|
OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES
|
Facility
|
IP
|
$6,313.18
|
|
|
Service Code
|
APR-DRG 3471
|
| 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
|
|
|
OTHER BEHAVIORAL HEALTH DIAGNOSES
|
Facility
|
OP
|
$86.48
|
|
|
Service Code
|
EAPG 00831
|
| Min. Negotiated Rate |
$83.15 |
| Max. Negotiated Rate |
$86.48 |
| Rate for Payer: Anthem Medicaid |
$83.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$83.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.15
|
| Rate for Payer: Dean Health Medicaid |
$83.15
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$83.15
|
| Rate for Payer: Managed Health Services Medicaid |
$86.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$83.15
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$83.15
|
| Rate for Payer: United Healthcare Medicaid |
$83.15
|
|
|
OTHER BLADDER PROCEDURES
|
Facility
|
IP
|
$9,645.14
|
|
|
Service Code
|
APR-DRG 4451
|
| 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 BLADDER PROCEDURES
|
Facility
|
IP
|
$27,181.76
|
|
|
Service Code
|
APR-DRG 4454
|
| Min. Negotiated Rate |
$24,144.54 |
| Max. Negotiated Rate |
$27,181.76 |
| Rate for Payer: Anthem Medicaid |
$26,028.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$26,028.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26,028.03
|
| Rate for Payer: Dean Health Medicaid |
$26,028.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24,144.54
|
| Rate for Payer: Managed Health Services Medicaid |
$27,181.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,028.03
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26,028.03
|
| Rate for Payer: United Healthcare Medicaid |
$26,028.03
|
|
|
OTHER BLADDER PROCEDURES
|
Facility
|
IP
|
$18,150.40
|
|
|
Service Code
|
APR-DRG 4453
|
| Min. Negotiated Rate |
$16,122.32 |
| Max. Negotiated Rate |
$18,150.40 |
| Rate for Payer: Anthem Medicaid |
$17,380.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,380.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,380.01
|
| Rate for Payer: Dean Health Medicaid |
$17,380.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,122.32
|
| Rate for Payer: Managed Health Services Medicaid |
$18,150.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,380.01
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,380.01
|
| Rate for Payer: United Healthcare Medicaid |
$17,380.01
|
|
|
OTHER BLADDER PROCEDURES
|
Facility
|
IP
|
$13,327.83
|
|
|
Service Code
|
APR-DRG 4452
|
| Min. Negotiated Rate |
$11,838.61 |
| Max. Negotiated Rate |
$13,327.83 |
| Rate for Payer: Anthem Medicaid |
$12,762.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,762.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,762.13
|
| Rate for Payer: Dean Health Medicaid |
$12,762.13
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,838.61
|
| Rate for Payer: Managed Health Services Medicaid |
$13,327.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,762.13
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,762.13
|
| Rate for Payer: United Healthcare Medicaid |
$12,762.13
|
|
|
OTHER CARDIOTHORACIC AND THORACIC CIRCULATORY PROCEDURES
|
Facility
|
IP
|
$28,584.69
|
|
|
Service Code
|
APR-DRG 1672
|
| Min. Negotiated Rate |
$25,390.71 |
| Max. Negotiated Rate |
$28,584.69 |
| Rate for Payer: Anthem Medicaid |
$27,371.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$27,371.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27,371.42
|
| Rate for Payer: Dean Health Medicaid |
$27,371.42
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$25,390.71
|
| Rate for Payer: Managed Health Services Medicaid |
$28,584.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,371.42
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$27,371.42
|
| Rate for Payer: United Healthcare Medicaid |
$27,371.42
|
|
|
OTHER CARDIOTHORACIC AND THORACIC CIRCULATORY PROCEDURES
|
Facility
|
IP
|
$22,622.24
|
|
|
Service Code
|
APR-DRG 1671
|
| Min. Negotiated Rate |
$20,094.48 |
| Max. Negotiated Rate |
$22,622.24 |
| Rate for Payer: Anthem Medicaid |
$21,662.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$21,662.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21,662.04
|
| Rate for Payer: Dean Health Medicaid |
$21,662.04
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,094.48
|
| Rate for Payer: Managed Health Services Medicaid |
$22,622.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,662.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21,662.04
|
| Rate for Payer: United Healthcare Medicaid |
$21,662.04
|
|
|
OTHER CARDIOTHORACIC AND THORACIC CIRCULATORY PROCEDURES
|
Facility
|
IP
|
$61,465.85
|
|
|
Service Code
|
APR-DRG 1674
|
| Min. Negotiated Rate |
$54,597.81 |
