|
OTHER HEPATOBILIARY, PANCREAS AND ABDOMINAL PROCEDURES
|
Facility
|
IP
|
$22,183.82
|
|
|
Service Code
|
APR-DRG 2643
|
| Min. Negotiated Rate |
$19,705.06 |
| Max. Negotiated Rate |
$22,183.82 |
| Rate for Payer: Anthem Medicaid |
$21,242.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$21,242.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21,242.23
|
| Rate for Payer: Dean Health Medicaid |
$21,242.23
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,705.06
|
| Rate for Payer: Managed Health Services Medicaid |
$22,183.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,242.23
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21,242.23
|
| Rate for Payer: United Healthcare Medicaid |
$21,242.23
|
|
|
OTHER HEPATOBILIARY, PANCREAS AND ABDOMINAL PROCEDURES
|
Facility
|
IP
|
$39,895.81
|
|
|
Service Code
|
APR-DRG 2644
|
| Min. Negotiated Rate |
$35,437.95 |
| Max. Negotiated Rate |
$39,895.81 |
| Rate for Payer: Anthem Medicaid |
$38,202.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$38,202.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38,202.44
|
| Rate for Payer: Dean Health Medicaid |
$38,202.44
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$35,437.95
|
| Rate for Payer: Managed Health Services Medicaid |
$39,895.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$38,202.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38,202.44
|
| Rate for Payer: United Healthcare Medicaid |
$38,202.44
|
|
|
OTHER HEPATOBILIARY, PANCREAS AND ABDOMINAL PROCEDURES
|
Facility
|
IP
|
$14,818.44
|
|
|
Service Code
|
APR-DRG 2642
|
| Min. Negotiated Rate |
$13,162.67 |
| Max. Negotiated Rate |
$14,818.44 |
| Rate for Payer: Anthem Medicaid |
$14,189.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,189.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,189.48
|
| Rate for Payer: Dean Health Medicaid |
$14,189.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,162.67
|
| Rate for Payer: Managed Health Services Medicaid |
$14,818.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,189.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,189.48
|
| Rate for Payer: United Healthcare Medicaid |
$14,189.48
|
|
|
OTHER HEPATOBILIARY SYSTEM DIAGNOSES
|
Facility
|
OP
|
$94.34
|
|
|
Service Code
|
EAPG 00639
|
| Min. Negotiated Rate |
$90.71 |
| Max. Negotiated Rate |
$94.34 |
| Rate for Payer: Anthem Medicaid |
$90.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$90.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.71
|
| Rate for Payer: Dean Health Medicaid |
$90.71
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$90.71
|
| Rate for Payer: Managed Health Services Medicaid |
$94.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$90.71
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$90.71
|
| Rate for Payer: United Healthcare Medicaid |
$90.71
|
|
|
OTHER INFECTIOUS AND PARASITIC DISEASES
|
Facility
|
IP
|
$21,394.68
|
|
|
Service Code
|
APR-DRG 7244
|
| Min. Negotiated Rate |
$19,004.09 |
| Max. Negotiated Rate |
$21,394.68 |
| Rate for Payer: Anthem Medicaid |
$20,486.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,486.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,486.58
|
| Rate for Payer: Dean Health Medicaid |
$20,486.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,004.09
|
| Rate for Payer: Managed Health Services Medicaid |
$21,394.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,486.58
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,486.58
|
| Rate for Payer: United Healthcare Medicaid |
$20,486.58
|
|
|
OTHER INFECTIOUS AND PARASITIC DISEASES
|
Facility
|
OP
|
$87.79
|
|
|
Service Code
|
EAPG 00809
|
| Min. Negotiated Rate |
$84.41 |
| Max. Negotiated Rate |
$87.79 |
| Rate for Payer: Anthem Medicaid |
$84.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$84.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.41
|
| Rate for Payer: Dean Health Medicaid |
$84.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$84.41
|
| Rate for Payer: Managed Health Services Medicaid |
$87.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$84.41
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$84.41
|
| Rate for Payer: United Healthcare Medicaid |
$84.41
|
|
|
OTHER INFECTIOUS AND PARASITIC DISEASES
|
Facility
|
IP
|
$10,872.70
|
|
|
Service Code
|
APR-DRG 7243
|
| Min. Negotiated Rate |
$9,657.81 |
| Max. Negotiated Rate |
$10,872.70 |
| Rate for Payer: Anthem Medicaid |
$10,411.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,411.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,411.21
|
| Rate for Payer: Dean Health Medicaid |
$10,411.21
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,657.81
|
| Rate for Payer: Managed Health Services Medicaid |
$10,872.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,411.21
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,411.21
|
