|
UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA
|
Facility
|
IP
|
$34,459.46
|
|
|
Service Code
|
APR-DRG 5194
|
| Min. Negotiated Rate |
$30,609.04 |
| Max. Negotiated Rate |
$34,459.46 |
| Rate for Payer: Anthem Medicaid |
$32,996.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$32,996.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32,996.83
|
| Rate for Payer: Dean Health Medicaid |
$32,996.83
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30,609.04
|
| Rate for Payer: Managed Health Services Medicaid |
$34,459.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,996.83
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$32,996.83
|
| Rate for Payer: United Healthcare Medicaid |
$32,996.83
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA
|
Facility
|
IP
|
$20,780.89
|
|
|
Service Code
|
APR-DRG 5193
|
| Min. Negotiated Rate |
$18,458.89 |
| Max. Negotiated Rate |
$20,780.89 |
| Rate for Payer: Anthem Medicaid |
$19,898.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$19,898.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19,898.85
|
| Rate for Payer: Dean Health Medicaid |
$19,898.85
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,458.89
|
| Rate for Payer: Managed Health Services Medicaid |
$20,780.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,898.85
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19,898.85
|
| Rate for Payer: United Healthcare Medicaid |
$19,898.85
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA
|
Facility
|
IP
|
$11,486.49
|
|
|
Service Code
|
APR-DRG 5192
|
| 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
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA
|
Facility
|
IP
|
$8,680.63
|
|
|
Service Code
|
APR-DRG 5191
|
| Min. Negotiated Rate |
$7,710.67 |
| Max. Negotiated Rate |
$8,680.63 |
| Rate for Payer: Anthem Medicaid |
$8,312.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,312.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,312.18
|
| Rate for Payer: Dean Health Medicaid |
$8,312.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,710.67
|
| Rate for Payer: Managed Health Services Medicaid |
$8,680.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,312.18
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,312.18
|
| Rate for Payer: United Healthcare Medicaid |
$8,312.18
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA
|
Facility
|
IP
|
$9,382.09
|
|
|
Service Code
|
APR-DRG 5131
|
| Min. Negotiated Rate |
$8,333.76 |
| Max. Negotiated Rate |
$9,382.09 |
| Rate for Payer: Anthem Medicaid |
$8,983.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,983.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,983.87
|
| Rate for Payer: Dean Health Medicaid |
$8,983.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,333.76
|
| Rate for Payer: Managed Health Services Medicaid |
$9,382.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,983.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,983.87
|
| Rate for Payer: United Healthcare Medicaid |
$8,983.87
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA
|
Facility
|
IP
|
$34,284.09
|
|
|
Service Code
|
APR-DRG 5134
|
| Min. Negotiated Rate |
$30,453.27 |
| Max. Negotiated Rate |
$34,284.09 |
| Rate for Payer: Anthem Medicaid |
$32,828.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$32,828.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32,828.91
|
| Rate for Payer: Dean Health Medicaid |
$32,828.91
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30,453.27
|
| Rate for Payer: Managed Health Services Medicaid |
$34,284.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,828.91
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$32,828.91
|
| Rate for Payer: United Healthcare Medicaid |
$32,828.91
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA
|
Facility
|
IP
|
$11,574.17
|
|
|
Service Code
|
APR-DRG 5132
|
| 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
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA
|
Facility
|
IP
|
$19,027.23
|
|
|
Service Code
|
APR-DRG 5133
|
| Min. Negotiated Rate |
$16,901.18 |
| Max. Negotiated Rate |
$19,027.23 |
| Rate for Payer: Anthem Medicaid |
$18,219.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$18,219.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18,219.62
|
| Rate for Payer: Dean Health Medicaid |
$18,219.62
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,901.18
|
| Rate for Payer: Managed Health Services Medicaid |
$19,027.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,219.62
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18,219.62
|
| Rate for Payer: United Healthcare Medicaid |
$18,219.62
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$49,601.76
|
|
|
Service Code
|
MSDRG 742
|
| Min. Negotiated Rate |
$14,558.04 |
| Max. Negotiated Rate |
$49,601.76 |
| Rate for Payer: Aetna Managed Medicare |
$14,558.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40,033.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,685.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29,153.36
|
| Rate for Payer: Anthem Medicare Advantage |
$14,558.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,558.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,558.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,558.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32,362.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,558.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,136.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,558.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,558.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,558.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,558.04
