MSDRG 833
|
| Min. Negotiated Rate |
$5,009.76 |
| Max. Negotiated Rate |
$13,927.00 |
| Rate for Payer: Aetna Managed Medicare |
$5,009.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,699.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,201.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,791.78
|
| Rate for Payer: Anthem Medicare Advantage |
$5,009.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,009.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,009.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,009.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,649.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,009.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,980.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,009.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,009.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,009.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,009.76
|
| Rate for Payer: NAPHCARE Commercial |
$7,514.64
|
| Rate for Payer: Quartz Medicare Advantage |
$5,009.76
|
| Rate for Payer: The Alliance Commercial |
$13,927.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,009.76
|
| Rate for Payer: United Healthcare PPO |
$7,769.64
|
| Rate for Payer: Wellcare Medicare |
$5,009.76
|
|
|
OTHER CARDIOTHORACIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$134,279.00
|
|
|
Service Code
|
MSDRG 228
|
| Min. Negotiated Rate |
$48,301.84 |
| Max. Negotiated Rate |
$134,279.00 |
| Rate for Payer: Aetna Managed Medicare |
$48,301.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105,739.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81,048.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$77,001.12
|
| Rate for Payer: Anthem Medicare Advantage |
$48,301.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$48,301.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$48,301.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$48,301.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85,478.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$48,301.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98,254.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48,301.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$48,301.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$48,301.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$48,301.84
|
| Rate for Payer: NAPHCARE Commercial |
$72,452.76
|
| Rate for Payer: Quartz Medicare Advantage |
$48,301.84
|
| Rate for Payer: The Alliance Commercial |
$134,279.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48,301.84
|
| Rate for Payer: United Healthcare PPO |
$76,492.50
|
| Rate for Payer: Wellcare Medicare |
$48,301.84
|
|
|
OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$84,853.00
|
|
|
Service Code
|
MSDRG 229
|
| Min. Negotiated Rate |
$30,522.71 |
| Max. Negotiated Rate |
$84,853.00 |
| Rate for Payer: Aetna Managed Medicare |
$30,522.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66,716.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51,137.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48,584.04
|
| Rate for Payer: Anthem Medicare Advantage |
$30,522.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30,522.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30,522.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$30,522.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53,932.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$30,522.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62,002.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30,522.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30,522.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$30,522.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$30,522.71
|
| Rate for Payer: NAPHCARE Commercial |
$45,784.06
|
| Rate for Payer: Quartz Medicare Advantage |
$30,522.71
|
| Rate for Payer: The Alliance Commercial |
$84,853.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30,522.71
|
| Rate for Payer: United Healthcare PPO |
$48,269.51
|
| Rate for Payer: Wellcare Medicare |
$30,522.71
|
|
|
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC
|
Facility
|
IP
|
$26,037.00
|
|
|
Service Code
|
MSDRG 315
|
| Min. Negotiated Rate |
$9,365.85 |
| Max. Negotiated Rate |
$26,037.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,365.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,350.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,598.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,819.66
|
| Rate for Payer: Anthem Medicare Advantage |
$9,365.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,365.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,365.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,365.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,451.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,365.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,862.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,365.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,365.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,365.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,365.85
|
| Rate for Payer: NAPHCARE Commercial |
$14,048.78
|
| Rate for Payer: Quartz Medicare Advantage |
$9,365.85
|
| Rate for Payer: The Alliance Commercial |
$26,037.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,365.85
|
| Rate for Payer: United Healthcare PPO |
$14,684.58
|
| Rate for Payer: Wellcare Medicare |
$9,365.85
|
|
|
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC
|
Facility
|
IP
|
$55,978.00
|
|
|
Service Code
|
MSDRG 314
|
| Min. Negotiated Rate |
$20,136.02 |
| Max. Negotiated Rate |
$55,978.00 |
| Rate for Payer: Aetna Managed Medicare |
$20,136.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43,848.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33,609.29
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31,931.02
|
| Rate for Payer: Anthem Medicare Advantage |
$20,136.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,136.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,136.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,136.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35,446.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,136.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,823.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,136.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,136.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,136.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,136.02
|
| Rate for Payer: NAPHCARE Commercial |
$30,204.03
|
| Rate for Payer: Quartz Medicare Advantage |
$20,136.02
|
| Rate for Payer: The Alliance Commercial |
$55,978.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,136.02
|
| Rate for Payer: United Healthcare PPO |
$31,781.42
|
| Rate for Payer: Wellcare Medicare |
$20,136.02
|
|
|
OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC
|
Facility
|
IP
|
$18,737.00
|
|
|
Service Code
|
MSDRG 316
|
| Min. Negotiated Rate |
$6,739.77 |
| Max. Negotiated Rate |
$18,737.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,739.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,476.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,095.89
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,541.82
|
| Rate for Payer: Anthem Medicare Advantage |
$6,739.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,739.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,739.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,739.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,702.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,739.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,507.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,739.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,739.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,739.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,739.77
