|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$56,760.08
|
|
|
Service Code
|
MSDRG 516
|
| Min. Negotiated Rate |
$16,421.29 |
| Max. Negotiated Rate |
$56,760.08 |
| Rate for Payer: Aetna Managed Medicare |
$16,421.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45,342.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34,754.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33,019.18
|
| Rate for Payer: Anthem Medicare Advantage |
$16,421.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,421.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,421.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,421.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36,654.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,421.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,387.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,421.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,421.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,421.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,421.29
|
| Rate for Payer: NAPHCARE Commercial |
$24,631.93
|
| Rate for Payer: Quartz Medicare Advantage |
$16,421.29
|
| Rate for Payer: The Alliance Commercial |
$56,760.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,421.29
|
| Rate for Payer: United Healthcare PPO |
$32,220.64
|
| Rate for Payer: Wellcare Medicare |
$16,421.29
|
|
|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$87,746.88
|
|
|
Service Code
|
MSDRG 515
|
| Min. Negotiated Rate |
$24,912.70 |
| Max. Negotiated Rate |
$87,746.88 |
| Rate for Payer: Aetna Managed Medicare |
$24,912.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69,535.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53,298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50,637.04
|
| Rate for Payer: Anthem Medicare Advantage |
$24,912.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24,912.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24,912.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24,912.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56,211.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24,912.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64,115.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24,912.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24,912.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24,912.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24,912.70
|
| Rate for Payer: NAPHCARE Commercial |
$37,369.05
|
| Rate for Payer: Quartz Medicare Advantage |
$24,912.70
|
| Rate for Payer: The Alliance Commercial |
$87,746.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24,912.70
|
| Rate for Payer: United Healthcare PPO |
$49,914.52
|
| Rate for Payer: Wellcare Medicare |
$24,912.70
|
|
|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$41,652.00
|
|
|
Service Code
|
MSDRG 517
|
| Min. Negotiated Rate |
$12,275.14 |
| Max. Negotiated Rate |
$41,652.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,275.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,529.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,700.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,416.81
|
| Rate for Payer: Anthem Medicare Advantage |
$12,275.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,275.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,275.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,275.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,104.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,275.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,306.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,275.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,275.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,275.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,275.14
|
| Rate for Payer: NAPHCARE Commercial |
$18,412.71
|
| Rate for Payer: Quartz Medicare Advantage |
$12,275.14
|
| Rate for Payer: The Alliance Commercial |
$41,652.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,275.14
|
| Rate for Payer: United Healthcare PPO |
$23,593.95
|
| Rate for Payer: Wellcare Medicare |
$12,275.14
|
|
|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES
|
Facility
|
IP
|
$14,730.76
|
|
|
Service Code
|
APR-DRG 3202
|
| Min. Negotiated Rate |
$13,084.78 |
| Max. Negotiated Rate |
$14,730.76 |
| Rate for Payer: Anthem Medicaid |
$14,105.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,105.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,105.52
|
| Rate for Payer: Dean Health Medicaid |
$14,105.52
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,084.78
|
| Rate for Payer: Managed Health Services Medicaid |
$14,730.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,105.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,105.52
|
| Rate for Payer: United Healthcare Medicaid |
$14,105.52
|
|
|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES
|
Facility
|
IP
|
$10,521.97
|
|
|
Service Code
|
APR-DRG 3201
|
| Min. Negotiated Rate |
$9,346.27 |
| Max. Negotiated Rate |
$10,521.97 |
| Rate for Payer: Anthem Medicaid |
$10,075.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,075.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,075.37
|
| Rate for Payer: Dean Health Medicaid |
$10,075.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,346.27
|
| Rate for Payer: Managed Health Services Medicaid |
$10,521.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,075.37
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,075.37
|
| Rate for Payer: United Healthcare Medicaid |
$10,075.37
|
|
|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES
