|
OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$37,834.16
|
|
|
Service Code
|
MSDRG 909
|
| Min. Negotiated Rate |
$10,559.69 |
| Max. Negotiated Rate |
$37,834.16 |
| Rate for Payer: Aetna Managed Medicare |
$10,559.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,642.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,953.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,857.65
|
| Rate for Payer: Anthem Medicare Advantage |
$10,559.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,559.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,559.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,559.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,153.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,559.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,505.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,559.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,559.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,559.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,559.69
|
| Rate for Payer: NAPHCARE Commercial |
$15,839.54
|
| Rate for Payer: Quartz Medicare Advantage |
$10,559.69
|
| Rate for Payer: The Alliance Commercial |
$37,834.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,559.69
|
| Rate for Payer: United Healthcare PPO |
$21,413.59
|
| Rate for Payer: Wellcare Medicare |
$10,559.69
|
|
|
OTHER O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS
|
Facility
|
IP
|
$15,432.23
|
|
|
Service Code
|
APR-DRG 6812
|
| Min. Negotiated Rate |
$13,707.87 |
| Max. Negotiated Rate |
$15,432.23 |
| Rate for Payer: Anthem Medicaid |
$14,777.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,777.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,777.21
|
| Rate for Payer: Dean Health Medicaid |
$14,777.21
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,707.87
|
| Rate for Payer: Managed Health Services Medicaid |
$15,432.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,777.21
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,777.21
|
| Rate for Payer: United Healthcare Medicaid |
$14,777.21
|
|
|
OTHER O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS
|
Facility
|
IP
|
$11,486.49
|
|
|
Service Code
|
APR-DRG 6811
|
| Min. Negotiated Rate |
$10,203.01 |
| Max. Negotiated Rate |
$11,486.49 |
| Rate for Payer: Anthem Medicaid |
$10,998.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,998.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,998.94
|
| Rate for Payer: Dean Health Medicaid |
$10,998.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,203.01
|
| Rate for Payer: Managed Health Services Medicaid |
$11,486.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,998.94
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,998.94
|
| Rate for Payer: United Healthcare Medicaid |
$10,998.94
|
|
|
OTHER O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS
|
Facility
|
IP
|
$48,488.75
|
|
|
Service Code
|
APR-DRG 6814
|
| Min. Negotiated Rate |
$43,070.74 |
| Max. Negotiated Rate |
$48,488.75 |
| Rate for Payer: Anthem Medicaid |
$46,430.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$46,430.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46,430.65
|
| Rate for Payer: Dean Health Medicaid |
$46,430.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$43,070.74
|
| Rate for Payer: Managed Health Services Medicaid |
$48,488.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$46,430.65
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$46,430.65
|
| Rate for Payer: United Healthcare Medicaid |
$46,430.65
|
|
|
OTHER O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS
|
Facility
|
IP
|
$24,288.22
|
|
|
Service Code
|
APR-DRG 6813
|
| Min. Negotiated Rate |
$21,574.31 |
| Max. Negotiated Rate |
$24,288.22 |
| Rate for Payer: Anthem Medicaid |
$23,257.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$23,257.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23,257.31
|
| Rate for Payer: Dean Health Medicaid |
$23,257.31
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21,574.31
|
| Rate for Payer: Managed Health Services Medicaid |
$24,288.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,257.31
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$23,257.31
|
| Rate for Payer: United Healthcare Medicaid |
$23,257.31
|
|
|
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC
|
Facility
|
IP
|
$112,169.20
|
|
|
Service Code
|
MSDRG 958
|
| Min. Negotiated Rate |
$32,777.65 |
| Max. Negotiated Rate |
$112,169.20 |
| Rate for Payer: Aetna Managed Medicare |
$32,777.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91,943.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$70,474.27
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66,955.16
|
| Rate for Payer: Anthem Medicare Advantage |
$32,777.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32,777.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32,777.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32,777.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74,326.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32,777.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82,028.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32,777.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32,777.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32,777.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32,777.65
|