|
| Rate for Payer: NAPHCARE Commercial |
$21,837.07
|
| Rate for Payer: Quartz Medicare Advantage |
$14,558.04
|
| Rate for Payer: The Alliance Commercial |
$49,601.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,558.04
|
| Rate for Payer: United Healthcare PPO |
$28,133.06
|
| Rate for Payer: Wellcare Medicare |
$14,558.04
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$32,461.52
|
|
|
Service Code
|
MSDRG 743
|
| Min. Negotiated Rate |
$10,008.30 |
| Max. Negotiated Rate |
$32,461.52 |
| Rate for Payer: Aetna Managed Medicare |
$10,008.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,071.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,749.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,713.63
|
| Rate for Payer: Anthem Medicare Advantage |
$10,008.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,008.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,008.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,008.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,883.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,008.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,565.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,008.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,008.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,008.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,008.30
|
| Rate for Payer: NAPHCARE Commercial |
$15,012.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,008.30
|
| Rate for Payer: The Alliance Commercial |
$32,461.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,008.30
|
| Rate for Payer: United Healthcare PPO |
$18,345.93
|
| Rate for Payer: Wellcare Medicare |
$10,008.30
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$12,538.68
|
|
|
Service Code
|
APR-DRG 5121
|
| Min. Negotiated Rate |
$11,137.64 |
| Max. Negotiated Rate |
$12,538.68 |
| Rate for Payer: Anthem Medicaid |
$12,006.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,006.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,006.48
|
| Rate for Payer: Dean Health Medicaid |
$12,006.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,137.64
|
| Rate for Payer: Managed Health Services Medicaid |
$12,538.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,006.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,006.48
|
| Rate for Payer: United Healthcare Medicaid |
$12,006.48
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$40,684.96
|
|
|
Service Code
|
APR-DRG 5124
|
| Min. Negotiated Rate |
$36,138.92 |
| Max. Negotiated Rate |
$40,684.96 |
| Rate for Payer: Anthem Medicaid |
$38,958.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$38,958.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38,958.09
|
| Rate for Payer: Dean Health Medicaid |
$38,958.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36,138.92
|
| Rate for Payer: Managed Health Services Medicaid |
$40,684.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$38,958.09
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38,958.09
|
| Rate for Payer: United Healthcare Medicaid |
$38,958.09
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$23,762.12
|
|
|
Service Code
|
APR-DRG 5123
|
| Min. Negotiated Rate |
$21,107.00 |
| Max. Negotiated Rate |
$23,762.12 |
| Rate for Payer: Anthem Medicaid |
$22,753.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,753.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,753.54
|
| Rate for Payer: Dean Health Medicaid |
$22,753.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21,107.00
|
| Rate for Payer: Managed Health Services Medicaid |
$23,762.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,753.54
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,753.54
|
| Rate for Payer: United Healthcare Medicaid |
$22,753.54
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$14,380.03
|
|
|
Service Code
|
APR-DRG 5122
|
| Min. Negotiated Rate |
$12,773.24 |
| Max. Negotiated Rate |
$14,380.03 |
| Rate for Payer: Anthem Medicaid |
$13,769.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,769.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,769.67
|
| Rate for Payer: Dean Health Medicaid |
$13,769.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,773.24
|
| Rate for Payer: Managed Health Services Medicaid |
$14,380.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,769.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,769.67
|
| Rate for Payer: United Healthcare Medicaid |
$13,769.67
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC
|
Facility
|
IP
|
$49,743.20
|
|
|
Service Code
|
MSDRG 740
|
| Min. Negotiated Rate |
$14,365.05 |
| Max. Negotiated Rate |
$49,743.20 |
| Rate for Payer: Aetna Managed Medicare |
$14,365.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,484.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,264.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,752.95
|
| Rate for Payer: Anthem Medicare Advantage |
$14,365.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,365.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,365.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,365.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,918.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,365.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,240.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,365.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,365.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,365.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,365.05