| Max. Negotiated Rate |
$61,465.85 |
| Rate for Payer: Anthem Medicaid |
$58,856.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$58,856.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$58,856.94
|
| Rate for Payer: Dean Health Medicaid |
$58,856.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$54,597.81
|
| Rate for Payer: Managed Health Services Medicaid |
$61,465.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$58,856.94
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$58,856.94
|
| Rate for Payer: United Healthcare Medicaid |
$58,856.94
|
|
|
OTHER CARDIOTHORACIC AND THORACIC CIRCULATORY PROCEDURES
|
Facility
|
IP
|
$39,018.98
|
|
|
Service Code
|
APR-DRG 1673
|
| Min. Negotiated Rate |
$34,659.09 |
| Max. Negotiated Rate |
$39,018.98 |
| Rate for Payer: Anthem Medicaid |
$37,362.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$37,362.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37,362.82
|
| Rate for Payer: Dean Health Medicaid |
$37,362.82
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$34,659.09
|
| Rate for Payer: Managed Health Services Medicaid |
$39,018.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$37,362.82
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$37,362.82
|
| Rate for Payer: United Healthcare Medicaid |
$37,362.82
|
|
|
OTHER CARDIOTHORACIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$139,650.16
|
|
|
Service Code
|
MSDRG 228
|
| Min. Negotiated Rate |
$38,394.95 |
| Max. Negotiated Rate |
$139,650.16 |
| Rate for Payer: Aetna Managed Medicare |
$38,394.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$107,948.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82,741.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78,609.83
|
| Rate for Payer: Anthem Medicare Advantage |
$38,394.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38,394.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38,394.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$38,394.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87,264.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$38,394.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102,184.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38,394.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38,394.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$38,394.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$38,394.95
|
| Rate for Payer: NAPHCARE Commercial |
$57,592.42
|
| Rate for Payer: Quartz Medicare Advantage |
$38,394.95
|
| Rate for Payer: The Alliance Commercial |
$139,650.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38,394.95
|
| Rate for Payer: United Healthcare PPO |
$79,552.20
|
| Rate for Payer: Wellcare Medicare |
$38,394.95
|
|
|
OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$88,247.12
|
|
|
Service Code
|
MSDRG 229
|
| Min. Negotiated Rate |
$24,626.26 |
| Max. Negotiated Rate |
$88,247.12 |
| Rate for Payer: Aetna Managed Medicare |
$24,626.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68,719.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52,672.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50,042.78
|
| Rate for Payer: Anthem Medicare Advantage |
$24,626.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24,626.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24,626.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24,626.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55,552.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24,626.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64,482.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24,626.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24,626.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24,626.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24,626.26
|
| Rate for Payer: NAPHCARE Commercial |
$36,939.40
|
| Rate for Payer: Quartz Medicare Advantage |
$24,626.26
|
| Rate for Payer: The Alliance Commercial |
$88,247.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24,626.26
|
| Rate for Payer: United Healthcare PPO |
$50,200.29
|
| Rate for Payer: Wellcare Medicare |
$24,626.26
|
|
|
OTHER CARDIOVASCULAR SYSTEM DIAGNOSES
|
Facility
|
OP
|
$93.03
|
|
|
Service Code
|
EAPG 00592
|
| Min. Negotiated Rate |
$89.45 |
| Max. Negotiated Rate |
$93.03 |
| Rate for Payer: Anthem Medicaid |
$89.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$89.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.45
|
| Rate for Payer: Dean Health Medicaid |
$89.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$89.45
|
| Rate for Payer: Managed Health Services Medicaid |
$93.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$89.45
