|
OTHER MALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES
|
Facility
|
IP
|
$10,697.34
|
|
|
Service Code
|
APR-DRG 4841
|
| Min. Negotiated Rate |
$9,502.04 |
| Max. Negotiated Rate |
$10,697.34 |
| Rate for Payer: Anthem Medicaid |
$10,243.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,243.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,243.29
|
| Rate for Payer: Dean Health Medicaid |
$10,243.29
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,502.04
|
| Rate for Payer: Managed Health Services Medicaid |
$10,697.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,243.29
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,243.29
|
| Rate for Payer: United Healthcare Medicaid |
$10,243.29
|
|
|
OTHER MALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES
|
Facility
|
IP
|
$21,043.94
|
|
|
Service Code
|
APR-DRG 4843
|
| Min. Negotiated Rate |
$18,692.54 |
| Max. Negotiated Rate |
$21,043.94 |
| Rate for Payer: Anthem Medicaid |
$20,150.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,150.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,150.74
|
| Rate for Payer: Dean Health Medicaid |
$20,150.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,692.54
|
| Rate for Payer: Managed Health Services Medicaid |
$21,043.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,150.74
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,150.74
|
| Rate for Payer: United Healthcare Medicaid |
$20,150.74
|
|
|
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES
|
Facility
|
OP
|
$94.34
|
|
|
Service Code
|
EAPG 00741
|
| 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 MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC
|
Facility
|
IP
|
$28,090.40
|
|
|
Service Code
|
MSDRG 729
|
| Min. Negotiated Rate |
$8,614.51 |
| Max. Negotiated Rate |
$28,090.40 |
| Rate for Payer: Aetna Managed Medicare |
$8,614.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,099.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,705.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,821.81
|
| Rate for Payer: Anthem Medicare Advantage |
$8,614.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,614.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,614.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,614.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,673.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,614.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,359.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,614.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,614.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,614.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,614.51
|
| Rate for Payer: NAPHCARE Commercial |
$12,921.76
|
| Rate for Payer: Quartz Medicare Advantage |
$8,614.51
|
| Rate for Payer: The Alliance Commercial |
$28,090.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,614.51
|
| Rate for Payer: United Healthcare PPO |
$15,849.82
|
| Rate for Payer: Wellcare Medicare |
$8,614.51
|
|
|
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC
|
Facility
|
IP
|
$17,519.84
|
|
|
Service Code
|
MSDRG 730
|
| Min. Negotiated Rate |
$5,653.09 |
| Max. Negotiated Rate |
$17,519.84 |
| Rate for Payer: Aetna Managed Medicare |
$5,653.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,662.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,238.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,677.49
|
| Rate for Payer: Anthem Medicare Advantage |
$5,653.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,653.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,653.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,653.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,852.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,653.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,606.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,653.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,653.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,653.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,653.09
|
| Rate for Payer: NAPHCARE Commercial |
$8,479.63
|
| Rate for Payer: Quartz Medicare Advantage |
$5,653.09
|
| Rate for Payer: The Alliance Commercial |
$17,519.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,653.09
|
| Rate for Payer: United Healthcare PPO |
$9,813.97
|
| Rate for Payer: Wellcare Medicare |
$5,653.09
|
|
|
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$50,480.56
|
|
|
Service Code
|
MSDRG 717
|
| Min. Negotiated Rate |
$14,984.59 |
| Max. Negotiated Rate |
$50,480.56 |
| Rate for Payer: Aetna Managed Medicare |
$14,984.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41,249.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31,617.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,038.38
|
| Rate for Payer: Anthem Medicare Advantage |
$14,984.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,984.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,984.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,984.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,345.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,984.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,781.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,984.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,984.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,984.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,984.59
|
| Rate for Payer: NAPHCARE Commercial |
$22,476.89
|
| Rate for Payer: Quartz Medicare Advantage |
$14,984.59
|
| Rate for Payer: The Alliance Commercial |
$50,480.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,984.59
|
| Rate for Payer: United Healthcare PPO |
$28,635.13
|
| Rate for Payer: Wellcare Medicare |
$14,984.59
|
|
|
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$32,843.20
|
|
|
Service Code
|
MSDRG 718
|
| Min. Negotiated Rate |
$10,792.51 |
| Max. Negotiated Rate |
$32,843.20 |
| Rate for Payer: Aetna Managed Medicare |
$10,792.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,305.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,462.33
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,340.68
|
