|
Ondansetron JW Waste Charge
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J2405 JW
|
| Hospital Charge Code |
5246653
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.13
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$1.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1.25
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$0.25
|
|
|
Ondansetron JW Waste Charge
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J2405 JW
|
| Hospital Charge Code |
5246653
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.10
|
| Rate for Payer: Health EOS Commercial |
$1.89
|
| Rate for Payer: HFN Commercial |
$1.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.98
|
| Rate for Payer: Quartz Beloit One Network |
$0.92
|
| Rate for Payer: Quartz Commercial |
$1.19
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: United Healthcare Medicaid |
$0.09
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$0.25
|
|
|
Ondansetron JW Waste Charge
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J2405 JW
|
| Hospital Charge Code |
5246653
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.25
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
ONYX DES STENT
|
Facility
|
OP
|
$4,357.00
|
|
| Hospital Charge Code |
6175142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,268.76 |
| Max. Negotiated Rate |
$4,168.78 |
| Rate for Payer: Aetna Commercial |
$4,078.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,896.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,268.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,945.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,265.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,175.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,401.58
|
| Rate for Payer: Cash Price |
$1,307.10
|
| Rate for Payer: Cigna Commercial |
$4,168.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,535.77
|
| Rate for Payer: Health EOS Commercial |
$4,032.84
|
| Rate for Payer: HFN Commercial |
$4,168.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,398.46
|
| Rate for Payer: Multiplan Commercial |
$3,625.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,718.77
|
| Rate for Payer: Preferred Network Access Commercial |
$4,168.78
|
| Rate for Payer: Quartz Beloit One Network |
$2,220.33
|
| Rate for Payer: Quartz Commercial |
$2,945.33
|
| Rate for Payer: Quartz Medicare Advantage |
$2,718.77
|
| Rate for Payer: The Alliance Commercial |
$2,265.64
|
| Rate for Payer: WEA Trust Commercial |
$2,492.20
|
| Rate for Payer: WPS Commercial |
$3,356.20
|
|
|
ONYX DES STENT
|
Facility
|
IP
|
$4,357.00
|
|
| Hospital Charge Code |
6175142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,220.33 |
| Max. Negotiated Rate |
$4,168.78 |
| Rate for Payer: Aetna Commercial |
$4,078.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,896.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,401.58
|
| Rate for Payer: Cash Price |
$1,307.10
|
| Rate for Payer: Cigna Commercial |
$4,168.78
|
| Rate for Payer: Health EOS Commercial |
$4,032.84
|
| Rate for Payer: HFN Commercial |
$4,168.78
|
| Rate for Payer: Multiplan Commercial |
$3,625.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,168.78
|
| Rate for Payer: Quartz Beloit One Network |
$2,220.33
|
| Rate for Payer: Quartz Commercial |
$2,718.77
|
| Rate for Payer: WEA Trust Commercial |
$2,492.20
|
| Rate for Payer: WPS Commercial |
$3,356.20
|
|
|
OP Cardiac Rehab w/Monitoring
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
3052595
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$135.66 |
| Max. Negotiated Rate |
$542.63 |
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Aetna Managed Medicare |
$135.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Anthem Medicare Advantage |
$135.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.66
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$354.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$135.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$135.66
|
| Rate for Payer: Health EOS Commercial |
$343.40
|
| Rate for Payer: HFN Commercial |
$354.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$504.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$135.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$135.66
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: NAPHCARE Commercial |
$203.49
|
| Rate for Payer: Preferred Network Access Commercial |
$354.97
|
| Rate for Payer: Quartz Beloit One Network |
$189.06
|
| Rate for Payer: Quartz Commercial |
$250.80
|
| Rate for Payer: Quartz Medicare Advantage |
$135.66
|
