|
DISORDERS OF IMPULSE CONTROL & DEVELOPMENT
|
Facility
|
IP
|
$4,033.42
|
|
|
Service Code
|
APR-DRG 7581
|
| Min. Negotiated Rate |
$3,582.74 |
| Max. Negotiated Rate |
$4,033.42 |
| Rate for Payer: Anthem Medicaid |
$3,862.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,862.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,862.22
|
| Rate for Payer: Dean Health Medicaid |
$3,862.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,582.74
|
| Rate for Payer: Managed Health Services Medicaid |
$4,033.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,862.22
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,862.22
|
| Rate for Payer: United Healthcare Medicaid |
$3,862.22
|
|
|
DISORDERS OF IMPULSE CONTROL & DEVELOPMENT
|
Facility
|
IP
|
$28,146.28
|
|
|
Service Code
|
APR-DRG 7584
|
| Min. Negotiated Rate |
$25,001.28 |
| Max. Negotiated Rate |
$28,146.28 |
| Rate for Payer: Anthem Medicaid |
$26,951.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$26,951.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26,951.61
|
| Rate for Payer: Dean Health Medicaid |
$26,951.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$25,001.28
|
| Rate for Payer: Managed Health Services Medicaid |
$28,146.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,951.61
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26,951.61
|
| Rate for Payer: United Healthcare Medicaid |
$26,951.61
|
|
|
DISORDERS OF IMPULSE CONTROL & DEVELOPMENT
|
Facility
|
IP
|
$8,329.89
|
|
|
Service Code
|
APR-DRG 7583
|
| Min. Negotiated Rate |
$7,399.13 |
| Max. Negotiated Rate |
$8,329.89 |
| Rate for Payer: Anthem Medicaid |
$7,976.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,976.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,976.33
|
| Rate for Payer: Dean Health Medicaid |
$7,976.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,399.13
|
| Rate for Payer: Managed Health Services Medicaid |
$8,329.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,976.33
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,976.33
|
| Rate for Payer: United Healthcare Medicaid |
$7,976.33
|
|
|
DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC
|
Facility
|
IP
|
$26,641.68
|
|
|
Service Code
|
MSDRG 442
|
| Min. Negotiated Rate |
$7,899.24 |
| Max. Negotiated Rate |
$26,641.68 |
| Rate for Payer: Aetna Managed Medicare |
$7,899.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,062.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,143.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,337.77
|
| Rate for Payer: Anthem Medicare Advantage |
$7,899.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,899.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,899.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,899.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,026.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,899.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,296.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,899.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,899.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,899.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,899.24
|
| Rate for Payer: NAPHCARE Commercial |
$11,848.86
|
| Rate for Payer: Quartz Medicare Advantage |
$7,899.24
|
| Rate for Payer: The Alliance Commercial |
$26,641.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,899.24
|
| Rate for Payer: United Healthcare PPO |
$15,022.51
|
| Rate for Payer: Wellcare Medicare |
$7,899.24
|
|
|
DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC
|
Facility
|
IP
|
$50,882.00
|
|
|
Service Code
|
MSDRG 441
|
| Min. Negotiated Rate |
$14,250.94 |
| Max. Negotiated Rate |
$50,882.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,250.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,158.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,014.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,516.20
|
| Rate for Payer: Anthem Medicare Advantage |
$14,250.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,250.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,250.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,250.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,655.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,250.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,075.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,250.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,250.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,250.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,250.94
|
| Rate for Payer: NAPHCARE Commercial |
$21,376.41
|
| Rate for Payer: Quartz Medicare Advantage |
$14,250.94
|
| Rate for Payer: The Alliance Commercial |
$50,882.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,250.94
|
| Rate for Payer: United Healthcare PPO |
$28,864.06
|
| Rate for Payer: Wellcare Medicare |
$14,250.94
|
|
|
DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$20,093.84
|
|
|
Service Code
|
MSDRG 443
|
| Min. Negotiated Rate |
$5,865.22 |
| Max. Negotiated Rate |
$20,093.84 |
| Rate for Payer: Aetna Managed Medicare |