| Rate for Payer: United Healthcare Medicaid |
$10,411.21
|
|
|
OTHER INFECTIOUS AND PARASITIC DISEASES
|
Facility
|
IP
|
$4,822.57
|
|
|
Service Code
|
APR-DRG 7241
|
| Min. Negotiated Rate |
$4,283.71 |
| Max. Negotiated Rate |
$4,822.57 |
| Rate for Payer: Anthem Medicaid |
$4,617.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,617.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,617.88
|
| Rate for Payer: Dean Health Medicaid |
$4,617.88
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,283.71
|
| Rate for Payer: Managed Health Services Medicaid |
$4,822.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,617.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,617.88
|
| Rate for Payer: United Healthcare Medicaid |
$4,617.88
|
|
|
OTHER INFECTIOUS AND PARASITIC DISEASES
|
Facility
|
IP
|
$6,926.96
|
|
|
Service Code
|
APR-DRG 7242
|
| 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 INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC
|
Facility
|
IP
|
$30,346.16
|
|
|
Service Code
|
MSDRG 868
|
| Min. Negotiated Rate |
$8,403.15 |
| Max. Negotiated Rate |
$30,346.16 |
| Rate for Payer: Aetna Managed Medicare |
$8,403.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,497.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,244.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,383.27
|
| Rate for Payer: Anthem Medicare Advantage |
$8,403.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,403.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,403.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,403.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,186.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,403.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,013.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,403.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,403.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,403.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,403.15
|
| Rate for Payer: NAPHCARE Commercial |
$12,604.72
|
| Rate for Payer: Quartz Medicare Advantage |
$8,403.15
|
| Rate for Payer: The Alliance Commercial |
$30,346.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,403.15
|
| Rate for Payer: United Healthcare PPO |
$17,138.14
|
| Rate for Payer: Wellcare Medicare |
$8,403.15
|
|
|
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC
|
Facility
|
IP
|
$58,183.84
|
|
|
Service Code
|
MSDRG 867
|
| Min. Negotiated Rate |
$16,536.90 |
| Max. Negotiated Rate |
$58,183.84 |
| Rate for Payer: Aetna Managed Medicare |
$16,536.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45,671.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35,007.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33,259.11
|
| Rate for Payer: Anthem Medicare Advantage |
$16,536.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,536.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,536.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,536.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36,920.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,536.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42,431.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,536.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,536.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,536.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,536.90
|
| Rate for Payer: NAPHCARE Commercial |
$24,805.36
|
| Rate for Payer: Quartz Medicare Advantage |
$16,536.90
|
| Rate for Payer: The Alliance Commercial |
$58,183.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,536.90
|
| Rate for Payer: United Healthcare PPO |
$33,033.74
|
| Rate for Payer: Wellcare Medicare |
$16,536.90
|
|
|
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC
|
Facility
|
IP
|
$19,430.32
|
|
|
Service Code
|
MSDRG 869
|
| Min. Negotiated Rate |
$6,094.97 |
| Max. Negotiated Rate |
$19,430.32 |
| Rate for Payer: Aetna Managed Medicare |
$6,094.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,921.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,203.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,594.29
|
| Rate for Payer: Anthem Medicare Advantage |
$6,094.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,094.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,094.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,094.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,870.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,094.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,007.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,094.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,094.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,094.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,094.97
|
| Rate for Payer: NAPHCARE Commercial |
$9,142.46
|
| Rate for Payer: Quartz Medicare Advantage |
$6,094.97
|
| Rate for Payer: The Alliance Commercial |