|
| Rate for Payer: NAPHCARE Commercial |
$10,109.66
|
| Rate for Payer: Quartz Medicare Advantage |
$6,739.77
|
| Rate for Payer: The Alliance Commercial |
$18,737.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,739.77
|
| Rate for Payer: United Healthcare PPO |
$10,515.88
|
| Rate for Payer: Wellcare Medicare |
$6,739.77
|
|
|
OTHER CIRCULATORY SYSTEM O.R. PROCEDURES
|
Facility
|
IP
|
$87,150.00
|
|
|
Service Code
|
MSDRG 264
|
| Min. Negotiated Rate |
$31,348.99 |
| Max. Negotiated Rate |
$87,150.00 |
| Rate for Payer: Aetna Managed Medicare |
$31,348.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68,604.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52,584.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49,959.06
|
| Rate for Payer: Anthem Medicare Advantage |
$31,348.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31,348.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31,348.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$31,348.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55,459.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$31,348.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63,687.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31,348.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31,348.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$31,348.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$31,348.99
|
| Rate for Payer: NAPHCARE Commercial |
$47,023.48
|
| Rate for Payer: Quartz Medicare Advantage |
$31,348.99
|
| Rate for Payer: The Alliance Commercial |
$87,150.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31,348.99
|
| Rate for Payer: United Healthcare PPO |
$49,581.15
|
| Rate for Payer: Wellcare Medicare |
$31,348.99
|
|
|
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC
|
Facility
|
IP
|
$25,229.00
|
|
|
Service Code
|
MSDRG 394
|
| Min. Negotiated Rate |
$9,075.12 |
| Max. Negotiated Rate |
$25,229.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,075.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,721.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,116.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,361.32
|
| Rate for Payer: Anthem Medicare Advantage |
$9,075.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,075.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,075.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,075.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,942.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,075.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,269.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,075.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,075.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,075.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,075.12
|
| Rate for Payer: NAPHCARE Commercial |
$13,612.68
|
| Rate for Payer: Quartz Medicare Advantage |
$9,075.12
|
| Rate for Payer: The Alliance Commercial |
$25,229.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,075.12
|
| Rate for Payer: United Healthcare PPO |
$14,223.08
|
| Rate for Payer: Wellcare Medicare |
$9,075.12
|
|
|
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC
|
Facility
|
IP
|
$43,379.00
|
|
|
Service Code
|
MSDRG 393
|
| Min. Negotiated Rate |
$15,603.97 |
| Max. Negotiated Rate |
$43,379.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,603.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,987.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,051.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,750.36
|
| Rate for Payer: Anthem Medicare Advantage |
$15,603.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,603.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,603.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,603.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,475.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,603.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,582.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,603.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,603.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,603.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,603.97
|
| Rate for Payer: NAPHCARE Commercial |
$23,405.96
|
| Rate for Payer: Quartz Medicare Advantage |
$15,603.97
|
| Rate for Payer: The Alliance Commercial |
$43,379.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,603.97
|
| Rate for Payer: United Healthcare PPO |
$24,587.15
|
| Rate for Payer: Wellcare Medicare |
$15,603.97
|
|
|
OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC
|
Facility
|
IP
|
$17,535.00
|
|
|
Service Code
|
MSDRG 395
|
| Min. Negotiated Rate |
$6,307.50 |
| Max. Negotiated Rate |
$17,535.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,307.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,637.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,452.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,930.70
|
| Rate for Payer: Anthem Medicare Advantage |
$6,307.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,307.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,307.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,307.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,023.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,307.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,626.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,307.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,307.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,307.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,307.50
|
| Rate for Payer: NAPHCARE Commercial |
$9,461.25
|
| Rate for Payer: Quartz Medicare Advantage |
$6,307.50
|
| Rate for Payer: The Alliance Commercial |
$17,535.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,307.50
|
| Rate for Payer: United Healthcare PPO |
$9,829.70
|
| Rate for Payer: Wellcare Medicare |
$6,307.50
|
|
|
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$58,724.00
|
|
|
Service Code
|
MSDRG 357
|
| Min. Negotiated Rate |
$21,123.91 |
| Max. Negotiated Rate |
$58,724.00 |
| Rate for Payer: Wellcare Medicare |
$21,123.91
|
| Rate for Payer: Aetna Managed Medicare |
$21,123.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46,156.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35,378.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33,611.60
|
| Rate for Payer: Anthem Medicare Advantage |
$21,123.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,123.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,123.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,123.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37,311.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,123.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42,837.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,123.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,123.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,123.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,123.91
|
| Rate for Payer: NAPHCARE Commercial |
$31,685.86
|
| Rate for Payer: Quartz Medicare Advantage |
$21,123.91
|
| Rate for Payer: The Alliance Commercial |
$58,724.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,123.91
|
| Rate for Payer: United Healthcare PPO |
$33,349.62
|
|
|
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$114,074.00
|
|
|
Service Code
|
MSDRG 356
|
| Min. Negotiated Rate |
$41,033.74 |
| Max. Negotiated Rate |
$114,074.00 |
| Rate for Payer: Aetna Managed Medicare |
$41,033.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89,794.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68,826.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65,389.84
|
| Rate for Payer: Anthem Medicare Advantage |