$5,865.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,266.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,701.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,117.62
|
| Rate for Payer: Anthem Medicare Advantage |
$5,865.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,865.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,865.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,865.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,341.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,865.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,494.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,865.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,865.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,865.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,865.22
|
| Rate for Payer: NAPHCARE Commercial |
$8,797.82
|
| Rate for Payer: Quartz Medicare Advantage |
$5,865.22
|
| Rate for Payer: The Alliance Commercial |
$20,093.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,865.22
|
| Rate for Payer: United Healthcare PPO |
$11,283.85
|
| Rate for Payer: Wellcare Medicare |
$5,865.22
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$4,822.57
|
|
|
Service Code
|
APR-DRG 2821
|
| 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
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$10,872.70
|
|
|
Service Code
|
APR-DRG 2823
|
| Min. Negotiated Rate |
$9,657.81 |
| Max. Negotiated Rate |
$10,872.70 |
| Rate for Payer: Anthem Medicaid |
$10,411.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,411.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,411.21
|
| Rate for Payer: Dean Health Medicaid |
$10,411.21
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,657.81
|
| Rate for Payer: Managed Health Services Medicaid |
$10,872.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,411.21
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,411.21
|
| Rate for Payer: United Healthcare Medicaid |
$10,411.21
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$6,663.92
|
|
|
Service Code
|
APR-DRG 2822
|
| Min. Negotiated Rate |
$5,919.31 |
| Max. Negotiated Rate |
$6,663.92 |
| Rate for Payer: Anthem Medicaid |
$6,381.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,381.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,381.07
|
| Rate for Payer: Dean Health Medicaid |
$6,381.07
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,919.31
|
| Rate for Payer: Managed Health Services Medicaid |
$6,663.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,381.07
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,381.07
|
| Rate for Payer: United Healthcare Medicaid |
$6,381.07
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$23,060.66
|
|
|
Service Code
|
APR-DRG 2824
|
| Min. Negotiated Rate |
$20,483.91 |
| Max. Negotiated Rate |
$23,060.66 |
| Rate for Payer: Anthem Medicaid |
$22,081.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,081.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,081.85
|
| Rate for Payer: Dean Health Medicaid |
$22,081.85
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,483.91
|
| Rate for Payer: Managed Health Services Medicaid |
$23,060.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,081.85
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,081.85
|
| Rate for Payer: United Healthcare Medicaid |
$22,081.85
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC
|
Facility
|
IP
|
$23,979.28
|
|
|
Service Code
|
MSDRG 439
|
| Min. Negotiated Rate |
$6,948.85 |
| Max. Negotiated Rate |
$23,979.28 |
| Rate for Payer: Aetna Managed Medicare |
$6,948.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,354.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,068.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,365.93
|
| Rate for Payer: Anthem Medicare Advantage |
$6,948.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,948.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,948.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,948.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,837.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,948.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,343.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,948.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,948.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,948.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,948.85
|
| Rate for Payer: NAPHCARE Commercial |
$10,423.28
|
| Rate for Payer: Quartz Medicare Advantage |
$6,948.85
|
| Rate for Payer: The Alliance Commercial |
$23,979.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,948.85
|
| Rate for Payer: United Healthcare PPO |
$13,502.10
|
| Rate for Payer: Wellcare Medicare |
$6,948.85
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC
|
Facility
|
IP
|
$46,474.48
|
|
|
Service Code
|
MSDRG 438
|
| Min. Negotiated Rate |
$12,991.17 |
| Max. Negotiated Rate |
$46,474.48 |
| Rate for Payer: Aetna Managed Medicare |
$12,991.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,569.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,263.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,902.44