|
Facility
|
IP
|
$21,219.31
|
|
|
Service Code
|
APR-DRG 3203
|
| Min. Negotiated Rate |
$18,848.32 |
| Max. Negotiated Rate |
$21,219.31 |
| Rate for Payer: Anthem Medicaid |
$20,318.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,318.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,318.66
|
| Rate for Payer: Dean Health Medicaid |
$20,318.66
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,848.32
|
| Rate for Payer: Managed Health Services Medicaid |
$21,219.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,318.66
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,318.66
|
| Rate for Payer: United Healthcare Medicaid |
$20,318.66
|
|
|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES
|
Facility
|
IP
|
$32,355.06
|
|
|
Service Code
|
APR-DRG 3204
|
| Min. Negotiated Rate |
$28,739.79 |
| Max. Negotiated Rate |
$32,355.06 |
| Rate for Payer: Anthem Medicaid |
$30,981.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$30,981.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30,981.76
|
| Rate for Payer: Dean Health Medicaid |
$30,981.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28,739.79
|
| Rate for Payer: Managed Health Services Medicaid |
$32,355.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,981.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$30,981.76
|
| Rate for Payer: United Healthcare Medicaid |
$30,981.76
|
|
|
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC
|
Facility
|
IP
|
$32,329.44
|
|
|
Service Code
|
MSDRG 844
|
| Min. Negotiated Rate |
$9,829.87 |
| Max. Negotiated Rate |
$32,329.44 |
| Rate for Payer: Aetna Managed Medicare |
$9,829.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,562.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,360.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,343.41
|
| Rate for Payer: Anthem Medicare Advantage |
$9,829.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,829.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,829.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,829.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,472.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,829.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,468.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,829.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,829.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,829.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,829.87
|
| Rate for Payer: NAPHCARE Commercial |
$14,744.81
|
| Rate for Payer: Quartz Medicare Advantage |
$9,829.87
|
| Rate for Payer: The Alliance Commercial |
$32,329.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,829.87
|
| Rate for Payer: United Healthcare PPO |
$18,270.15
|
| Rate for Payer: Wellcare Medicare |
$9,829.87
|
|
|
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC
|
Facility
|
IP
|
$51,777.44
|
|
|
Service Code
|
MSDRG 843
|
| Min. Negotiated Rate |
$15,783.35 |
| Max. Negotiated Rate |
$51,777.44 |
| Rate for Payer: Aetna Managed Medicare |
$15,783.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43,524.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33,361.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31,695.62
|
| Rate for Payer: Anthem Medicare Advantage |
$15,783.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,783.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,783.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,783.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35,185.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,783.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,732.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,783.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,783.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,783.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,783.35
|
| Rate for Payer: NAPHCARE Commercial |
$23,675.03
|
| Rate for Payer: Quartz Medicare Advantage |
$15,783.35
|
| Rate for Payer: The Alliance Commercial |
$51,777.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,783.35
|
| Rate for Payer: United Healthcare PPO |
$29,375.60
|
| Rate for Payer: Wellcare Medicare |
$15,783.35
|
|
|
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC
|
Facility
|
IP
|
$24,247.60
|
|
|
Service Code
|
MSDRG 845
|
| Min. Negotiated Rate |
$7,028.50 |
| Max. Negotiated Rate |
$24,247.60 |
| Rate for Payer: Aetna Managed Medicare |
$7,028.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,581.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,242.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,531.17
|
| Rate for Payer: Anthem Medicare Advantage |
$7,028.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,028.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,028.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,028.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,020.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,028.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,540.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,028.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,028.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,028.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,028.50
|
| Rate for Payer: NAPHCARE Commercial |
$10,542.75
|
| Rate for Payer: Quartz Medicare Advantage |
$7,028.50
|
| Rate for Payer: The Alliance Commercial |
$24,247.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,028.50
|
| Rate for Payer: United Healthcare PPO |
$13,655.25
|
| Rate for Payer: Wellcare Medicare |
$7,028.50
|
|
|
OTHER NERVOUS SYSTEM AND RELATED PROCEDURES
|
Facility
|
IP