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$89.45
|
| Rate for Payer: United Healthcare Medicaid |
$89.45
|
|
|
OTHER CENTRAL NERVOUS SYSTEM DIAGNOSES
|
Facility
|
OP
|
$89.10
|
|
|
Service Code
|
EAPG 00524
|
| 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 CEREBROVASCULAR DISORDERS WITH CC
|
Facility
|
IP
|
$29,690.96
|
|
|
Service Code
|
MSDRG 071
|
| Min. Negotiated Rate |
$8,364.09 |
| Max. Negotiated Rate |
$29,690.96 |
| Rate for Payer: Aetna Managed Medicare |
$8,364.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,386.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,159.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,302.24
|
| Rate for Payer: Anthem Medicare Advantage |
$8,364.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,364.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,364.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,364.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,096.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,364.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,533.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,364.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,364.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,364.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,364.09
|
| Rate for Payer: NAPHCARE Commercial |
$12,546.13
|
| Rate for Payer: Quartz Medicare Advantage |
$8,364.09
|
| Rate for Payer: The Alliance Commercial |
$29,690.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,364.09
|
| Rate for Payer: United Healthcare PPO |
$16,763.96
|
| Rate for Payer: Wellcare Medicare |
$8,364.09
|
|
|
OTHER CEREBROVASCULAR DISORDERS WITH MCC
|
Facility
|
IP
|
$49,811.84
|
|
|
Service Code
|
MSDRG 070
|
| Min. Negotiated Rate |
$13,256.14 |
| Max. Negotiated Rate |
$49,811.84 |
| Rate for Payer: Aetna Managed Medicare |
$13,256.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,324.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,842.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,452.21
|
| Rate for Payer: Anthem Medicare Advantage |
$13,256.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,256.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,256.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,256.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,364.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,256.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,291.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,256.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,256.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,256.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,256.14
|
| Rate for Payer: NAPHCARE Commercial |
$19,884.21
|
| Rate for Payer: Quartz Medicare Advantage |
$13,256.14
|
| Rate for Payer: The Alliance Commercial |
$49,811.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,256.14
|
| Rate for Payer: United Healthcare PPO |
$28,253.06
|
| Rate for Payer: Wellcare Medicare |
$13,256.14
|
|
|
OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$21,982.48
|
|
|
Service Code
|
MSDRG 072
|
| Min. Negotiated Rate |
$6,297.92 |
| Max. Negotiated Rate |
$21,982.48 |
| Rate for Payer: Aetna Managed Medicare |
$6,297.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,499.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,646.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,015.35
|
| Rate for Payer: Anthem Medicare Advantage |
$6,297.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,297.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,297.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,297.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,338.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,297.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,879.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,297.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,297.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,297.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,297.92
|
| Rate for Payer: NAPHCARE Commercial |
$9,446.88
|
| Rate for Payer: Quartz Medicare Advantage |
$6,297.92
|
| Rate for Payer: The Alliance Commercial |
$21,982.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,297.92
|
| Rate for Payer: United Healthcare PPO |
$12,362.19
|
| Rate for Payer: Wellcare Medicare |
$6,297.92
|
|
|
OTHER CHEMOTHERAPY
|
Facility
|
IP
|
$13,941.61
|
|
|
Service Code
|
APR-DRG 6963
|
| Min. Negotiated Rate |
$12,383.81 |
| Max. Negotiated Rate |
$13,941.61 |
| Rate for Payer: Anthem Medicaid |
$13,349.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,349.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,349.86