|
| Rate for Payer: Anthem Medicare Advantage |
$12,991.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,991.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,991.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,991.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,754.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,991.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,843.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,991.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,991.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,991.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,991.17
|
| Rate for Payer: NAPHCARE Commercial |
$19,486.76
|
| Rate for Payer: Quartz Medicare Advantage |
$12,991.17
|
| Rate for Payer: The Alliance Commercial |
$46,474.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,991.17
|
| Rate for Payer: United Healthcare PPO |
$26,347.41
|
| Rate for Payer: Wellcare Medicare |
$12,991.17
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$17,354.48
|
|
|
Service Code
|
MSDRG 440
|
| Min. Negotiated Rate |
$5,265.58 |
| Max. Negotiated Rate |
$17,354.48 |
| Rate for Payer: Aetna Managed Medicare |
$5,265.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,558.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,392.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,873.50
|
| Rate for Payer: Anthem Medicare Advantage |
$5,265.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,265.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,265.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,265.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,960.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,265.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,484.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,265.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,265.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,265.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,265.58
|
| Rate for Payer: NAPHCARE Commercial |
$7,898.37
|
| Rate for Payer: Quartz Medicare Advantage |
$5,265.58
|
| Rate for Payer: The Alliance Commercial |
$17,354.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,265.58
|
| Rate for Payer: United Healthcare PPO |
$9,719.24
|
| Rate for Payer: Wellcare Medicare |
$5,265.58
|
|
|
DISORDERS OF PERSONALITY AND IMPULSE CONTROL
|
Facility
|
IP
|
$52,187.20
|
|
|
Service Code
|
MSDRG 883
|
| Min. Negotiated Rate |
$15,565.10 |
| Max. Negotiated Rate |
$52,187.20 |
| Rate for Payer: Aetna Managed Medicare |
$15,565.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42,903.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32,884.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31,242.78
|
| Rate for Payer: Anthem Medicare Advantage |
$15,565.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,565.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,565.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,565.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34,682.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,565.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,565.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,565.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,565.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,565.10
|
| Rate for Payer: NAPHCARE Commercial |
$23,347.65
|
| Rate for Payer: Quartz Medicare Advantage |
$15,565.10
|
| Rate for Payer: The Alliance Commercial |
$52,187.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,565.10
|
| Rate for Payer: United Healthcare PPO |
$29,609.27
|
| Rate for Payer: Wellcare Medicare |
$15,565.10
|
|
|
DISORDERS OF THE BILIARY TRACT WITH CC
|
Facility
|
IP
|
$30,382.56
|
|
|
Service Code
|
MSDRG 445
|
| Min. Negotiated Rate |
$8,887.91 |
| Max. Negotiated Rate |
$30,382.56 |
| Rate for Payer: Aetna Managed Medicare |
$8,887.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,878.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,303.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,389.05
|
| Rate for Payer: Anthem Medicare Advantage |
$8,887.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,887.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,887.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,887.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,303.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,887.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,040.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,887.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,887.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,887.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,887.91
|
| Rate for Payer: NAPHCARE Commercial |
$13,331.87
|
| Rate for Payer: Quartz Medicare Advantage |
$8,887.91
|
| Rate for Payer: The Alliance Commercial |
$30,382.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,887.91
|
| Rate for Payer: United Healthcare PPO |
$17,158.66
|
| Rate for Payer: Wellcare Medicare |
$8,887.91
|
|
|
