|
OT Evaluation Moderate Complexity
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
5250657
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$190.74 |
| Max. Negotiated Rate |
$626.70 |
| Rate for Payer: Aetna Commercial |
$613.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.83
|
| Rate for Payer: Aetna Managed Medicare |
$190.74
|
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.04
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$626.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.21
|
| Rate for Payer: Health EOS Commercial |
$606.27
|
| Rate for Payer: HFN Commercial |
$626.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$544.96
|
| Rate for Payer: NAPHCARE Commercial |
$408.72
|
| Rate for Payer: Preferred Network Access Commercial |
$626.70
|
| Rate for Payer: Quartz Beloit One Network |
$333.79
|
| Rate for Payer: Quartz Commercial |
$442.78
|
| Rate for Payer: Quartz Medicare Advantage |
$408.72
|
| Rate for Payer: The Alliance Commercial |
$408.76
|
| Rate for Payer: United Healthcare PPO |
$510.90
|
| Rate for Payer: WEA Trust Commercial |
$374.66
|
| Rate for Payer: WPS Commercial |
$504.55
|
|
|
OT Evaluation Moderate Complexity
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
5250657
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$333.79 |
| Max. Negotiated Rate |
$626.70 |
| Rate for Payer: Aetna Commercial |
$613.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.04
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$626.70
|
| Rate for Payer: Health EOS Commercial |
$606.27
|
| Rate for Payer: HFN Commercial |
$626.70
|
| Rate for Payer: Multiplan Commercial |
$544.96
|
| Rate for Payer: Preferred Network Access Commercial |
$626.70
|
| Rate for Payer: Quartz Beloit One Network |
$333.79
|
| Rate for Payer: Quartz Commercial |
$408.72
|
| Rate for Payer: WEA Trust Commercial |
$374.66
|
| Rate for Payer: WPS Commercial |
$504.55
|
|
|
OTHER AFTERCARE AND CONVALESCENCE
|
Facility
|
IP
|
$7,803.80
|
|
|
Service Code
|
APR-DRG 8622
|
| 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
|
|
|
OTHER AFTERCARE AND CONVALESCENCE
|
Facility
|
OP
|
$89.10
|
|
|
Service Code
|
EAPG 00872
|
| Min. Negotiated Rate |
$85.67 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Anthem Medicaid |
$85.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$85.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.67
|
| Rate for Payer: Dean Health Medicaid |
$85.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$85.67
|
| Rate for Payer: Managed Health Services Medicaid |
$89.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$85.67
|
| Rate for Payer: United Healthcare Medicaid |
$85.67
|
|
|
OTHER AFTERCARE AND CONVALESCENCE
|
Facility
|
IP
|
$9,908.19
|
|
|
Service Code
|
APR-DRG 8624
|
| Min. Negotiated Rate |
$8,801.07 |
| Max. Negotiated Rate |
$9,908.19 |
| Rate for Payer: Anthem Medicaid |
$9,487.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,487.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,487.64
|
| Rate for Payer: Dean Health Medicaid |
$9,487.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,801.07
|
| Rate for Payer: Managed Health Services Medicaid |
$9,908.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,487.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,487.64
|
| Rate for Payer: United Healthcare Medicaid |
$9,487.64
|
|
|
OTHER AFTERCARE AND CONVALESCENCE
|
Facility
|
IP
|
$9,908.19
|
|
|
Service Code
|
APR-DRG 8623
|
| Min. Negotiated Rate |
$8,801.07 |
| Max. Negotiated Rate |
$9,908.19 |
| Rate for Payer: Anthem Medicaid |
$9,487.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,487.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,487.64
|
| Rate for Payer: Dean Health Medicaid |
$9,487.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,801.07
|
| Rate for Payer: Managed Health Services Medicaid |
$9,908.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,487.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,487.64
|
| Rate for Payer: United Healthcare Medicaid |
$9,487.64
|
|
|
OTHER AFTERCARE AND CONVALESCENCE
|
Facility
|
IP
|
$3,419.64
|
|
|
Service Code
|
APR-DRG 8621
|
| Min. Negotiated Rate |
$3,037.54 |
| Max. Negotiated Rate |
$3,419.64 |
| Rate for Payer: Anthem Medicaid |
$3,274.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,274.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,274.49
|
| Rate for Payer: Dean Health Medicaid |
$3,274.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,037.54
|
| Rate for Payer: Managed Health Services Medicaid |
$3,419.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,274.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,274.49
|
| Rate for Payer: United Healthcare Medicaid |
$3,274.49
|
|
|
OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE
|
Facility
|
IP
|
$6,926.96
|
|
|
Service Code
|
APR-DRG 2532
|
| Min. Negotiated Rate |
$6,152.96 |
| Max. Negotiated Rate |
$6,926.96 |
| Rate for Payer: Anthem Medicaid |
$6,632.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,632.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,632.95
|
| Rate for Payer: Dean Health Medicaid |
$6,632.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,152.96
|
