|
Major Dressing Change
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
3026414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Aetna Managed Medicare |
$43.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$101.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$74.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.30
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.60
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$101.40
|
| Rate for Payer: Quartz Medicare Advantage |
$93.60
|
| Rate for Payer: The Alliance Commercial |
$624.00
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
MAJOR ESOPHAGEAL DISORDERS WITH CC
|
Facility
|
IP
|
$26,595.00
|
|
|
Service Code
|
MSDRG 369
|
| Min. Negotiated Rate |
$9,566.67 |
| Max. Negotiated Rate |
$26,595.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,566.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,770.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,920.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,125.22
|
| Rate for Payer: Anthem Medicare Advantage |
$9,566.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,566.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,566.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,566.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,790.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,566.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,271.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,566.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,566.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,566.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,566.67
|
| Rate for Payer: NAPHCARE Commercial |
$14,350.00
|
| Rate for Payer: Quartz Medicare Advantage |
$9,566.67
|
| Rate for Payer: The Alliance Commercial |
$26,595.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,566.67
|
| Rate for Payer: United Healthcare PPO |
$15,003.38
|
| Rate for Payer: Wellcare Medicare |
$9,566.67
|
|
|
MAJOR ESOPHAGEAL DISORDERS WITH MCC
|
Facility
|
IP
|
$44,240.00
|
|
|
Service Code
|
MSDRG 368
|
| Min. Negotiated Rate |
$15,913.83 |
| Max. Negotiated Rate |
$44,240.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,913.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34,617.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,533.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,208.70
|
| Rate for Payer: Anthem Medicare Advantage |
$15,913.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,913.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,913.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,913.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,983.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,913.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,214.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,913.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,913.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,913.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,913.83
|
| Rate for Payer: NAPHCARE Commercial |
$23,870.74
|
| Rate for Payer: Quartz Medicare Advantage |
$15,913.83
|
| Rate for Payer: The Alliance Commercial |
$44,240.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,913.83
|
| Rate for Payer: United Healthcare PPO |
$25,079.01
|
| Rate for Payer: Wellcare Medicare |
$15,913.83
|
|
|
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$20,092.00
|
|
|
Service Code
|
MSDRG 370
|
| Min. Negotiated Rate |
$7,227.48 |
| Max. Negotiated Rate |
$20,092.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,227.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,525.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,899.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,305.72
|
| Rate for Payer: Anthem Medicare Advantage |
$7,227.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,227.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,227.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,227.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,550.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,227.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,502.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,227.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,227.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,227.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,227.48
|
| Rate for Payer: NAPHCARE Commercial |
$10,841.22
|
| Rate for Payer: Quartz Medicare Advantage |
$7,227.48
|
| Rate for Payer: The Alliance Commercial |
$20,092.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,227.48
|
| Rate for Payer: United Healthcare PPO |
$11,290.11
|
| Rate for Payer: Wellcare Medicare |
$7,227.48
|
|
|
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC
|
Facility
|
IP
|
$28,031.00
|
|
|
Service Code
|
MSDRG 372
|
| Min. Negotiated Rate |
$10,083.09 |
| Max. Negotiated Rate |
$28,031.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,083.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,819.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$10,083.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,083.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,083.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,083.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,638.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,083.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,324.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,083.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,083.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,083.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,083.09
|
| Rate for Payer: NAPHCARE Commercial |
$15,124.64
|
| Rate for Payer: Quartz Medicare Advantage |
$10,083.09
|
| Rate for Payer: The Alliance Commercial |
$28,031.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,083.09
|
| Rate for Payer: United Healthcare PPO |
$15,823.16
|
| Rate for Payer: Wellcare Medicare |
$10,083.09
|
|
|
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC
|
Facility
|
IP
|
$46,785.00
|
|
|
Service Code
|
MSDRG 371
|
| Min. Negotiated Rate |
$16,829.04 |
| Max. Negotiated Rate |
$46,785.00 |
| Rate for Payer: Aetna Managed Medicare |
$16,829.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,715.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,141.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,736.50
|
| Rate for Payer: Anthem Medicare Advantage |