| Rate for Payer: Anthem Medicare Advantage |
$10,792.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,792.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,792.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,792.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,690.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,792.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,845.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,792.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,792.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,792.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,792.51
|
| Rate for Payer: NAPHCARE Commercial |
$16,188.76
|
| Rate for Payer: Quartz Medicare Advantage |
$10,792.51
|
| Rate for Payer: The Alliance Commercial |
$32,843.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,792.51
|
| Rate for Payer: United Healthcare PPO |
$18,563.81
|
| Rate for Payer: Wellcare Medicare |
$10,792.51
|
|
|
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$61,369.36
|
|
|
Service Code
|
MSDRG 715
|
| Min. Negotiated Rate |
$17,640.46 |
| Max. Negotiated Rate |
$61,369.36 |
| Rate for Payer: Aetna Managed Medicare |
$17,640.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48,816.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37,417.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35,548.73
|
| Rate for Payer: Anthem Medicare Advantage |
$17,640.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,640.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,640.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,640.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39,462.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,640.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44,768.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,640.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,640.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,640.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,640.46
|
| Rate for Payer: NAPHCARE Commercial |
$26,460.69
|
| Rate for Payer: Quartz Medicare Advantage |
$17,640.46
|
| Rate for Payer: The Alliance Commercial |
$61,369.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,640.46
|
| Rate for Payer: United Healthcare PPO |
$34,852.54
|
| Rate for Payer: Wellcare Medicare |
$17,640.46
|
|
|
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$39,656.24
|
|
|
Service Code
|
MSDRG 716
|
| Min. Negotiated Rate |
$11,772.00 |
| Max. Negotiated Rate |
$39,656.24 |
| Rate for Payer: Aetna Managed Medicare |
$11,772.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,096.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,601.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,372.90
|
| Rate for Payer: Anthem Medicare Advantage |
$11,772.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,772.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,772.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,772.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,946.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,772.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,842.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,772.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,772.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,772.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$17,658.00
|
| Rate for Payer: Quartz Medicare Advantage |
$11,772.00
|
| Rate for Payer: The Alliance Commercial |
$39,656.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,772.00
|
| Rate for Payer: United Healthcare PPO |
$22,454.04
|
| Rate for Payer: Wellcare Medicare |
$11,772.00
|
|
|
OTHER MENTAL DISORDER DIAGNOSES
|
Facility
|
IP
|
$36,155.60
|
|
|
Service Code
|
MSDRG 887
|
| Min. Negotiated Rate |
$8,707.95 |
| Max. Negotiated Rate |
$36,155.60 |
| Rate for Payer: Aetna Managed Medicare |
$8,707.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,366.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,909.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,015.66
|
| Rate for Payer: Anthem Medicare Advantage |
$8,707.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,707.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,707.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,707.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,888.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,707.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,707.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,707.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,707.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,707.95
|
| Rate for Payer: NAPHCARE Commercial |
$13,061.93
|
| Rate for Payer: Quartz Medicare Advantage |
$8,707.95
|
| Rate for Payer: The Alliance Commercial |
$36,155.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,707.95
|
| Rate for Payer: United Healthcare PPO |
$20,455.24
|
| Rate for Payer: Wellcare Medicare |
$8,707.95
|
|
|
OTHER MENTAL HEALTH CONDITIONS AND DISORDERS
|
Facility
|
IP
|
$18,413.45
|
|
|
Service Code
|
APR-DRG 7604
|
| Min. Negotiated Rate |
$16,355.98 |
| Max. Negotiated Rate |
$18,413.45 |
| Rate for Payer: Anthem Medicaid |
$17,631.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,631.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,631.89
|
| Rate for Payer: Dean Health Medicaid |
$17,631.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,355.98
|
| Rate for Payer: Managed Health Services Medicaid |
$18,413.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,631.89
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,631.89
|
| Rate for Payer: United Healthcare Medicaid |
$17,631.89
|
|
|
OTHER MENTAL HEALTH CONDITIONS AND DISORDERS
|
Facility
|
IP
|
$4,822.57
|
|
|
Service Code
|
APR-DRG 7601
|
| 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 MENTAL HEALTH CONDITIONS AND DISORDERS
|
Facility
|
IP
|
$9,031.36
|
|
|
Service Code
|
APR-DRG 7603
|
| Min. Negotiated Rate |
$8,022.22 |
| Max. Negotiated Rate |
$9,031.36 |
| Rate for Payer: Anthem Medicaid |
$8,648.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,648.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,648.02
|