| Rate for Payer: The Alliance Commercial |
$542.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.66
|
| Rate for Payer: United Healthcare PPO |
$289.38
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: Wellcare Medicare |
$135.66
|
| Rate for Payer: WPS Commercial |
$285.78
|
|
|
OP Cardiac Rehab w/Monitoring
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
3052595
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$189.06 |
| Max. Negotiated Rate |
$354.97 |
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.50
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$354.97
|
| Rate for Payer: Health EOS Commercial |
$343.40
|
| Rate for Payer: HFN Commercial |
$354.97
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: Preferred Network Access Commercial |
$354.97
|
| Rate for Payer: Quartz Beloit One Network |
$189.06
|
| Rate for Payer: Quartz Commercial |
$231.50
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: WPS Commercial |
$285.78
|
|
|
OP Dialysis
|
Facility
|
OP
|
$1,151.00
|
|
|
Service Code
|
CPT 90999
|
| Hospital Charge Code |
3005571
|
|
Hospital Revenue Code
|
821
|
| Min. Negotiated Rate |
$335.17 |
| Max. Negotiated Rate |
$1,332.24 |
| Rate for Payer: Aetna Commercial |
$1,077.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,029.45
|
| Rate for Payer: Aetna Managed Medicare |
$335.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,332.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,194.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,134.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$634.43
|
| Rate for Payer: Cash Price |
$345.30
|
| Rate for Payer: Cash Price |
$345.30
|
| Rate for Payer: Cigna Commercial |
$1,101.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$669.88
|
| Rate for Payer: Health EOS Commercial |
$1,065.37
|
| Rate for Payer: HFN Commercial |
$1,101.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$897.78
|
| Rate for Payer: Multiplan Commercial |
$957.63
|
| Rate for Payer: NAPHCARE Commercial |
$718.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,101.28
|
| Rate for Payer: Quartz Beloit One Network |
$586.55
|
| Rate for Payer: Quartz Commercial |
$778.08
|
| Rate for Payer: Quartz Medicare Advantage |
$718.22
|
| Rate for Payer: The Alliance Commercial |
$598.52
|
| Rate for Payer: United Healthcare PPO |
$897.78
|
| Rate for Payer: WEA Trust Commercial |
$658.37
|
| Rate for Payer: WPS Commercial |
$886.62
|
|
|
OP Dialysis
|
Facility
|
IP
|
$1,151.00
|
|
|
Service Code
|
CPT 90999
|
| Hospital Charge Code |
3005571
|
|
Hospital Revenue Code
|
821
|
| Min. Negotiated Rate |
$586.55 |
| Max. Negotiated Rate |
$1,101.28 |
| Rate for Payer: Aetna Commercial |
$1,077.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,029.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$634.43
|
| Rate for Payer: Cash Price |
$345.30
|
| Rate for Payer: Cigna Commercial |
$1,101.28
|
| Rate for Payer: Health EOS Commercial |
$1,065.37
|
| Rate for Payer: HFN Commercial |
$1,101.28
|
| Rate for Payer: Multiplan Commercial |
$957.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,101.28
|
| Rate for Payer: Quartz Beloit One Network |
$586.55
|
| Rate for Payer: Quartz Commercial |
$718.22
|
| Rate for Payer: WEA Trust Commercial |
$658.37
|
| Rate for Payer: WPS Commercial |
$886.62
|
|
|
O.P.Dressing Change Major (includes nursing care, irrigate, - Daily Charges
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
3003961
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$139.69 |
| Rate for Payer: Aetna Commercial |
$136.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Aetna Managed Medicare |
$42.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.48
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$139.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.97
|
| Rate for Payer: Health EOS Commercial |
$135.14
|
| Rate for Payer: HFN Commercial |
$139.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.88
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: NAPHCARE Commercial |
$91.10
|
| Rate for Payer: Preferred Network Access Commercial |
$139.69
|
| Rate for Payer: Quartz Beloit One Network |
$74.40
|
| Rate for Payer: Quartz Commercial |
$98.70
|
| Rate for Payer: Quartz Medicare Advantage |
$91.10
|
| Rate for Payer: The Alliance Commercial |
$122.47
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: WPS Commercial |
$112.46
|
|
|
O.P.Dressing Change Major (includes nursing care, irrigate, - Daily Charges
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
3003961
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$139.69 |