$16,829.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,829.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,829.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,829.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,679.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,829.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,080.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,829.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,829.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,829.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,829.04
|
| Rate for Payer: NAPHCARE Commercial |
$25,243.56
|
| Rate for Payer: Quartz Medicare Advantage |
$16,829.04
|
| Rate for Payer: The Alliance Commercial |
$46,785.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,829.04
|
| Rate for Payer: United Healthcare PPO |
$26,531.83
|
| Rate for Payer: Wellcare Medicare |
$16,829.04
|
|
|
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$19,369.00
|
|
|
Service Code
|
MSDRG 373
|
| Min. Negotiated Rate |
$6,967.38 |
| Max. Negotiated Rate |
$19,369.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,967.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,105.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,578.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,000.16
|
| Rate for Payer: Anthem Medicare Advantage |
$6,967.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,967.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,967.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,967.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,211.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,967.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,971.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,967.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,967.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,967.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,967.38
|
| Rate for Payer: NAPHCARE Commercial |
$10,451.07
|
| Rate for Payer: Quartz Medicare Advantage |
$6,967.38
|
| Rate for Payer: The Alliance Commercial |
$19,369.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,967.38
|
| Rate for Payer: United Healthcare PPO |
$10,877.19
|
| Rate for Payer: Wellcare Medicare |
$6,967.38
|
|
|
MAJOR HEAD AND NECK PROCEDURES WITH CC
|
Facility
|
IP
|
$55,399.00
|
|
|
Service Code
|
MSDRG 141
|
| Min. Negotiated Rate |
$19,927.54 |
| Max. Negotiated Rate |
$55,399.00 |
| Rate for Payer: Quartz Medicare Advantage |
$19,927.54
|
| Rate for Payer: The Alliance Commercial |
$55,399.00
|
| Rate for Payer: Aetna Managed Medicare |
$19,927.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43,428.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33,287.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31,625.46
|
| Rate for Payer: Anthem Medicare Advantage |
$19,927.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,927.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,927.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,927.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35,107.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,927.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,398.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,927.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,927.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,927.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,927.54
|
| Rate for Payer: NAPHCARE Commercial |
$29,891.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,927.54
|
| Rate for Payer: United Healthcare PPO |
$31,450.48
|
| Rate for Payer: Wellcare Medicare |
$19,927.54
|
|
|
MAJOR HEAD AND NECK PROCEDURES WITH MCC
|
Facility
|
IP
|
$100,765.00
|
|
|
Service Code
|
MSDRG 140
|
| Min. Negotiated Rate |
$36,246.34 |
| Max. Negotiated Rate |
$100,765.00 |
| Rate for Payer: Aetna Managed Medicare |
$36,246.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79,304.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60,786.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57,750.84
|
| Rate for Payer: Anthem Medicare Advantage |
$36,246.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36,246.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36,246.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36,246.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64,108.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36,246.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73,672.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36,246.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36,246.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36,246.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36,246.34
|
| Rate for Payer: NAPHCARE Commercial |
$54,369.51
|
| Rate for Payer: Quartz Medicare Advantage |
$36,246.34
|
| Rate for Payer: The Alliance Commercial |
$100,765.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36,246.34
|
| Rate for Payer: United Healthcare PPO |
$57,355.34
|
| Rate for Payer: Wellcare Medicare |
$36,246.34
|
|
|
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$41,396.00
|
|
|
Service Code
|
MSDRG 142
|
| Min. Negotiated Rate |
$14,890.55 |
| Max. Negotiated Rate |
$41,396.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,890.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,519.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,925.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,680.90
|
| Rate for Payer: Anthem Medicare Advantage |
$14,890.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,890.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,890.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,890.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,287.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,890.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,127.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,890.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,890.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,890.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,890.55
|
| Rate for Payer: NAPHCARE Commercial |
$22,335.82
|
| Rate for Payer: Quartz Medicare Advantage |
$14,890.55
|
| Rate for Payer: The Alliance Commercial |
$41,396.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,890.55
|
| Rate for Payer: United Healthcare PPO |
$23,454.65
|
| Rate for Payer: Wellcare Medicare |
$14,890.55
|
|
|
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC
|
Facility
|
IP
|
$32,341.00
|
|
|
Service Code
|
MSDRG 809
|
| Min. Negotiated Rate |
$11,633.30 |
| Max. Negotiated Rate |