|
$38,317.51
|
|
|
Service Code
|
APR-DRG 0264
|
| Min. Negotiated Rate |
$34,036.01 |
| Max. Negotiated Rate |
$38,317.51 |
| Rate for Payer: Anthem Medicaid |
$36,691.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$36,691.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36,691.13
|
| Rate for Payer: Dean Health Medicaid |
$36,691.13
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$34,036.01
|
| Rate for Payer: Managed Health Services Medicaid |
$38,317.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$36,691.13
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36,691.13
|
| Rate for Payer: United Healthcare Medicaid |
$36,691.13
|
|
|
OTHER NERVOUS SYSTEM AND RELATED PROCEDURES
|
Facility
|
IP
|
$18,413.45
|
|
|
Service Code
|
APR-DRG 0262
|
| 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 NERVOUS SYSTEM AND RELATED PROCEDURES
|
Facility
|
IP
|
$24,463.58
|
|
|
Service Code
|
APR-DRG 0263
|
| Min. Negotiated Rate |
$21,730.08 |
| Max. Negotiated Rate |
$24,463.58 |
| Rate for Payer: Anthem Medicaid |
$23,425.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$23,425.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23,425.23
|
| Rate for Payer: Dean Health Medicaid |
$23,425.23
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21,730.08
|
| Rate for Payer: Managed Health Services Medicaid |
$24,463.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,425.23
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$23,425.23
|
| Rate for Payer: United Healthcare Medicaid |
$23,425.23
|
|
|
OTHER NERVOUS SYSTEM AND RELATED PROCEDURES
|
Facility
|
IP
|
$12,363.32
|
|
|
Service Code
|
APR-DRG 0261
|
| Min. Negotiated Rate |
$10,981.87 |
| Max. Negotiated Rate |
$12,363.32 |
| Rate for Payer: Anthem Medicaid |
$11,838.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,838.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,838.56
|
| Rate for Payer: Dean Health Medicaid |
$11,838.56
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,981.87
|
| Rate for Payer: Managed Health Services Medicaid |
$12,363.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,838.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,838.56
|
| Rate for Payer: United Healthcare Medicaid |
$11,838.56
|
|
|
OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$5,611.72
|
|
|
Service Code
|
APR-DRG 4252
|
| Min. Negotiated Rate |
$4,984.68 |
| Max. Negotiated Rate |
$5,611.72 |
| Rate for Payer: Anthem Medicaid |
$5,373.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,373.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,373.53
|
| Rate for Payer: Dean Health Medicaid |
$5,373.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,984.68
|
| Rate for Payer: Managed Health Services Medicaid |
$5,611.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,373.53
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,373.53
|
| Rate for Payer: United Healthcare Medicaid |
$5,373.53
|
|
|
OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$4,208.79
|
|
|
Service Code
|
APR-DRG 4251
|
| Min. Negotiated Rate |
$3,738.51 |
| Max. Negotiated Rate |
$4,208.79 |
| Rate for Payer: Anthem Medicaid |
$4,030.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,030.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,030.15
|
| Rate for Payer: Dean Health Medicaid |
$4,030.15
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,738.51
|
| Rate for Payer: Managed Health Services Medicaid |
$4,208.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,030.15
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,030.15
|
| Rate for Payer: United Healthcare Medicaid |
$4,030.15
|
|
|
OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$16,221.37
|
|
|
Service Code
|
APR-DRG 4254
|
| Min. Negotiated Rate |
$14,408.84 |
| Max. Negotiated Rate |
$16,221.37 |
| Rate for Payer: Anthem Medicaid |
$15,532.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$15,532.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,532.86
|
| Rate for Payer: Dean Health Medicaid |
$15,532.86
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,408.84
|
| Rate for Payer: Managed Health Services Medicaid |
$16,221.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,532.86
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15,532.86
|
| Rate for Payer: United Healthcare Medicaid |
$15,532.86
|
|
|
OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$8,242.21
|
|
|
Service Code
|
APR-DRG 4253
|
| Min. Negotiated Rate |
$7,321.25 |
| Max. Negotiated Rate |
$8,242.21 |
| Rate for Payer: Anthem Medicaid |
$7,892.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,892.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,892.37
|
| Rate for Payer: Dean Health Medicaid |
$7,892.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,321.25
|
| Rate for Payer: Managed Health Services Medicaid |
$8,242.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,892.37
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,892.37
|
| Rate for Payer: United Healthcare Medicaid |
$7,892.37
|
|
|
OTHER OPEN CRANIOTOMY
|
Facility
|
IP
|
$45,419.85
|
|
|
Service Code
|
APR-DRG 0274
|
| Min. Negotiated Rate |
$40,344.74 |
| Max. Negotiated Rate |
$45,419.85 |
| Rate for Payer: Anthem Medicaid |
$43,492.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$43,492.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43,492.01
|
| Rate for Payer: Dean Health Medicaid |
$43,492.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$40,344.74
|
| Rate for Payer: Managed Health Services Medicaid |
$45,419.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$43,492.01