| Rate for Payer: Managed Health Services Medicaid |
$6,926.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,632.95
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,632.95
|
| Rate for Payer: United Healthcare Medicaid |
$6,632.95
|
|
|
OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE
|
Facility
|
IP
|
$5,348.67
|
|
|
Service Code
|
APR-DRG 2531
|
| Min. Negotiated Rate |
$4,751.02 |
| Max. Negotiated Rate |
$5,348.67 |
| Rate for Payer: Anthem Medicaid |
$5,121.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,121.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,121.65
|
| Rate for Payer: Dean Health Medicaid |
$5,121.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,751.02
|
| Rate for Payer: Managed Health Services Medicaid |
$5,348.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,121.65
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,121.65
|
| Rate for Payer: United Healthcare Medicaid |
$5,121.65
|
|
|
OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE
|
Facility
|
IP
|
$17,975.04
|
|
|
Service Code
|
APR-DRG 2534
|
| Min. Negotiated Rate |
$15,966.55 |
| Max. Negotiated Rate |
$17,975.04 |
| Rate for Payer: Anthem Medicaid |
$17,212.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,212.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,212.09
|
| Rate for Payer: Dean Health Medicaid |
$17,212.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,966.55
|
| Rate for Payer: Managed Health Services Medicaid |
$17,975.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,212.09
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,212.09
|
| Rate for Payer: United Healthcare Medicaid |
$17,212.09
|
|
|
OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE
|
Facility
|
IP
|
$10,434.29
|
|
|
Service Code
|
APR-DRG 2533
|
| Min. Negotiated Rate |
$9,268.39 |
| Max. Negotiated Rate |
$10,434.29 |
| Rate for Payer: Anthem Medicaid |
$9,991.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,991.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,991.41
|
| Rate for Payer: Dean Health Medicaid |
$9,991.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,268.39
|
| Rate for Payer: Managed Health Services Medicaid |
$10,434.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,991.41
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,991.41
|
| Rate for Payer: United Healthcare Medicaid |
$9,991.41
|
|
|
OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS
|
Facility
|
IP
|
$16,922.84
|
|
|
Service Code
|
APR-DRG 6634
|
| Min. Negotiated Rate |
$15,031.92 |
| Max. Negotiated Rate |
$16,922.84 |
| Rate for Payer: Anthem Medicaid |
$16,204.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,204.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,204.55
|
| Rate for Payer: Dean Health Medicaid |
$16,204.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,031.92
|
| Rate for Payer: Managed Health Services Medicaid |
$16,922.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,204.55
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,204.55
|
| Rate for Payer: United Healthcare Medicaid |
$16,204.55
|
|
|
OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS
|
Facility
|
IP
|
$6,839.28
|
|
|
Service Code
|
APR-DRG 6632
|
| Min. Negotiated Rate |
$6,075.08 |
| Max. Negotiated Rate |
$6,839.28 |
| Rate for Payer: Anthem Medicaid |
$6,548.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,548.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,548.99
|
| Rate for Payer: Dean Health Medicaid |
$6,548.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,075.08
|
| Rate for Payer: Managed Health Services Medicaid |
$6,839.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,548.99
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,548.99
|
| Rate for Payer: United Healthcare Medicaid |
$6,548.99
|
|
|
OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS
|
Facility
|
IP
|
$4,910.25
|
|
|
Service Code
|
APR-DRG 6631
|
| 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
|
|
|
OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS
|
Facility
|
IP
|
$9,645.14
|
|
|
Service Code
|
APR-DRG 6633
|
| Min. Negotiated Rate |
$8,567.42 |
| Max. Negotiated Rate |
$9,645.14 |
| Rate for Payer: Anthem Medicaid |
$9,235.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,235.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,235.75
|
| Rate for Payer: Dean Health Medicaid |
$9,235.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,567.42
|
| Rate for Payer: Managed Health Services Medicaid |
$9,645.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,235.75
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,235.75
|
| Rate for Payer: United Healthcare Medicaid |
$9,235.75
|
|
|
OTHER ANTEPARTUM DIAGNOSES
|
Facility
|
OP
|
$100.89
|
|
|
Service Code
|
EAPG 00765
|
| Min. Negotiated Rate |
$97.01 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Anthem Medicaid |
$97.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$97.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.01
|
| Rate for Payer: Dean Health Medicaid |
$97.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$97.01
|
| Rate for Payer: Managed Health Services Medicaid |
$100.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$97.01