|
| Rate for Payer: Dean Health Medicaid |
$13,349.86
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,383.81
|
| Rate for Payer: Managed Health Services Medicaid |
$13,941.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,349.86
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,349.86
|
| Rate for Payer: United Healthcare Medicaid |
$13,349.86
|
|
|
OTHER CHEMOTHERAPY
|
Facility
|
IP
|
$6,839.28
|
|
|
Service Code
|
APR-DRG 6961
|
| 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 CHEMOTHERAPY
|
Facility
|
IP
|
$25,603.47
|
|
|
Service Code
|
APR-DRG 6964
|
| Min. Negotiated Rate |
$22,742.60 |
| Max. Negotiated Rate |
$25,603.47 |
| Rate for Payer: Anthem Medicaid |
$24,516.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$24,516.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24,516.73
|
| Rate for Payer: Dean Health Medicaid |
$24,516.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$22,742.60
|
| Rate for Payer: Managed Health Services Medicaid |
$25,603.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,516.73
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24,516.73
|
| Rate for Payer: United Healthcare Medicaid |
$24,516.73
|
|
|
OTHER CHEMOTHERAPY
|
Facility
|
IP
|
$8,592.94
|
|
|
Service Code
|
APR-DRG 6962
|
| Min. Negotiated Rate |
$7,632.79 |
| Max. Negotiated Rate |
$8,592.94 |
| Rate for Payer: Anthem Medicaid |
$8,228.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,228.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,228.22
|
| Rate for Payer: Dean Health Medicaid |
$8,228.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,632.79
|
| Rate for Payer: Managed Health Services Medicaid |
$8,592.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,228.22
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,228.22
|
| Rate for Payer: United Healthcare Medicaid |
$8,228.22
|
|
|
OTHER CIRCULATORY SYSTEM DIAGNOSES
|
Facility
|
IP
|
$17,887.35
|
|
|
Service Code
|
APR-DRG 2074
|
| Min. Negotiated Rate |
$15,888.66 |
| Max. Negotiated Rate |
$17,887.35 |
| Rate for Payer: Anthem Medicaid |
$17,128.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,128.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,128.13
|
| Rate for Payer: Dean Health Medicaid |
$17,128.13
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,888.66
|
| Rate for Payer: Managed Health Services Medicaid |
$17,887.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,128.13
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,128.13
|
| Rate for Payer: United Healthcare Medicaid |
$17,128.13
|
|
|
OTHER CIRCULATORY SYSTEM DIAGNOSES
|
Facility
|
IP
|
$6,576.23
|
|
|
Service Code
|
APR-DRG 2072
|
| Min. Negotiated Rate |
$5,841.42 |
| Max. Negotiated Rate |
$6,576.23 |
| Rate for Payer: Anthem Medicaid |
$6,297.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,297.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,297.10
|
| Rate for Payer: Dean Health Medicaid |
$6,297.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,841.42
|
| Rate for Payer: Managed Health Services Medicaid |
$6,576.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,297.10
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,297.10
|
| Rate for Payer: United Healthcare Medicaid |
$6,297.10
|
|
|
OTHER CIRCULATORY SYSTEM DIAGNOSES
|
Facility
|
IP
|
$4,997.94
|
|
|
Service Code
|
APR-DRG 2071
|
| Min. Negotiated Rate |
$4,439.48 |
| Max. Negotiated Rate |
$4,997.94 |
| Rate for Payer: Anthem Medicaid |
$4,785.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,785.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,785.80
|
| Rate for Payer: Dean Health Medicaid |
$4,785.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,439.48
|
| Rate for Payer: Managed Health Services Medicaid |
$4,997.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,785.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,785.80
|
| Rate for Payer: United Healthcare Medicaid |
$4,785.80
|
|
|
OTHER CIRCULATORY SYSTEM DIAGNOSES
|
Facility
|
IP
|
$9,557.46
|
|
|
Service Code
|
APR-DRG 2073
|
| Min. Negotiated Rate |
$8,489.53 |
| Max. Negotiated Rate |
$9,557.46 |
| Rate for Payer: Anthem Medicaid |
$9,151.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,151.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,151.79
|
| Rate for Payer: Dean Health Medicaid |
$9,151.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,489.53
|
| Rate for Payer: Managed Health Services Medicaid |
$9,557.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,151.79
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,151.79
|
| Rate for Payer: United Healthcare Medicaid |
$9,151.79
|
|