| Rate for Payer: Aetna Commercial |
$136.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.48
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$139.69
|
| Rate for Payer: Health EOS Commercial |
$135.14
|
| Rate for Payer: HFN Commercial |
$139.69
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: Preferred Network Access Commercial |
$139.69
|
| Rate for Payer: Quartz Beloit One Network |
$74.40
|
| Rate for Payer: Quartz Commercial |
$91.10
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: WPS Commercial |
$112.46
|
|
|
O.P Dressing Change Minor (includes nursing care) - Daily Charges
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3003966
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$25.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.22
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.64
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$59.49
|
| Rate for Payer: Quartz Medicare Advantage |
$54.91
|
| Rate for Payer: The Alliance Commercial |
$30.74
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
O.P Dressing Change Minor (includes nursing care) - Daily Charges
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3003966
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$54.91
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
OPEN CRANIOTOMY EXCEPT TRAUMA
|
Facility
|
IP
|
$27,532.49
|
|
|
Service Code
|
APR-DRG 0212
|
| 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
|
|
|
OPEN CRANIOTOMY EXCEPT TRAUMA
|
Facility
|
IP
|
$20,780.89
|
|
|
Service Code
|
APR-DRG 0211
|
| Min. Negotiated Rate |
$18,458.89 |
| Max. Negotiated Rate |
$20,780.89 |
| Rate for Payer: Anthem Medicaid |
$19,898.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$19,898.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19,898.85
|
| Rate for Payer: Dean Health Medicaid |
$19,898.85
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,458.89
|
| Rate for Payer: Managed Health Services Medicaid |
$20,780.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,898.85
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19,898.85
|
| Rate for Payer: United Healthcare Medicaid |
$19,898.85
|
|
|
OPEN CRANIOTOMY EXCEPT TRAUMA
|
Facility
|
IP
|
$54,012.79
|
|
|
Service Code
|
APR-DRG 0214
|
| Min. Negotiated Rate |
$47,977.53 |
| Max. Negotiated Rate |
$54,012.79 |
| Rate for Payer: Anthem Medicaid |
$51,720.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$51,720.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51,720.22
|
| Rate for Payer: Dean Health Medicaid |
$51,720.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$47,977.53
|
| Rate for Payer: Managed Health Services Medicaid |
$54,012.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$51,720.22
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$51,720.22
|
| Rate for Payer: United Healthcare Medicaid |
$51,720.22
|
|
|
OPEN CRANIOTOMY EXCEPT TRAUMA
|
Facility
|
IP
|
$37,966.78
|
|
|
Service Code
|
APR-DRG 0213
|
| Min. Negotiated Rate |
$33,724.46 |
| Max. Negotiated Rate |
$37,966.78 |
| Rate for Payer: Anthem Medicaid |
$36,355.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$36,355.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36,355.29
|
| Rate for Payer: Dean Health Medicaid |
$36,355.29
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$33,724.46
|
| Rate for Payer: Managed Health Services Medicaid |
$37,966.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$36,355.29
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36,355.29
|
| Rate for Payer: United Healthcare Medicaid |
$36,355.29
|
|
|
OPEN CRANIOTOMY FOR TRAUMA
|
Facility
|
IP
|
$32,530.43
|
|
|
Service Code
|
APR-DRG 0203
|
| Min. Negotiated Rate |
$28,895.56 |
| Max. Negotiated Rate |
$32,530.43 |
| Rate for Payer: Anthem Medicaid |
$31,149.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$31,149.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31,149.68
|
| Rate for Payer: Dean Health Medicaid |
$31,149.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28,895.56
|
| Rate for Payer: Managed Health Services Medicaid |
$32,530.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,149.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$31,149.68
|
| Rate for Payer: United Healthcare Medicaid |
$31,149.68
|
|
|
OPEN CRANIOTOMY FOR TRAUMA
|
Facility
|
IP
|
$17,624.30
|
|
|
Service Code
|
APR-DRG 0201
|
| Min. Negotiated Rate |
$15,655.01 |
| Max. Negotiated Rate |
$17,624.30 |
| Rate for Payer: Anthem Medicaid |
$16,876.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,876.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,876.24