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$43,492.01
|
| Rate for Payer: United Healthcare Medicaid |
$43,492.01
|
|
|
OTHER OPEN CRANIOTOMY
|
Facility
|
IP
|
$15,958.32
|
|
|
Service Code
|
APR-DRG 0271
|
| Min. Negotiated Rate |
$14,175.18 |
| Max. Negotiated Rate |
$15,958.32 |
| Rate for Payer: Anthem Medicaid |
$15,280.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$15,280.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,280.97
|
| Rate for Payer: Dean Health Medicaid |
$15,280.97
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,175.18
|
| Rate for Payer: Managed Health Services Medicaid |
$15,958.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,280.97
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15,280.97
|
| Rate for Payer: United Healthcare Medicaid |
$15,280.97
|
|
|
OTHER OPEN CRANIOTOMY
|
Facility
|
IP
|
$21,920.78
|
|
|
Service Code
|
APR-DRG 0272
|
| Min. Negotiated Rate |
$19,471.40 |
| Max. Negotiated Rate |
$21,920.78 |
| Rate for Payer: Anthem Medicaid |
$20,990.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,990.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,990.35
|
| Rate for Payer: Dean Health Medicaid |
$20,990.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,471.40
|
| Rate for Payer: Managed Health Services Medicaid |
$21,920.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,990.35
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,990.35
|
| Rate for Payer: United Healthcare Medicaid |
$20,990.35
|
|
|
OTHER OPEN CRANIOTOMY
|
Facility
|
IP
|
$31,916.65
|
|
|
Service Code
|
APR-DRG 0273
|
| Min. Negotiated Rate |
$28,350.36 |
| Max. Negotiated Rate |
$31,916.65 |
| Rate for Payer: Anthem Medicaid |
$30,561.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$30,561.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30,561.95
|
| Rate for Payer: Dean Health Medicaid |
$30,561.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28,350.36
|
| Rate for Payer: Managed Health Services Medicaid |
$31,916.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,561.95
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$30,561.95
|
| Rate for Payer: United Healthcare Medicaid |
$30,561.95
|
|
|
OTHER OPHTHALMIC SYSTEM DIAGNOSES
|
Facility
|
OP
|
$98.27
|
|
|
Service Code
|
EAPG 00553
|
| Min. Negotiated Rate |
$94.49 |
| Max. Negotiated Rate |
$98.27 |
| Rate for Payer: Anthem Medicaid |
$94.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$94.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.49
|
| Rate for Payer: Dean Health Medicaid |
$94.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$94.49
|
| Rate for Payer: Managed Health Services Medicaid |
$98.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$94.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$94.49
|
| Rate for Payer: United Healthcare Medicaid |
$94.49
|
|
|
OTHER O.R. PROCEDURES FOR INJURIES WITH CC
|
Facility
|
IP
|
$55,745.04
|
|
|
Service Code
|
MSDRG 908
|
| Min. Negotiated Rate |
$15,786.41 |
| Max. Negotiated Rate |
$55,745.04 |
| Rate for Payer: Aetna Managed Medicare |
$15,786.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43,533.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33,368.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31,701.97
|
| Rate for Payer: Anthem Medicare Advantage |
$15,786.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,786.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,786.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,786.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35,192.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,786.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,643.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,786.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,786.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,786.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,786.41
|
| Rate for Payer: NAPHCARE Commercial |
$23,679.61
|
| Rate for Payer: Quartz Medicare Advantage |
$15,786.41
|
| Rate for Payer: The Alliance Commercial |
$55,745.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,786.41
|
| Rate for Payer: United Healthcare PPO |
$31,641.21
|
| Rate for Payer: Wellcare Medicare |
$15,786.41
|
|
|
OTHER O.R. PROCEDURES FOR INJURIES WITH MCC
|
Facility
|
IP
|
$103,175.28
|
|
|
Service Code
|
MSDRG 907
|
| Min. Negotiated Rate |
$29,908.89 |
| Max. Negotiated Rate |
$103,175.28 |
| Rate for Payer: Aetna Managed Medicare |
$29,908.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83,770.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64,209.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61,003.10
|
| Rate for Payer: Anthem Medicare Advantage |
$29,908.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29,908.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29,908.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$29,908.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67,719.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$29,908.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75,431.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29,908.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29,908.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$29,908.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$29,908.89
|
| Rate for Payer: NAPHCARE Commercial |
$44,863.34
|
| Rate for Payer: Quartz Medicare Advantage |
$29,908.89
|
| Rate for Payer: The Alliance Commercial |
$103,175.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29,908.89
|
| Rate for Payer: United Healthcare PPO |
$58,724.36
|
| Rate for Payer: Wellcare Medicare |
$29,908.89
|
|