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$97.01
|
| Rate for Payer: United Healthcare Medicaid |
$97.01
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$39,902.72
|
|
|
Service Code
|
MSDRG 818
|
| Min. Negotiated Rate |
$9,384.16 |
| Max. Negotiated Rate |
$39,902.72 |
| Rate for Payer: Aetna Managed Medicare |
$9,384.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,001.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,630.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,750.31
|
| Rate for Payer: Anthem Medicare Advantage |
$9,384.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,384.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,384.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,384.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,594.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,384.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,790.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,384.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,384.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,384.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,384.16
|
| Rate for Payer: NAPHCARE Commercial |
$14,076.24
|
| Rate for Payer: Quartz Medicare Advantage |
$9,384.16
|
| Rate for Payer: The Alliance Commercial |
$39,902.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,384.16
|
| Rate for Payer: United Healthcare PPO |
$18,521.18
|
| Rate for Payer: Wellcare Medicare |
$9,384.16
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$78,216.32
|
|
|
Service Code
|
MSDRG 817
|
| Min. Negotiated Rate |
$17,979.72 |
| Max. Negotiated Rate |
$78,216.32 |
| Rate for Payer: Aetna Managed Medicare |
$17,979.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,830.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,230.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,820.83
|
| Rate for Payer: Anthem Medicare Advantage |
$17,979.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,979.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,979.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,979.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,773.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,979.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45,731.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,979.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,979.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,979.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,979.72
|
| Rate for Payer: NAPHCARE Commercial |
$26,969.58
|
| Rate for Payer: Quartz Medicare Advantage |
$17,979.72
|
| Rate for Payer: The Alliance Commercial |
$78,216.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,979.72
|
| Rate for Payer: United Healthcare PPO |
$35,602.49
|
| Rate for Payer: Wellcare Medicare |
$17,979.72
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$25,416.56
|
|
|
Service Code
|
MSDRG 819
|
| Min. Negotiated Rate |
$7,092.07 |
| Max. Negotiated Rate |
$25,416.56 |
| Rate for Payer: Aetna Managed Medicare |
$7,092.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,762.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,381.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,663.05
|
| Rate for Payer: Anthem Medicare Advantage |
$7,092.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,092.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,092.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,092.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,167.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,092.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,398.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,092.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,092.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,092.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,092.07
|
| Rate for Payer: NAPHCARE Commercial |
$10,638.11
|
| Rate for Payer: Quartz Medicare Advantage |
$7,092.07
|
| Rate for Payer: The Alliance Commercial |
$25,416.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,092.07
|
| Rate for Payer: United Healthcare PPO |
$14,323.09
|
| Rate for Payer: Wellcare Medicare |
$7,092.07
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$20,730.32
|
|
|
Service Code
|
MSDRG 832
|
| Min. Negotiated Rate |
$6,032.95 |
| Max. Negotiated Rate |
$20,730.32 |
| Rate for Payer: Aetna Managed Medicare |
$6,032.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,744.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,068.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,465.59
|
| Rate for Payer: Anthem Medicare Advantage |
$6,032.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,032.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,032.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,032.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,727.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,032.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,960.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,032.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,032.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,032.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,032.95