$32,341.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,633.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,176.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,297.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,333.60
|
| Rate for Payer: Anthem Medicare Advantage |
$11,633.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,633.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,633.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,633.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,351.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,633.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,485.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,633.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,633.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,633.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,633.30
|
| Rate for Payer: NAPHCARE Commercial |
$17,449.95
|
| Rate for Payer: Quartz Medicare Advantage |
$11,633.30
|
| Rate for Payer: The Alliance Commercial |
$32,341.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,633.30
|
| Rate for Payer: United Healthcare PPO |
$18,284.00
|
| Rate for Payer: Wellcare Medicare |
$11,633.30
|
|
|
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC
|
Facility
|
IP
|
$58,546.00
|
|
|
Service Code
|
MSDRG 808
|
| Min. Negotiated Rate |
$21,059.83 |
| Max. Negotiated Rate |
$58,546.00 |
| Rate for Payer: Aetna Managed Medicare |
$21,059.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45,946.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35,217.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33,458.82
|
| Rate for Payer: Anthem Medicare Advantage |
$21,059.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,059.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,059.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,059.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37,142.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,059.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42,706.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,059.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,059.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,059.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,059.83
|
| Rate for Payer: NAPHCARE Commercial |
$31,589.74
|
| Rate for Payer: Quartz Medicare Advantage |
$21,059.83
|
| Rate for Payer: The Alliance Commercial |
$58,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,059.83
|
| Rate for Payer: United Healthcare PPO |
$33,247.91
|
| Rate for Payer: Wellcare Medicare |
$21,059.83
|
|
|
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$27,026.00
|
|
|
Service Code
|
MSDRG 810
|
| Min. Negotiated Rate |
$9,721.59 |
| Max. Negotiated Rate |
$27,026.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,721.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,980.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,278.00
|
| Rate for Payer: Anthem Medicare Advantage |
$9,721.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,721.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,721.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,721.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,959.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,721.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,587.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,721.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,721.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,721.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,721.59
|
| Rate for Payer: NAPHCARE Commercial |
$14,582.38
|
| Rate for Payer: Quartz Medicare Advantage |
$9,721.59
|
| Rate for Payer: The Alliance Commercial |
$27,026.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,721.59
|
| Rate for Payer: United Healthcare PPO |
$15,249.31
|
| Rate for Payer: Wellcare Medicare |
$9,721.59
|
|
|
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT
|
Facility
|
IP
|
$88,846.00
|
|
|
Service Code
|
MSDRG 469
|
| Min. Negotiated Rate |
$31,959.13 |
| Max. Negotiated Rate |
$88,846.00 |
| Rate for Payer: Aetna Managed Medicare |
$31,959.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69,863.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53,549.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50,875.74
|
| Rate for Payer: Anthem Medicare Advantage |
$31,959.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31,959.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31,959.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$31,959.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56,476.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$31,959.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64,931.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31,959.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31,959.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$31,959.13
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$31,959.13
|
| Rate for Payer: NAPHCARE Commercial |
$47,938.70
|
| Rate for Payer: Quartz Medicare Advantage |
$31,959.13
|
| Rate for Payer: The Alliance Commercial |
$88,846.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31,959.13
|
| Rate for Payer: United Healthcare PPO |
$50,549.69
|
| Rate for Payer: Wellcare Medicare |
$31,959.13
|
|
|
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC
|
Facility
|
IP
|
$50,347.00
|
|
|
Service Code
|
MSDRG 470
|
| Min. Negotiated Rate |
$18,110.51 |
| Max. Negotiated Rate |
$50,347.00 |
| Rate for Payer: NAPHCARE Commercial |
$27,165.76
|
| Rate for Payer: Quartz Medicare Advantage |
$18,110.51
|
| Rate for Payer: The Alliance Commercial |
$50,347.00
|
| Rate for Payer: Aetna Managed Medicare |
$18,110.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,442.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,232.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,722.64
|
| Rate for Payer: Anthem Medicare Advantage |
$18,110.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,110.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,110.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,110.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,884.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,110.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,693.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,110.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,110.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,110.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,110.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,110.51
|