|
| Rate for Payer: NAPHCARE Commercial |
$21,547.58
|
| Rate for Payer: Quartz Medicare Advantage |
$14,365.05
|
| Rate for Payer: The Alliance Commercial |
$49,743.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,365.05
|
| Rate for Payer: United Healthcare PPO |
$28,213.59
|
| Rate for Payer: Wellcare Medicare |
$14,365.05
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC
|
Facility
|
IP
|
$100,321.52
|
|
|
Service Code
|
MSDRG 739
|
| Min. Negotiated Rate |
$27,944.56 |
| Max. Negotiated Rate |
$100,321.52 |
| Rate for Payer: Aetna Managed Medicare |
$27,944.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76,941.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58,974.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56,029.80
|
| Rate for Payer: Anthem Medicare Advantage |
$27,944.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,944.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,944.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,944.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62,198.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,944.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73,338.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,944.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,944.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,944.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,944.56
|
| Rate for Payer: NAPHCARE Commercial |
$41,916.84
|
| Rate for Payer: Quartz Medicare Advantage |
$27,944.56
|
| Rate for Payer: The Alliance Commercial |
$100,321.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,944.56
|
| Rate for Payer: United Healthcare PPO |
$57,095.01
|
| Rate for Payer: Wellcare Medicare |
$27,944.56
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$36,258.56
|
|
|
Service Code
|
MSDRG 741
|
| Min. Negotiated Rate |
$11,428.14 |
| Max. Negotiated Rate |
$36,258.56 |
| Rate for Payer: Aetna Managed Medicare |
$11,428.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,116.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,850.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,659.47
|
| Rate for Payer: Anthem Medicare Advantage |
$11,428.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,428.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,428.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,428.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,154.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,428.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,349.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,428.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,428.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,428.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,428.14
|
| Rate for Payer: NAPHCARE Commercial |
$17,142.22
|
| Rate for Payer: Quartz Medicare Advantage |
$11,428.14
|
| Rate for Payer: The Alliance Commercial |
$36,258.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,428.14
|
| Rate for Payer: United Healthcare PPO |
$20,513.66
|
| Rate for Payer: Wellcare Medicare |
$11,428.14
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$15,169.18
|
|
|
Service Code
|
APR-DRG 5112
|
| Min. Negotiated Rate |
$13,474.21 |
| Max. Negotiated Rate |
$15,169.18 |
| Rate for Payer: Anthem Medicaid |
$14,525.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,525.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,525.32
|
| Rate for Payer: Dean Health Medicaid |
$14,525.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,474.21
|
| Rate for Payer: Managed Health Services Medicaid |
$15,169.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,525.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,525.32
|
| Rate for Payer: United Healthcare Medicaid |
$14,525.32
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$12,538.68
|
|
|
Service Code
|
APR-DRG 5111
|
| Min. Negotiated Rate |
$11,137.64 |
| Max. Negotiated Rate |
$12,538.68 |
| Rate for Payer: Anthem Medicaid |
$12,006.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,006.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,006.48
|
| Rate for Payer: Dean Health Medicaid |
$12,006.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,137.64
|
| Rate for Payer: Managed Health Services Medicaid |
$12,538.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,006.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,006.48
|
| Rate for Payer: United Healthcare Medicaid |
$12,006.48
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$23,236.02
|
|
|
Service Code
|
APR-DRG 5113
|
| Min. Negotiated Rate |
$20,639.68 |
| Max. Negotiated Rate |
$23,236.02 |
| Rate for Payer: Anthem Medicaid |
$22,249.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,249.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,249.77
|
| Rate for Payer: Dean Health Medicaid |
$22,249.77
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,639.68
|
| Rate for Payer: Managed Health Services Medicaid |
$23,236.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,249.77
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,249.77
|
| Rate for Payer: United Healthcare Medicaid |
$22,249.77
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$42,526.30
|
|
|
Service Code
|
APR-DRG 5114
|
| Min. Negotiated Rate |
$37,774.52 |
| Max. Negotiated Rate |
$42,526.30 |
| Rate for Payer: Anthem Medicaid |
$40,721.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$40,721.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40,721.28