| Rate for Payer: NAPHCARE Commercial |
$49,166.47
|
| Rate for Payer: Quartz Medicare Advantage |
$32,777.65
|
| Rate for Payer: The Alliance Commercial |
$112,169.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,777.65
|
| Rate for Payer: United Healthcare PPO |
$63,860.27
|
| Rate for Payer: Wellcare Medicare |
$32,777.65
|
|
|
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC
|
Facility
|
IP
|
$200,307.12
|
|
|
Service Code
|
MSDRG 957
|
| Min. Negotiated Rate |
$58,861.46 |
| Max. Negotiated Rate |
$200,307.12 |
| Rate for Payer: Aetna Managed Medicare |
$58,861.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$166,260.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$127,437.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$121,073.51
|
| Rate for Payer: Anthem Medicare Advantage |
$58,861.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58,861.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58,861.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$58,861.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134,402.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$58,861.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146,675.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58,861.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58,861.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$58,861.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$58,861.46
|
| Rate for Payer: NAPHCARE Commercial |
$88,292.19
|
| Rate for Payer: Quartz Medicare Advantage |
$58,861.46
|
| Rate for Payer: The Alliance Commercial |
$200,307.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58,861.46
|
| Rate for Payer: United Healthcare PPO |
$114,188.44
|
| Rate for Payer: Wellcare Medicare |
$58,861.46
|
|
|
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC
|
Facility
|
IP
|
$70,352.88
|
|
|
Service Code
|
MSDRG 959
|
| Min. Negotiated Rate |
$23,053.28 |
| Max. Negotiated Rate |
$70,352.88 |
| Rate for Payer: Aetna Managed Medicare |
$23,053.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64,237.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49,237.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46,779.16
|
| Rate for Payer: Anthem Medicare Advantage |
$23,053.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,053.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,053.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,053.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51,929.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,053.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51,357.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,053.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,053.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,053.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,053.28
|
| Rate for Payer: NAPHCARE Commercial |
$34,579.93
|
| Rate for Payer: Quartz Medicare Advantage |
$23,053.28
|
| Rate for Payer: The Alliance Commercial |
$70,352.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,053.28
|
| Rate for Payer: United Healthcare PPO |
$39,982.13
|
| Rate for Payer: Wellcare Medicare |
$23,053.28
|
|
|
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC
|
Facility
|
IP
|
$51,710.88
|
|
|
Service Code
|
MSDRG 803
|
| Min. Negotiated Rate |
$14,742.60 |
| Max. Negotiated Rate |
$51,710.88 |
| Rate for Payer: Aetna Managed Medicare |
$14,742.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40,559.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31,088.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29,536.29
|
| Rate for Payer: Anthem Medicare Advantage |
$14,742.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,742.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,742.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,742.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32,787.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,742.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,684.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,742.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,742.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,742.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,742.60
|
| Rate for Payer: NAPHCARE Commercial |
$22,113.90
|
| Rate for Payer: Quartz Medicare Advantage |
$14,742.60
|
| Rate for Payer: The Alliance Commercial |
$51,710.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,742.60
|
| Rate for Payer: United Healthcare PPO |
$29,337.70
|
| Rate for Payer: Wellcare Medicare |
$14,742.60
|
|
|
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC
|
Facility
|
IP
|
$95,193.28
|
|
|
Service Code
|
MSDRG 802
|
| Min. Negotiated Rate |
$31,017.80 |
| Max. Negotiated Rate |
$95,193.28 |
| Rate for Payer: Aetna Managed Medicare |
$31,017.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86,929.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66,631.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63,303.84
|
| Rate for Payer: Anthem Medicare Advantage |
$31,017.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31,017.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31,017.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$31,017.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70,273.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$31,017.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68,755.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31,017.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31,017.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$31,017.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$31,017.80