| Rate for Payer: United Healthcare PPO |
$28,566.09
|
| Rate for Payer: Wellcare Medicare |
$18,110.51
|
|
|
Major Joint 20610 - Admin Intra-articular Injection Charge
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
3475534
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.65 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.20
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$209.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.00
|
| Rate for Payer: Health EOS Commercial |
$200.20
|
| Rate for Payer: HFN Commercial |
$209.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$150.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$150.77
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: Preferred Network Access Commercial |
$209.00
|
| Rate for Payer: Quartz Beloit One Network |
$96.80
|
| Rate for Payer: Quartz Commercial |
$125.40
|
| Rate for Payer: The Alliance Commercial |
$110.00
|
| Rate for Payer: United Healthcare Medicaid |
$64.65
|
| Rate for Payer: WEA Trust Commercial |
$121.00
|
| Rate for Payer: WPS Commercial |
$162.95
|
|
|
Major Joint 20610 - Admin Intra-articular Injection Charge
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
3475534
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$292.75 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$550.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$526.32
|
| Rate for Payer: Aetna Managed Medicare |
$292.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$397.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$306.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$293.76
|
| Rate for Payer: Anthem Medicare Advantage |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$324.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$292.75
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna Commercial |
$563.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$292.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$292.75
|
| Rate for Payer: Health EOS Commercial |
$544.68
|
| Rate for Payer: HFN Commercial |
$563.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,089.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$292.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$292.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$292.75
|
| Rate for Payer: Multiplan Commercial |
$489.60
|
| Rate for Payer: NAPHCARE Commercial |
$439.12
|
| Rate for Payer: Preferred Network Access Commercial |
$563.04
|
| Rate for Payer: Quartz Beloit One Network |
$299.88
|
| Rate for Payer: Quartz Commercial |
$397.80
|
| Rate for Payer: Quartz Medicare Advantage |
$292.75
|
| Rate for Payer: The Alliance Commercial |
$1,171.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.75
|
| Rate for Payer: WEA Trust Commercial |
$336.60
|
| Rate for Payer: Wellcare Medicare |
$292.75
|
| Rate for Payer: WPS Commercial |
$453.31
|
|
|
Major Joint 20610 - Admin Intra-articular Injection Charge
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
3475534
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$299.88 |
| Max. Negotiated Rate |
$563.04 |
| Rate for Payer: Aetna Commercial |
$550.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$526.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$324.36
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna Commercial |
$563.04
|
| Rate for Payer: Health EOS Commercial |
$544.68
|
| Rate for Payer: HFN Commercial |
$563.04
|
| Rate for Payer: Multiplan Commercial |
$489.60
|
| Rate for Payer: NAPHCARE Commercial |
$367.20
|
| Rate for Payer: Preferred Network Access Commercial |
$563.04
|
| Rate for Payer: Quartz Beloit One Network |
$299.88
|
| Rate for Payer: Quartz Commercial |
$367.20
|
| Rate for Payer: WEA Trust Commercial |
$336.60
|
| Rate for Payer: WPS Commercial |
$453.31
|
|
|
Major joint or bursa w/ultrasound guidance 20611
|
Professional
|
Both
|
$1,188.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
4494833
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.94 |
| Max. Negotiated Rate |
$1,128.60 |
| Rate for Payer: Aetna Commercial |
$1,128.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,021.68
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,128.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$712.80
|
| Rate for Payer: Health EOS Commercial |
$1,081.08
|
| Rate for Payer: HFN Commercial |
$1,128.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$200.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$200.15
|
| Rate for Payer: Multiplan Commercial |
$950.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.60
|
| Rate for Payer: Quartz Beloit One Network |
$522.72
|
| Rate for Payer: Quartz Commercial |
$677.16
|
| Rate for Payer: The Alliance Commercial |
$594.00
|
| Rate for Payer: United Healthcare Medicaid |
$69.94
|
| Rate for Payer: WEA Trust Commercial |
$653.40
|
| Rate for Payer: WPS Commercial |
$879.95
|
|
|
MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES
|
Facility
|
IP
|
$66,365.00
|
|
|
Service Code
|
MSDRG 483
|
| Min. Negotiated Rate |
$23,872.40 |
| Max. Negotiated Rate |
$66,365.00 |
| Rate for Payer: Aetna Managed Medicare |
$23,872.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52,030.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39,880.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37,889.44
|
| Rate for Payer: Anthem Medicare Advantage |
$23,872.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,872.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,872.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,872.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42,060.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,872.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48,441.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,872.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,872.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,872.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,872.40
|
| Rate for Payer: NAPHCARE Commercial |
$35,808.60
|
| Rate for Payer: Quartz Medicare Advantage |
$23,872.40
|
| Rate for Payer: The Alliance Commercial |
$66,365.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,872.40
|
| Rate for Payer: United Healthcare PPO |
$37,712.64
|
| Rate for Payer: Wellcare Medicare |
$23,872.40
|
|
|
MAJOR MALE PELVIC PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$52,479.00
|
|
|
Service Code
|
MSDRG 707
|
| Min. Negotiated Rate |
$18,877.50 |
| Max. Negotiated Rate |
$52,479.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,877.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41,120.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31,518.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29,944.88