|
| Rate for Payer: Dean Health Medicaid |
$16,876.24
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,655.01
|
| Rate for Payer: Managed Health Services Medicaid |
$17,624.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,876.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,876.24
|
| Rate for Payer: United Healthcare Medicaid |
$16,876.24
|
|
|
OPEN CRANIOTOMY FOR TRAUMA
|
Facility
|
IP
|
$47,173.51
|
|
|
Service Code
|
APR-DRG 0204
|
| Min. Negotiated Rate |
$41,902.45 |
| Max. Negotiated Rate |
$47,173.51 |
| Rate for Payer: Anthem Medicaid |
$45,171.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$45,171.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45,171.23
|
| Rate for Payer: Dean Health Medicaid |
$45,171.23
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$41,902.45
|
| Rate for Payer: Managed Health Services Medicaid |
$47,173.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$45,171.23
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$45,171.23
|
| Rate for Payer: United Healthcare Medicaid |
$45,171.23
|
|
|
OPEN CRANIOTOMY FOR TRAUMA
|
Facility
|
IP
|
$22,797.61
|
|
|
Service Code
|
APR-DRG 0202
|
| Min. Negotiated Rate |
$20,250.26 |
| Max. Negotiated Rate |
$22,797.61 |
| Rate for Payer: Anthem Medicaid |
$21,829.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$21,829.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21,829.96
|
| Rate for Payer: Dean Health Medicaid |
$21,829.96
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,250.26
|
| Rate for Payer: Managed Health Services Medicaid |
$22,797.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,829.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21,829.96
|
| Rate for Payer: United Healthcare Medicaid |
$21,829.96
|
|
|
OPEN EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$20,956.26
|
|
|
Service Code
|
APR-DRG 0243
|
| Min. Negotiated Rate |
$18,614.66 |
| Max. Negotiated Rate |
$20,956.26 |
| Rate for Payer: Anthem Medicaid |
$20,066.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,066.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,066.77
|
| Rate for Payer: Dean Health Medicaid |
$20,066.77
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,614.66
|
| Rate for Payer: Managed Health Services Medicaid |
$20,956.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,066.77
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,066.77
|
| Rate for Payer: United Healthcare Medicaid |
$20,066.77
|
|
|
OPEN EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$11,749.54
|
|
|
Service Code
|
APR-DRG 0242
|
| Min. Negotiated Rate |
$10,436.67 |
| Max. Negotiated Rate |
$11,749.54 |
| Rate for Payer: Anthem Medicaid |
$11,250.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,250.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,250.83
|
| Rate for Payer: Dean Health Medicaid |
$11,250.83
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,436.67
|
| Rate for Payer: Managed Health Services Medicaid |
$11,749.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,250.83
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,250.83
|
| Rate for Payer: United Healthcare Medicaid |
$11,250.83
|
|
|
OPEN EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$32,705.80
|
|
|
Service Code
|
APR-DRG 0244
|
| Min. Negotiated Rate |
$29,051.33 |
| Max. Negotiated Rate |
$32,705.80 |
| Rate for Payer: Anthem Medicaid |
$31,317.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$31,317.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31,317.60
|
| Rate for Payer: Dean Health Medicaid |
$31,317.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$29,051.33
|
| Rate for Payer: Managed Health Services Medicaid |
$32,705.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,317.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$31,317.60
|
| Rate for Payer: United Healthcare Medicaid |
$31,317.60
|
|
|
OPEN EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$8,855.99
|
|
|
Service Code
|
APR-DRG 0241
|
| Min. Negotiated Rate |
$7,866.45 |
| Max. Negotiated Rate |
$8,855.99 |
| Rate for Payer: Anthem Medicaid |
$8,480.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,480.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,480.10
|
| Rate for Payer: Dean Health Medicaid |
$8,480.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,866.45
|
| Rate for Payer: Managed Health Services Medicaid |
$8,855.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,480.10
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,480.10
|
| Rate for Payer: United Healthcare Medicaid |
$8,480.10
|
|