|
| Rate for Payer: NAPHCARE Commercial |
$9,049.42
|
| Rate for Payer: Quartz Medicare Advantage |
$6,032.95
|
| Rate for Payer: The Alliance Commercial |
$20,730.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,032.95
|
| Rate for Payer: United Healthcare PPO |
$11,646.98
|
| Rate for Payer: Wellcare Medicare |
$6,032.95
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$30,064.32
|
|
|
Service Code
|
MSDRG 831
|
| Min. Negotiated Rate |
$9,715.75 |
| Max. Negotiated Rate |
$30,064.32 |
| Rate for Payer: Aetna Managed Medicare |
$9,715.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,237.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,110.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,106.67
|
| Rate for Payer: Anthem Medicare Advantage |
$9,715.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,715.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,715.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,715.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,210.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,715.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,478.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,715.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,715.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,715.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,715.75
|
| Rate for Payer: NAPHCARE Commercial |
$14,573.63
|
| Rate for Payer: Quartz Medicare Advantage |
$9,715.75
|
| Rate for Payer: The Alliance Commercial |
$30,064.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,715.75
|
| Rate for Payer: United Healthcare PPO |
$15,942.96
|
| Rate for Payer: Wellcare Medicare |
$9,715.75
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$14,484.08
|
|
|
Service Code
|
MSDRG 833
|
| Min. Negotiated Rate |
$4,511.25 |
| Max. Negotiated Rate |
$14,484.08 |
| Rate for Payer: Aetna Managed Medicare |
$4,511.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,409.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,745.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,308.42
|
| Rate for Payer: Anthem Medicare Advantage |
$4,511.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,511.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,511.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,511.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,223.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,511.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,379.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,511.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,511.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,511.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,511.25
|
| Rate for Payer: NAPHCARE Commercial |
$6,766.87
|
| Rate for Payer: Quartz Medicare Advantage |
$4,511.25
|
| Rate for Payer: The Alliance Commercial |
$14,484.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,511.25
|
| Rate for Payer: United Healthcare PPO |
$8,080.43
|
| Rate for Payer: Wellcare Medicare |
$4,511.25
|
|
|
OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES
|
Facility
|
IP
|
$8,066.85
|
|
|
Service Code
|
APR-DRG 3472
|
| Min. Negotiated Rate |
$7,165.48 |
| Max. Negotiated Rate |
$8,066.85 |
| Rate for Payer: Anthem Medicaid |
$7,724.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,724.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,724.45
|
| Rate for Payer: Dean Health Medicaid |
$7,724.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,165.48
|
| Rate for Payer: Managed Health Services Medicaid |
$8,066.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,724.45
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,724.45
|
| Rate for Payer: United Healthcare Medicaid |
$7,724.45
|
|
|
OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES
|
Facility
|
IP
|
$18,851.87
|
|
|
Service Code
|
APR-DRG 3474
|
| Min. Negotiated Rate |
$16,745.40 |
| Max. Negotiated Rate |
$18,851.87 |
| Rate for Payer: Anthem Medicaid |
$18,051.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$18,051.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18,051.70
|
| Rate for Payer: Dean Health Medicaid |
$18,051.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,745.40
|
| Rate for Payer: Managed Health Services Medicaid |
$18,851.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,051.70
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18,051.70
|
| Rate for Payer: United Healthcare Medicaid |
$18,051.70
|
|
|
OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES
|
Facility
|
IP
|
$11,398.80
|
|
|
Service Code
|
APR-DRG 3473
|
| Min. Negotiated Rate |
$10,125.13 |
| Max. Negotiated Rate |
$11,398.80 |
| Rate for Payer: Anthem Medicaid |
$10,914.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,914.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,914.98
|
| Rate for Payer: Dean Health Medicaid |
$10,914.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,125.13
|
| Rate for Payer: Managed Health Services Medicaid |
$11,398.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,914.98
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,914.98
|
| Rate for Payer: United Healthcare Medicaid |
$10,914.98
|
|