|
| Rate for Payer: Dean Health Medicaid |
$40,721.28
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$37,774.52
|
| Rate for Payer: Managed Health Services Medicaid |
$42,526.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$40,721.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$40,721.28
|
| Rate for Payer: United Healthcare Medicaid |
$40,721.28
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC
|
Facility
|
IP
|
$54,907.84
|
|
|
Service Code
|
MSDRG 737
|
| Min. Negotiated Rate |
$16,287.26 |
| Max. Negotiated Rate |
$54,907.84 |
| Rate for Payer: Aetna Managed Medicare |
$16,287.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44,960.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34,461.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32,741.12
|
| Rate for Payer: Anthem Medicare Advantage |
$16,287.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,287.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,287.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,287.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36,345.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,287.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,028.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,287.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,287.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,287.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,287.26
|
| Rate for Payer: NAPHCARE Commercial |
$24,430.89
|
| Rate for Payer: Quartz Medicare Advantage |
$16,287.26
|
| Rate for Payer: The Alliance Commercial |
$54,907.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,287.26
|
| Rate for Payer: United Healthcare PPO |
$31,162.83
|
| Rate for Payer: Wellcare Medicare |
$16,287.26
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC
|
Facility
|
IP
|
$107,811.60
|
|
|
Service Code
|
MSDRG 736
|
| Min. Negotiated Rate |
$27,881.01 |
| Max. Negotiated Rate |
$107,811.60 |
| Rate for Payer: Aetna Managed Medicare |
$27,881.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77,992.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59,780.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56,795.66
|
| Rate for Payer: Anthem Medicare Advantage |
$27,881.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,881.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,881.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,881.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63,048.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,881.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78,832.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,881.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,881.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,881.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,881.01
|
| Rate for Payer: NAPHCARE Commercial |
$41,821.51
|
| Rate for Payer: Quartz Medicare Advantage |
$27,881.01
|
| Rate for Payer: The Alliance Commercial |
$107,811.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,881.01
|
| Rate for Payer: United Healthcare PPO |
$61,372.04
|
| Rate for Payer: Wellcare Medicare |
$27,881.01
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$38,064.00
|
|
|
Service Code
|
MSDRG 738
|
| Min. Negotiated Rate |
$11,752.84 |
| Max. Negotiated Rate |
$38,064.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,752.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,041.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,559.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,333.17
|
| Rate for Payer: Anthem Medicare Advantage |
$11,752.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,752.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,752.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,752.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,901.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,752.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,674.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,752.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,752.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,752.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,752.84
|
| Rate for Payer: NAPHCARE Commercial |
$17,629.26
|
| Rate for Payer: Quartz Medicare Advantage |
$11,752.84
|
| Rate for Payer: The Alliance Commercial |
$38,064.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,752.84
|
| Rate for Payer: United Healthcare PPO |
$21,544.63
|
| Rate for Payer: Wellcare Medicare |
$11,752.84
|
|
|
UTERINE EVACUATION AND CURETTAGE FOR HYDATIDIFORM MOLE
|
Facility
|
OP
|
$13,626.87
|
|
|
Service Code
|
CPT 59870
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,626.87 |
| Rate for Payer: Aetna Managed Medicare |
$3,406.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,406.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,406.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,406.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,672.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,406.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,406.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,406.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,406.72
|
| Rate for Payer: NAPHCARE Commercial |
$5,110.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,406.72
|
| Rate for Payer: The Alliance Commercial |
$13,626.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,406.72
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,406.72
|
|