|
| Rate for Payer: NAPHCARE Commercial |
$46,526.70
|
| Rate for Payer: Quartz Medicare Advantage |
$31,017.80
|
| Rate for Payer: The Alliance Commercial |
$95,193.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31,017.80
|
| Rate for Payer: United Healthcare PPO |
$53,526.87
|
| Rate for Payer: Wellcare Medicare |
$31,017.80
|
|
|
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC
|
Facility
|
IP
|
$33,800.00
|
|
|
Service Code
|
MSDRG 804
|
| Min. Negotiated Rate |
$10,891.29 |
| Max. Negotiated Rate |
$33,800.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,891.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,586.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,678.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,545.65
|
| Rate for Payer: Anthem Medicare Advantage |
$10,891.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,891.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,891.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,891.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,917.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,891.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,546.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,891.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,891.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,891.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,891.29
|
| Rate for Payer: NAPHCARE Commercial |
$16,336.93
|
| Rate for Payer: Quartz Medicare Advantage |
$10,891.29
|
| Rate for Payer: The Alliance Commercial |
$33,800.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,891.29
|
| Rate for Payer: United Healthcare PPO |
$19,110.08
|
| Rate for Payer: Wellcare Medicare |
$10,891.29
|
|
|
OTHER PATHOLOGICAL FRACTURES W/O MUSCULOSKELETAL MALIGNANCY
|
Facility
|
OP
|
$112.69
|
|
|
Service Code
|
EAPG 00649
|
| Min. Negotiated Rate |
$108.35 |
| Max. Negotiated Rate |
$112.69 |
| Rate for Payer: Anthem Medicaid |
$108.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$108.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.35
|
| Rate for Payer: Dean Health Medicaid |
$108.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$108.35
|
| Rate for Payer: Managed Health Services Medicaid |
$112.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.35
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$108.35
|
| Rate for Payer: United Healthcare Medicaid |
$108.35
|
|
|
OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES
|
Facility
|
IP
|
$20,079.43
|
|
|
Service Code
|
APR-DRG 0292
|
| Min. Negotiated Rate |
$17,835.80 |
| Max. Negotiated Rate |
$20,079.43 |
| Rate for Payer: Anthem Medicaid |
$19,227.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$19,227.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19,227.16
|
| Rate for Payer: Dean Health Medicaid |
$19,227.16
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17,835.80
|
| Rate for Payer: Managed Health Services Medicaid |
$20,079.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,227.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19,227.16
|
| Rate for Payer: United Healthcare Medicaid |
$19,227.16
|
|
|
OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES
|
Facility
|
IP
|
$28,847.74
|
|
|
Service Code
|
APR-DRG 0293
|
| Min. Negotiated Rate |
$25,624.36 |
| Max. Negotiated Rate |
$28,847.74 |
| Rate for Payer: Anthem Medicaid |
$27,623.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$27,623.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27,623.30
|
| Rate for Payer: Dean Health Medicaid |
$27,623.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$25,624.36
|
| Rate for Payer: Managed Health Services Medicaid |
$28,847.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,623.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$27,623.30
|
| Rate for Payer: United Healthcare Medicaid |
$27,623.30
|
|
|
OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES
|
Facility
|
IP
|
$16,046.01
|
|
|
Service Code
|
APR-DRG 0291
|
| Min. Negotiated Rate |
$14,253.06 |
| Max. Negotiated Rate |
$16,046.01 |
| Rate for Payer: Anthem Medicaid |
$15,364.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$15,364.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,364.94
|
| Rate for Payer: Dean Health Medicaid |
$15,364.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,253.06
|
| Rate for Payer: Managed Health Services Medicaid |
$16,046.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,364.94
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15,364.94
|
| Rate for Payer: United Healthcare Medicaid |
$15,364.94
|
|
|
OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES
|
Facility
|
IP
|
$38,492.88
|
|
|
Service Code
|
APR-DRG 0294
|
| Min. Negotiated Rate |
$34,191.78 |
| Max. Negotiated Rate |
$38,492.88 |
| Rate for Payer: Anthem Medicaid |
$36,859.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$36,859.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36,859.05
|
| Rate for Payer: Dean Health Medicaid |
$36,859.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$34,191.78
|
| Rate for Payer: Managed Health Services Medicaid |