$19,430.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,094.97
|
| Rate for Payer: United Healthcare PPO |
$10,904.94
|
| Rate for Payer: Wellcare Medicare |
$6,094.97
|
|
|
OTHER INJURIES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE
|
Facility
|
OP
|
$137.58
|
|
|
Service Code
|
EAPG 00652
|
| Min. Negotiated Rate |
$132.29 |
| Max. Negotiated Rate |
$137.58 |
| Rate for Payer: Anthem Medicaid |
$132.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$132.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$132.29
|
| Rate for Payer: Dean Health Medicaid |
$132.29
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$132.29
|
| Rate for Payer: Managed Health Services Medicaid |
$137.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$132.29
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$132.29
|
| Rate for Payer: United Healthcare Medicaid |
$132.29
|
|
|
OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES
|
Facility
|
IP
|
$6,137.82
|
|
|
Service Code
|
APR-DRG 8152
|
| Min. Negotiated Rate |
$5,451.99 |
| Max. Negotiated Rate |
$6,137.82 |
| Rate for Payer: Anthem Medicaid |
$5,877.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,877.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,877.30
|
| Rate for Payer: Dean Health Medicaid |
$5,877.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,451.99
|
| Rate for Payer: Managed Health Services Medicaid |
$6,137.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,877.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,877.30
|
| Rate for Payer: United Healthcare Medicaid |
$5,877.30
|
|
|
OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES
|
Facility
|
IP
|
$10,258.92
|
|
|
Service Code
|
APR-DRG 8153
|
| Min. Negotiated Rate |
$9,112.62 |
| Max. Negotiated Rate |
$10,258.92 |
| Rate for Payer: Anthem Medicaid |
$9,823.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,823.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,823.48
|
| Rate for Payer: Dean Health Medicaid |
$9,823.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,112.62
|
| Rate for Payer: Managed Health Services Medicaid |
$10,258.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,823.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,823.48
|
| Rate for Payer: United Healthcare Medicaid |
$9,823.48
|
|
|
OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES
|
Facility
|
IP
|
$4,033.42
|
|
|
Service Code
|
APR-DRG 8151
|
| Min. Negotiated Rate |
$3,582.74 |
| Max. Negotiated Rate |
$4,033.42 |
| Rate for Payer: Anthem Medicaid |
$3,862.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,862.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,862.22
|
| Rate for Payer: Dean Health Medicaid |
$3,862.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,582.74
|
| Rate for Payer: Managed Health Services Medicaid |
$4,033.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,862.22
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,862.22
|
| Rate for Payer: United Healthcare Medicaid |
$3,862.22
|
|
|
OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES
|
Facility
|
IP
|
$21,745.41
|
|
|
Service Code
|
APR-DRG 8154
|
| Min. Negotiated Rate |
$19,315.63 |
| Max. Negotiated Rate |
$21,745.41 |
| Rate for Payer: Anthem Medicaid |
$20,822.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,822.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,822.43
|
| Rate for Payer: Dean Health Medicaid |
$20,822.43
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,315.63
|
| Rate for Payer: Managed Health Services Medicaid |
$21,745.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,822.43
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,822.43
|
| Rate for Payer: United Healthcare Medicaid |
$20,822.43
|
|
|
OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES
|
Facility
|
OP
|
$117.93
|
|
|
Service Code
|
EAPG 00853
|
| Min. Negotiated Rate |
$113.39 |
| Max. Negotiated Rate |
$117.93 |
| Rate for Payer: Anthem Medicaid |
$113.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$113.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.39
|
| Rate for Payer: Dean Health Medicaid |
$113.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$113.39
|
| Rate for Payer: Managed Health Services Medicaid |
$117.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$113.39
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$113.39
|
| Rate for Payer: United Healthcare Medicaid |
$113.39
|
|
|
OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC
|
Facility
|
IP
|
$48,578.40
|
|
|
Service Code
|
MSDRG 922
|
| Min. Negotiated Rate |
$13,904.03 |
| Max. Negotiated Rate |
$48,578.40 |
| Rate for Payer: Aetna Managed Medicare |
$13,904.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38,170.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,257.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,796.43