| Rate for Payer: Dean Health Medicaid |
$8,648.02
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,022.22
|
| Rate for Payer: Managed Health Services Medicaid |
$9,031.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,648.02
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,648.02
|
| Rate for Payer: United Healthcare Medicaid |
$8,648.02
|
|
|
OTHER MENTAL HEALTH CONDITIONS AND DISORDERS
|
Facility
|
IP
|
$5,787.08
|
|
|
Service Code
|
APR-DRG 7602
|
| Min. Negotiated Rate |
$5,140.45 |
| Max. Negotiated Rate |
$5,787.08 |
| Rate for Payer: Anthem Medicaid |
$5,541.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,541.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,541.45
|
| Rate for Payer: Dean Health Medicaid |
$5,541.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,140.45
|
| Rate for Payer: Managed Health Services Medicaid |
$5,787.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,541.45
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,541.45
|
| Rate for Payer: United Healthcare Medicaid |
$5,541.45
|
|
|
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC
|
Facility
|
IP
|
$41,835.04
|
|
|
Service Code
|
MSDRG 964
|
| Min. Negotiated Rate |
$12,243.73 |
| Max. Negotiated Rate |
$41,835.04 |
| Rate for Payer: Aetna Managed Medicare |
$12,243.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,440.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,631.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,351.67
|
| Rate for Payer: Anthem Medicare Advantage |
$12,243.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,243.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,243.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,243.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,032.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,243.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,440.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,243.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,243.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,243.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,243.73
|
| Rate for Payer: NAPHCARE Commercial |
$18,365.60
|
| Rate for Payer: Quartz Medicare Advantage |
$12,243.73
|
| Rate for Payer: The Alliance Commercial |
$41,835.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,243.73
|
| Rate for Payer: United Healthcare PPO |
$23,698.15
|
| Rate for Payer: Wellcare Medicare |
$12,243.73
|
|
|
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC
|
Facility
|
IP
|
$75,934.56
|
|
|
Service Code
|
MSDRG 963
|
| Min. Negotiated Rate |
$21,442.75 |
| Max. Negotiated Rate |
$75,934.56 |
| Rate for Payer: Aetna Managed Medicare |
$21,442.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59,649.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45,720.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43,437.68
|
| Rate for Payer: Anthem Medicare Advantage |
$21,442.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,442.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,442.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,442.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48,219.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,442.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55,451.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,442.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,442.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,442.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,442.75
|
| Rate for Payer: NAPHCARE Commercial |
$32,164.13
|
| Rate for Payer: Quartz Medicare Advantage |
$21,442.75
|
| Rate for Payer: The Alliance Commercial |
$75,934.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,442.75
|
| Rate for Payer: United Healthcare PPO |
$43,169.79
|
| Rate for Payer: Wellcare Medicare |
$21,442.75
|
|
|
OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC
|
Facility
|
IP
|
$26,763.36
|
|
|
Service Code
|
MSDRG 965
|
| Min. Negotiated Rate |
$7,709.30 |
| Max. Negotiated Rate |
$26,763.36 |
| Rate for Payer: Aetna Managed Medicare |
$7,709.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,520.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,729.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,943.72
|
| Rate for Payer: Anthem Medicare Advantage |
$7,709.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,709.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,709.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,709.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,588.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,709.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,385.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,709.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,709.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,709.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,709.30
|
| Rate for Payer: NAPHCARE Commercial |
$11,563.95
|
| Rate for Payer: Quartz Medicare Advantage |
$7,709.30
|
| Rate for Payer: The Alliance Commercial |
$26,763.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,709.30
|
| Rate for Payer: United Healthcare PPO |
$15,091.98
|
| Rate for Payer: Wellcare Medicare |
$7,709.30
|
|
|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES
|
Facility
|
IP
|
$6,488.55
|
|
|
Service Code
|
APR-DRG 3512
|
| Min. Negotiated Rate |
$5,763.53 |
| Max. Negotiated Rate |
$6,488.55 |
| Rate for Payer: Anthem Medicaid |
$6,213.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,213.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,213.14
|
| Rate for Payer: Dean Health Medicaid |
$6,213.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,763.53
|
| Rate for Payer: Managed Health Services Medicaid |
$6,488.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,213.14
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,213.14
|
| Rate for Payer: United Healthcare Medicaid |
$6,213.14
|
|
|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES
|
Facility
|
IP
|
$5,173.30
|
|
|
Service Code
|
APR-DRG 3511
|
| Min. Negotiated Rate |
$4,595.25 |
| Max. Negotiated Rate |
$5,173.30 |
| Rate for Payer: Anthem Medicaid |