$38,492.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$36,859.05
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36,859.05
|
| Rate for Payer: United Healthcare Medicaid |
$36,859.05
|
|
|
OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES
|
Facility
|
IP
|
$17,799.67
|
|
|
Service Code
|
APR-DRG 1822
|
| Min. Negotiated Rate |
$15,810.78 |
| Max. Negotiated Rate |
$17,799.67 |
| Rate for Payer: Anthem Medicaid |
$17,044.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,044.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,044.16
|
| Rate for Payer: Dean Health Medicaid |
$17,044.16
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,810.78
|
| Rate for Payer: Managed Health Services Medicaid |
$17,799.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,044.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,044.16
|
| Rate for Payer: United Healthcare Medicaid |
$17,044.16
|
|
|
OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES
|
Facility
|
IP
|
$22,709.92
|
|
|
Service Code
|
APR-DRG 1823
|
| Min. Negotiated Rate |
$20,172.37 |
| Max. Negotiated Rate |
$22,709.92 |
| Rate for Payer: Anthem Medicaid |
$21,746.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$21,746.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21,746.00
|
| Rate for Payer: Dean Health Medicaid |
$21,746.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,172.37
|
| Rate for Payer: Managed Health Services Medicaid |
$22,709.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,746.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21,746.00
|
| Rate for Payer: United Healthcare Medicaid |
$21,746.00
|
|
|
OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES
|
Facility
|
IP
|
$35,511.66
|
|
|
Service Code
|
APR-DRG 1824
|
| Min. Negotiated Rate |
$31,543.67 |
| Max. Negotiated Rate |
$35,511.66 |
| Rate for Payer: Anthem Medicaid |
$34,004.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$34,004.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34,004.37
|
| Rate for Payer: Dean Health Medicaid |
$34,004.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$31,543.67
|
| Rate for Payer: Managed Health Services Medicaid |
$35,511.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,004.37
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$34,004.37
|
| Rate for Payer: United Healthcare Medicaid |
$34,004.37
|
|
|
OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES
|
Facility
|
IP
|
$14,467.71
|
|
|
Service Code
|
APR-DRG 1821
|
| Min. Negotiated Rate |
$12,851.12 |
| Max. Negotiated Rate |
$14,467.71 |
| Rate for Payer: Anthem Medicaid |
$13,853.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,853.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,853.63
|
| Rate for Payer: Dean Health Medicaid |
$13,853.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,851.12
|
| Rate for Payer: Managed Health Services Medicaid |
$14,467.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,853.63
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,853.63
|
| Rate for Payer: United Healthcare Medicaid |
$13,853.63
|
|
|
OTHER PNEUMONIA
|
Facility
|
IP
|
$5,787.08
|
|
|
Service Code
|
APR-DRG 1392
|
| 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 PNEUMONIA
|
Facility
|
IP
|
$8,768.31
|
|
|
Service Code
|
APR-DRG 1393
|
| Min. Negotiated Rate |
$7,788.56 |
| Max. Negotiated Rate |
$8,768.31 |
| Rate for Payer: Anthem Medicaid |
$8,396.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,396.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,396.14
|
| Rate for Payer: Dean Health Medicaid |
$8,396.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,788.56
|
| Rate for Payer: Managed Health Services Medicaid |
$8,768.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,396.14
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,396.14
|
| Rate for Payer: United Healthcare Medicaid |
$8,396.14
|
|
|
OTHER PNEUMONIA
|
Facility
|
IP
|
$14,292.35
|
|
|
Service Code
|
APR-DRG 1394
|
| Min. Negotiated Rate |
$12,695.35 |
| Max. Negotiated Rate |
$14,292.35 |
| Rate for Payer: Anthem Medicaid |
$13,685.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,685.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,685.71
|
| Rate for Payer: Dean Health Medicaid |
$13,685.71
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,695.35
|
| Rate for Payer: Managed Health Services Medicaid |
$14,292.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,685.71
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,685.71
|
| Rate for Payer: United Healthcare Medicaid |
$13,685.71
|
|
|
OTHER PNEUMONIA
|
Facility
|
IP
|
$4,208.79
|
|
|
Service Code
|
APR-DRG 1391
|
| 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 PROCEDURES FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS
|
Facility
|
IP
|
$11,574.17
|
|
|
Service Code
|
APR-DRG 4051
|
| Min. Negotiated Rate |
$10,280.90 |
| Max. Negotiated Rate |
$11,574.17 |
| Rate for Payer: Anthem Medicaid |
$11,082.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,082.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,082.90
|
| Rate for Payer: Dean Health Medicaid |
$11,082.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,280.90
|
| Rate for Payer: Managed Health Services Medicaid |
$11,574.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,082.90
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,082.90
|
| Rate for Payer: United Healthcare Medicaid |
$11,082.90
|
|