$41,033.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41,033.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41,033.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$41,033.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72,588.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$41,033.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83,434.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41,033.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41,033.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$41,033.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$41,033.74
|
| Rate for Payer: NAPHCARE Commercial |
$61,550.61
|
| Rate for Payer: Quartz Medicare Advantage |
$41,033.74
|
| Rate for Payer: The Alliance Commercial |
$114,074.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41,033.74
|
| Rate for Payer: United Healthcare PPO |
$64,954.94
|
| Rate for Payer: Wellcare Medicare |
$41,033.74
|
|
|
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$34,380.00
|
|
|
Service Code
|
MSDRG 358
|
| Min. Negotiated Rate |
$12,366.80 |
| Max. Negotiated Rate |
$34,380.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,366.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,854.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,583.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,555.84
|
| Rate for Payer: Anthem Medicare Advantage |
$12,366.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,366.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,366.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,366.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,708.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,366.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,981.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,366.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,366.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,366.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,366.80
|
| Rate for Payer: NAPHCARE Commercial |
$18,550.20
|
| Rate for Payer: Quartz Medicare Advantage |
$12,366.80
|
| Rate for Payer: The Alliance Commercial |
$34,380.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,366.80
|
| Rate for Payer: United Healthcare PPO |
$19,448.38
|
| Rate for Payer: Wellcare Medicare |
$12,366.80
|
|
|
OTHER DISORDERS OF NERVOUS SYSTEM WITH CC
|
Facility
|
IP
|
$27,600.00
|
|
|
Service Code
|
MSDRG 092
|
| Min. Negotiated Rate |
$9,928.16 |
| Max. Negotiated Rate |
$27,600.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,928.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,609.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,563.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,736.34
|
| Rate for Payer: Anthem Medicare Advantage |
$9,928.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,928.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,928.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,928.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,468.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,928.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,008.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,928.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,928.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,928.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,928.16
|
| Rate for Payer: NAPHCARE Commercial |
$14,892.24
|
| Rate for Payer: Quartz Medicare Advantage |
$9,928.16
|
| Rate for Payer: The Alliance Commercial |
$27,600.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,928.16
|
| Rate for Payer: United Healthcare PPO |
$15,577.22
|
| Rate for Payer: Wellcare Medicare |
$9,928.16
|
|
|
OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC
|
Facility
|
IP
|
$47,888.00
|
|
|
Service Code
|
MSDRG 091
|
| Min. Negotiated Rate |
$17,225.91 |
| Max. Negotiated Rate |
$47,888.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,225.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37,554.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,784.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,347.62
|
| Rate for Payer: Anthem Medicare Advantage |
$17,225.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,225.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,225.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,225.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,358.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,225.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,889.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,225.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,225.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,225.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,225.91
|
| Rate for Payer: NAPHCARE Commercial |
$25,838.86
|
| Rate for Payer: Quartz Medicare Advantage |
$17,225.91
|
| Rate for Payer: The Alliance Commercial |
$47,888.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,225.91
|
| Rate for Payer: United Healthcare PPO |
$27,161.85
|
| Rate for Payer: Wellcare Medicare |
$17,225.91
|
|
|
OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC
|
Facility
|
IP
|
$20,909.00
|
|
|
Service Code
|
MSDRG 093
|
| Min. Negotiated Rate |
$7,521.08 |
| Max. Negotiated Rate |
$20,909.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,521.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,154.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,382.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,764.06
|
| Rate for Payer: Anthem Medicare Advantage |
$7,521.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,521.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,521.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,521.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,059.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,521.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,100.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,521.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,521.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,521.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,521.08
|
| Rate for Payer: NAPHCARE Commercial |
$11,281.62
|
| Rate for Payer: Quartz Medicare Advantage |
$7,521.08
|
| Rate for Payer: The Alliance Commercial |
$20,909.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,521.08
|
| Rate for Payer: United Healthcare PPO |
$11,756.17
|
| Rate for Payer: Wellcare Medicare |
$7,521.08
|
|
|
OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT
|
Facility
|
IP
|
$35,464.00
|
|
|
Service Code
|
MSDRG 124
|
| Min. Negotiated Rate |
$12,757.00 |
| Max. Negotiated Rate |
$35,464.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,757.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,693.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,226.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,166.96
|
| Rate for Payer: Anthem Medicare Advantage |
$12,757.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,757.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,757.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,757.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,387.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,757.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,777.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,757.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,757.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,757.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,757.00
|
| Rate for Payer: NAPHCARE Commercial |
$19,135.50
|
| Rate for Payer: Quartz Medicare Advantage |
$12,757.00
|
| Rate for Payer: The Alliance Commercial |
$35,464.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,757.00
|
| Rate for Payer: United Healthcare PPO |
$20,067.76
|
| Rate for Payer: Wellcare Medicare |
$12,757.00
|
|