$4,953.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,953.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,953.72
|
| Rate for Payer: Dean Health Medicaid |
$4,953.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,595.25
|
| Rate for Payer: Managed Health Services Medicaid |
$5,173.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,953.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,953.72
|
| Rate for Payer: United Healthcare Medicaid |
$4,953.72
|
|
|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES
|
Facility
|
IP
|
$9,557.46
|
|
|
Service Code
|
APR-DRG 3513
|
| 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
|
|
|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES
|
Facility
|
OP
|
$99.58
|
|
|
Service Code
|
EAPG 00660
|
| Min. Negotiated Rate |
$95.75 |
| Max. Negotiated Rate |
$99.58 |
| Rate for Payer: Anthem Medicaid |
$95.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$95.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$95.75
|
| Rate for Payer: Dean Health Medicaid |
$95.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$95.75
|
| Rate for Payer: Managed Health Services Medicaid |
$99.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$95.75
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$95.75
|
| Rate for Payer: United Healthcare Medicaid |
$95.75
|
|
|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES
|
Facility
|
IP
|
$16,835.16
|
|
|
Service Code
|
APR-DRG 3514
|
| Min. Negotiated Rate |
$14,954.04 |
| Max. Negotiated Rate |
$16,835.16 |
| Rate for Payer: Anthem Medicaid |
$16,120.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,120.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,120.59
|
| Rate for Payer: Dean Health Medicaid |
$16,120.59
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,954.04
|
| Rate for Payer: Managed Health Services Medicaid |
$16,835.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,120.59
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,120.59
|
| Rate for Payer: United Healthcare Medicaid |
$16,120.59
|
|
|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC
|
Facility
|
IP
|
$27,965.60
|
|
|
Service Code
|
MSDRG 565
|
| Min. Negotiated Rate |
$7,968.93 |
| Max. Negotiated Rate |
$27,965.60 |
| Rate for Payer: Aetna Managed Medicare |
$7,968.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,260.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,296.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,482.36
|
| Rate for Payer: Anthem Medicare Advantage |
$7,968.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,968.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,968.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,968.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,186.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,968.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,267.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,968.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,968.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,968.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,968.93
|
| Rate for Payer: NAPHCARE Commercial |
$11,953.39
|
| Rate for Payer: Quartz Medicare Advantage |
$7,968.93
|
| Rate for Payer: The Alliance Commercial |
$27,965.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,968.93
|
| Rate for Payer: United Healthcare PPO |
$15,778.77
|
| Rate for Payer: Wellcare Medicare |
$7,968.93
|
|
|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC
|
Facility
|
IP
|
$43,518.80
|
|
|
Service Code
|
MSDRG 564
|
| Min. Negotiated Rate |
$12,327.96 |
| Max. Negotiated Rate |
$43,518.80 |
| Rate for Payer: Aetna Managed Medicare |
$12,327.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,680.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,815.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,526.45
|
| Rate for Payer: Anthem Medicare Advantage |
$12,327.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,327.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,327.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,327.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,226.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,327.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,675.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,327.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,327.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,327.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,327.96
|
| Rate for Payer: NAPHCARE Commercial |
$18,491.94
|
| Rate for Payer: Quartz Medicare Advantage |
$12,327.96
|
| Rate for Payer: The Alliance Commercial |
$43,518.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,327.96
|
| Rate for Payer: United Healthcare PPO |
$24,659.65
|
| Rate for Payer: Wellcare Medicare |
$12,327.96
|
|
|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC
|
Facility
|
IP
|
$21,083.92
|
|
|
Service Code
|
MSDRG 566
|
| Min. Negotiated Rate |
$6,245.06 |
| Max. Negotiated Rate |
$21,083.92 |
| Rate for Payer: Aetna Managed Medicare |
$6,245.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,349.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,531.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,905.72
|
| Rate for Payer: Anthem Medicare Advantage |
$6,245.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,245.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,245.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,245.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,216.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,245.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,220.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,245.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,245.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,245.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,245.06
|
| Rate for Payer: NAPHCARE Commercial |
$9,367.60
|
| Rate for Payer: Quartz Medicare Advantage |
$6,245.06
|
| Rate for Payer: The Alliance Commercial |
$21,083.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,245.06
|
| Rate for Payer: United Healthcare PPO |
$11,849.07
|
| Rate for Payer: Wellcare Medicare |
$6,245.06
|
|