|
| Rate for Payer: Anthem Medicare Advantage |
$13,904.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,904.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,904.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,904.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,856.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,904.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,386.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,904.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,904.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,904.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,904.03
|
| Rate for Payer: NAPHCARE Commercial |
$20,856.05
|
| Rate for Payer: Quartz Medicare Advantage |
$13,904.03
|
| Rate for Payer: The Alliance Commercial |
$48,578.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,904.03
|
| Rate for Payer: United Healthcare PPO |
$27,548.90
|
| Rate for Payer: Wellcare Medicare |
$13,904.03
|
|
|
OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC
|
Facility
|
IP
|
$28,297.36
|
|
|
Service Code
|
MSDRG 923
|
| Min. Negotiated Rate |
$8,566.58 |
| Max. Negotiated Rate |
$28,297.36 |
| Rate for Payer: Aetna Managed Medicare |
$8,566.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,205.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,020.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,170.36
|
| Rate for Payer: Anthem Medicare Advantage |
$8,566.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,566.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,566.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,566.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,950.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,566.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,511.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,566.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,566.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,566.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,566.58
|
| Rate for Payer: NAPHCARE Commercial |
$12,849.88
|
| Rate for Payer: Quartz Medicare Advantage |
$8,566.58
|
| Rate for Payer: The Alliance Commercial |
$28,297.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,566.58
|
| Rate for Payer: United Healthcare PPO |
$15,968.22
|
| Rate for Payer: Wellcare Medicare |
$8,566.58
|
|
|
OTHER INTRA-ABDOMINAL AND INTRAPERITONEAL SURGICAL PROCEDURES
|
Facility
|
OP
|
$1,487.19
|
|
|
Service Code
|
EAPG 00108
|
| Min. Negotiated Rate |
$1,429.99 |
| Max. Negotiated Rate |
$1,487.19 |
| Rate for Payer: Anthem Medicaid |
$1,429.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,429.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,429.99
|
| Rate for Payer: Dean Health Medicaid |
$1,429.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1,429.99
|
| Rate for Payer: Managed Health Services Medicaid |
$1,487.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,429.99
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,429.99
|
| Rate for Payer: United Healthcare Medicaid |
$1,429.99
|
|
|
OTHER KIDNEY AND URINARY TRACT DIAGNOSES, SIGNS AND SYMPTOMS
|
Facility
|
IP
|
$17,361.25
|
|
|
Service Code
|
APR-DRG 4684
|
| Min. Negotiated Rate |
$15,421.35 |
| Max. Negotiated Rate |
$17,361.25 |
| Rate for Payer: Anthem Medicaid |
$16,624.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,624.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,624.36
|
| Rate for Payer: Dean Health Medicaid |
$16,624.36
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,421.35
|
| Rate for Payer: Managed Health Services Medicaid |
$17,361.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,624.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,624.36
|
| Rate for Payer: United Healthcare Medicaid |
$16,624.36
|
|
|
OTHER KIDNEY AND URINARY TRACT DIAGNOSES, SIGNS AND SYMPTOMS
|
Facility
|
IP
|
$6,313.18
|
|
|
Service Code
|
APR-DRG 4682
|
| 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 KIDNEY AND URINARY TRACT DIAGNOSES, SIGNS AND SYMPTOMS
|
Facility
|
IP
|
$4,910.25
|
|
|
Service Code
|
APR-DRG 4681
|
| 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 KIDNEY AND URINARY TRACT DIAGNOSES, SIGNS AND SYMPTOMS
|
Facility
|
IP
|
$9,820.51
|
|
|
Service Code
|
APR-DRG 4683
|
| Min. Negotiated Rate |
$8,723.19 |
| Max. Negotiated Rate |
$9,820.51 |
| Rate for Payer: Anthem Medicaid |
$9,403.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,403.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,403.68
|
| Rate for Payer: Dean Health Medicaid |
$9,403.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,723.19
|
| Rate for Payer: Managed Health Services Medicaid |
$9,820.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,403.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,403.68
|
| Rate for Payer: United Healthcare Medicaid |
$9,403.68
|
|