DISORDERS OF THE BILIARY TRACT WITH MCC
|
Facility
|
IP
|
$45,490.64
|
|
|
Service Code
|
MSDRG 444
|
| Min. Negotiated Rate |
$13,302.87 |
| Max. Negotiated Rate |
$45,490.64 |
| Rate for Payer: Aetna Managed Medicare |
$13,302.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,457.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,944.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,549.13
|
| Rate for Payer: Anthem Medicare Advantage |
$13,302.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,302.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,302.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,302.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,471.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,302.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,121.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,302.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,302.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,302.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,302.87
|
| Rate for Payer: NAPHCARE Commercial |
$19,954.30
|
| Rate for Payer: Quartz Medicare Advantage |
$13,302.87
|
| Rate for Payer: The Alliance Commercial |
$45,490.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,302.87
|
| Rate for Payer: United Healthcare PPO |
$25,785.35
|
| Rate for Payer: Wellcare Medicare |
$13,302.87
|
|
|
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC
|
Facility
|
IP
|
$22,494.16
|
|
|
Service Code
|
MSDRG 446
|
| Min. Negotiated Rate |
$6,842.41 |
| Max. Negotiated Rate |
$22,494.16 |
| Rate for Payer: Aetna Managed Medicare |
$6,842.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,051.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,835.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,145.07
|
| Rate for Payer: Anthem Medicare Advantage |
$6,842.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,842.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,842.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,842.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,592.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,842.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,254.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,842.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,842.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,842.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,842.41
|
| Rate for Payer: NAPHCARE Commercial |
$10,263.61
|
| Rate for Payer: Quartz Medicare Advantage |
$6,842.41
|
| Rate for Payer: The Alliance Commercial |
$22,494.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,842.41
|
| Rate for Payer: United Healthcare PPO |
$12,654.27
|
| Rate for Payer: Wellcare Medicare |
$6,842.41
|
|
|
DISPENSER OMI BLOC GIS-11D
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
2971856
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.74
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$43.68
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$47.32
|
| Rate for Payer: Quartz Medicare Advantage |
$43.68
|
| Rate for Payer: The Alliance Commercial |
$36.40
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
DISPENSER OMI BLOC GIS-11D
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
2971856
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
Dispensing Fee Bicros
|
Facility
|
OP
|
$1,924.00
|
|
|
Service Code
|
HCPCS V5240
|
| Hospital Charge Code |
3243591
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$560.27 |
| Max. Negotiated Rate |
$1,840.88 |
| Rate for Payer: Health EOS Commercial |
$1,780.85
|
| Rate for Payer: Aetna Commercial |
$1,800.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,720.83
|
| Rate for Payer: Aetna Managed Medicare |
$560.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,300.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,000.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$960.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,060.51
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$1,840.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,119.77
|
| Rate for Payer: HFN Commercial |
$1,840.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,500.72
|
| Rate for Payer: Multiplan Commercial |
$1,600.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,200.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,840.88
|
| Rate for Payer: Quartz Beloit One Network |
$980.47
|
| Rate for Payer: Quartz Commercial |
$1,300.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,200.58
|
| Rate for Payer: The Alliance Commercial |
$1,000.48
|
| Rate for Payer: United Healthcare PPO |
$1,500.72
|
| Rate for Payer: WEA Trust Commercial |
$1,100.53
|
| Rate for Payer: WPS Commercial |
$1,482.06
|
|
|
Dispensing Fee Bicros
|
Facility
|
IP
|
$1,924.00
|
|
|
Service Code
|
HCPCS V5240
|
| Hospital Charge Code |
3243591
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$980.47 |
| Max. Negotiated Rate |
$1,840.88 |
| Rate for Payer: Aetna Commercial |
$1,800.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,720.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,060.51