|
| Rate for Payer: Anthem Medicare Advantage |
$18,877.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,877.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,877.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,877.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,241.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,877.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,257.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,877.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,877.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,877.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,877.50
|
| Rate for Payer: NAPHCARE Commercial |
$28,316.25
|
| Rate for Payer: Quartz Medicare Advantage |
$18,877.50
|
| Rate for Payer: The Alliance Commercial |
$52,479.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,877.50
|
| Rate for Payer: United Healthcare PPO |
$29,783.60
|
| Rate for Payer: Wellcare Medicare |
$18,877.50
|
|
|
MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$39,096.00
|
|
|
Service Code
|
MSDRG 708
|
| Min. Negotiated Rate |
$14,063.34 |
| Max. Negotiated Rate |
$39,096.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,063.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,630.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,478.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,305.88
|
| Rate for Payer: Anthem Medicare Advantage |
$14,063.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,063.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,063.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,063.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,761.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,063.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,440.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,063.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,063.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,063.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,063.34
|
| Rate for Payer: NAPHCARE Commercial |
$21,095.01
|
| Rate for Payer: Quartz Medicare Advantage |
$14,063.34
|
| Rate for Payer: The Alliance Commercial |
$39,096.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,063.34
|
| Rate for Payer: United Healthcare PPO |
$22,141.49
|
| Rate for Payer: Wellcare Medicare |
$14,063.34
|
|
|
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$56,994.00
|
|
|
Service Code
|
MSDRG 507
|
| Min. Negotiated Rate |
$20,501.34 |
| Max. Negotiated Rate |
$56,994.00 |
| Rate for Payer: Aetna Managed Medicare |
$20,501.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44,687.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34,252.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32,542.14
|
| Rate for Payer: Anthem Medicare Advantage |
$20,501.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,501.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,501.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,501.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36,124.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,501.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,568.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,501.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,501.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,501.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,501.34
|
| Rate for Payer: NAPHCARE Commercial |
$30,752.01
|
| Rate for Payer: Quartz Medicare Advantage |
$20,501.34
|
| Rate for Payer: The Alliance Commercial |
$56,994.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,501.34
|
| Rate for Payer: United Healthcare PPO |
$32,361.34
|
| Rate for Payer: Wellcare Medicare |
$20,501.34
|
|
|
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$38,445.00
|
|
|
Service Code
|
MSDRG 508
|
| Min. Negotiated Rate |
$13,829.04 |
| Max. Negotiated Rate |
$38,445.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,829.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,001.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,995.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,847.54
|
| Rate for Payer: Anthem Medicare Advantage |
$13,829.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,829.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,829.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,829.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,252.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,829.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,963.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,829.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,829.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,829.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,829.04
|
| Rate for Payer: NAPHCARE Commercial |
$20,743.56
|
| Rate for Payer: Quartz Medicare Advantage |
$13,829.04
|
| Rate for Payer: The Alliance Commercial |
$38,445.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,829.04
|
| Rate for Payer: United Healthcare PPO |
$21,769.55
|
| Rate for Payer: Wellcare Medicare |
$13,829.04
|
|
|
MAJOR SKIN DISORDERS WITH MCC
|
Facility
|
IP
|
$58,145.00
|
|
|
Service Code
|
MSDRG 595
|
| Min. Negotiated Rate |
$20,915.44 |
| Max. Negotiated Rate |
$58,145.00 |
| Rate for Payer: Aetna Managed Medicare |
$20,915.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45,736.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35,056.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33,306.04
|
| Rate for Payer: Anthem Medicare Advantage |
$20,915.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,915.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,915.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,915.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36,972.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,915.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42,412.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,915.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,915.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,915.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,915.44
|
| Rate for Payer: NAPHCARE Commercial |
$31,373.16
|
| Rate for Payer: Quartz Medicare Advantage |
$20,915.44
|
| Rate for Payer: The Alliance Commercial |
$58,145.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,915.44
|
| Rate for Payer: United Healthcare PPO |
$33,018.68
|
| Rate for Payer: Wellcare Medicare |
$20,915.44
|
|