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$1,840.88
|
| Rate for Payer: Health EOS Commercial |
$1,780.85
|
| Rate for Payer: HFN Commercial |
$1,840.88
|
| Rate for Payer: Multiplan Commercial |
$1,600.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,840.88
|
| Rate for Payer: Quartz Beloit One Network |
$980.47
|
| Rate for Payer: Quartz Commercial |
$1,200.58
|
| Rate for Payer: WEA Trust Commercial |
$1,100.53
|
| Rate for Payer: WPS Commercial |
$1,482.06
|
|
|
Dispensing Fee Bicros
|
Professional
|
Both
|
$1,924.00
|
|
|
Service Code
|
HCPCS V5240
|
| Hospital Charge Code |
3243591
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$880.42 |
| Max. Negotiated Rate |
$1,900.91 |
| Rate for Payer: Aetna Commercial |
$1,900.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,720.83
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$1,900.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,000.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,200.58
|
| Rate for Payer: Health EOS Commercial |
$1,820.87
|
| Rate for Payer: HFN Commercial |
$1,900.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$942.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$942.44
|
| Rate for Payer: Multiplan Commercial |
$1,600.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,900.91
|
| Rate for Payer: Quartz Beloit One Network |
$880.42
|
| Rate for Payer: Quartz Commercial |
$1,140.55
|
| Rate for Payer: The Alliance Commercial |
$1,000.48
|
| Rate for Payer: WEA Trust Commercial |
$1,100.53
|
| Rate for Payer: WPS Commercial |
$1,482.06
|
|
|
Dispensing Fee Binaural
|
Facility
|
OP
|
$2,428.00
|
|
|
Service Code
|
HCPCS V5160
|
| Hospital Charge Code |
3243567
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$707.03 |
| Max. Negotiated Rate |
$2,323.11 |
| Rate for Payer: Aetna Commercial |
$2,272.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,171.60
|
| Rate for Payer: Aetna Managed Medicare |
$707.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,641.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,262.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,212.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,338.31
|
| Rate for Payer: Cash Price |
$728.40
|
| Rate for Payer: Cigna Commercial |
$2,323.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,413.10
|
| Rate for Payer: Health EOS Commercial |
$2,247.36
|
| Rate for Payer: HFN Commercial |
$2,323.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,893.84
|
| Rate for Payer: Multiplan Commercial |
$2,020.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,515.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,323.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,237.31
|
| Rate for Payer: Quartz Commercial |
$1,641.33
|
| Rate for Payer: Quartz Medicare Advantage |
$1,515.07
|
| Rate for Payer: The Alliance Commercial |
$1,262.56
|
| Rate for Payer: United Healthcare PPO |
$1,893.84
|
| Rate for Payer: WEA Trust Commercial |
$1,388.82
|
| Rate for Payer: WPS Commercial |
$1,870.29
|
|
|
Dispensing Fee Binaural
|
Facility
|
IP
|
$2,428.00
|
|
|
Service Code
|
HCPCS V5160
|
| Hospital Charge Code |
3243567
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$1,237.31 |
| Max. Negotiated Rate |
$2,323.11 |
| Rate for Payer: Aetna Commercial |
$2,272.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,171.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,338.31
|
| Rate for Payer: Cash Price |
$728.40
|
| Rate for Payer: Cigna Commercial |
$2,323.11
|
| Rate for Payer: Health EOS Commercial |
$2,247.36
|
| Rate for Payer: HFN Commercial |
$2,323.11
|
| Rate for Payer: Multiplan Commercial |
$2,020.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,323.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,237.31
|
| Rate for Payer: Quartz Commercial |
$1,515.07
|
| Rate for Payer: WEA Trust Commercial |
$1,388.82
|
| Rate for Payer: WPS Commercial |
$1,870.29
|
|
|
Dispensing Fee Binaural
|
Professional
|
Both
|
$2,428.00
|
|
|
Service Code
|
HCPCS V5160
|
| Hospital Charge Code |
3243567
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$1,099.30 |
| Max. Negotiated Rate |
$2,398.86 |
| Rate for Payer: Aetna Commercial |
$2,398.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,171.60
|
| Rate for Payer: Cash Price |
$728.40
|
| Rate for Payer: Cash Price |
$728.40
|
| Rate for Payer: Cigna Commercial |
$2,398.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,262.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,515.07
|
| Rate for Payer: Health EOS Commercial |
$2,297.86
|
| Rate for Payer: HFN Commercial |
$2,398.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,099.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,099.30
|
| Rate for Payer: Multiplan Commercial |
$2,020.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,398.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,111.05
|
| Rate for Payer: Quartz Commercial |
$1,439.32
|
| Rate for Payer: The Alliance Commercial |
$1,262.56
|
| Rate for Payer: WEA Trust Commercial |
$1,388.82
|
| Rate for Payer: WPS Commercial |
$1,870.29
|
|
