|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
NDC 49483008010
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.11 |
| Max. Negotiated Rate |
$680.40 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Medicare |
$378.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$491.40
|
| Rate for Payer: BCBS Complete |
$302.40
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cofinity Advantage |
$529.20
|
| Rate for Payer: Cofinity Commercial |
$650.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.80
|
| Rate for Payer: Healthscope Commercial |
$680.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$604.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$567.00
|
| Rate for Payer: PHP Commercial |
$642.60
|
| Rate for Payer: Priority Health SBD |
$476.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$491.40
|
| Rate for Payer: UHC Core |
$393.88
|
| Rate for Payer: UHC Exchange |
$297.11
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$56.70
|
|
|
Service Code
|
NDC 70000044703
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.72 |
| Max. Negotiated Rate |
$51.03 |
| Rate for Payer: Aetna Commercial |
$48.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.85
|
| Rate for Payer: Cash Price |
$45.36
|
| Rate for Payer: Cofinity Advantage |
$39.69
|
| Rate for Payer: Cofinity Commercial |
$48.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.36
|
| Rate for Payer: Healthscope Commercial |
$51.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.52
|
| Rate for Payer: PHP Commercial |
$48.20
|
| Rate for Payer: Priority Health SBD |
$35.72
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$299.25
|
|
|
Service Code
|
NDC 96295013519
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.53 |
| Max. Negotiated Rate |
$269.32 |
| Rate for Payer: Aetna Commercial |
$254.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.51
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cofinity Advantage |
$209.47
|
| Rate for Payer: Cofinity Commercial |
$257.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.40
|
| Rate for Payer: Healthscope Commercial |
$269.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.44
|
| Rate for Payer: PHP Commercial |
$254.36
|
| Rate for Payer: Priority Health SBD |
$188.53
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
NDC 00904725261
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.24 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Advantage |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.00
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health SBD |
$93.24
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$163.80
|
|
|
Service Code
|
NDC 51645085101
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.37 |
| Max. Negotiated Rate |
$147.42 |
| Rate for Payer: Aetna Commercial |
$139.23
|
| Rate for Payer: Aetna Medicare |
$81.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.47
|
| Rate for Payer: BCBS Complete |
$65.52
|
| Rate for Payer: Cash Price |
$131.04
|
| Rate for Payer: Cofinity Advantage |
$114.66
|
| Rate for Payer: Cofinity Commercial |
$140.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.04
|
| Rate for Payer: Healthscope Commercial |
$147.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.85
|
| Rate for Payer: PHP Commercial |
$139.23
|
| Rate for Payer: Priority Health SBD |
$103.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.47
|
| Rate for Payer: UHC Core |
$85.34
|
| Rate for Payer: UHC Exchange |
$64.37
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$299.25
|
|
|
Service Code
|
NDC 96295013519
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.61 |
| Max. Negotiated Rate |
$269.32 |
| Rate for Payer: Aetna Commercial |
$254.36
|
| Rate for Payer: Aetna Medicare |
$149.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.51
|
| Rate for Payer: BCBS Complete |
$119.70
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cofinity Advantage |
$209.47
|
| Rate for Payer: Cofinity Commercial |
$257.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.40
|
| Rate for Payer: Healthscope Commercial |
$269.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$239.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.44
|
| Rate for Payer: PHP Commercial |
$254.36
|
| Rate for Payer: Priority Health SBD |
$188.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.51
|
| Rate for Payer: UHC Core |
$155.91
|
| Rate for Payer: UHC Exchange |
$117.61
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$94.50
|
|
|
Service Code
|
NDC 00904725260
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.14 |
| Max. Negotiated Rate |
$85.05 |
| Rate for Payer: Aetna Commercial |
$80.33
|
| Rate for Payer: Aetna Medicare |
$47.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.42
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cofinity Advantage |
$66.15
|
| Rate for Payer: Cofinity Commercial |
$81.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.60
|
| Rate for Payer: Healthscope Commercial |
$85.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.88
|
| Rate for Payer: PHP Commercial |
$80.33
|
| Rate for Payer: Priority Health SBD |
$59.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.42
|
| Rate for Payer: UHC Core |
$49.23
|
| Rate for Payer: UHC Exchange |
$37.14
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
NDC 57896043401
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.61
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Advantage |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.33
|
| Rate for Payer: PHP Commercial |
$91.03
|
| Rate for Payer: Priority Health SBD |
$67.47
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$132.30
|
|
|
Service Code
|
NDC 49483008001
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.35 |
| Max. Negotiated Rate |
$119.07 |
| Rate for Payer: Aetna Commercial |
$112.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.00
|
| Rate for Payer: Cash Price |
$105.84
|
| Rate for Payer: Cofinity Advantage |
$92.61
|
| Rate for Payer: Cofinity Commercial |
$113.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.84
|
| Rate for Payer: Healthscope Commercial |
$119.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.22
|
| Rate for Payer: PHP Commercial |
$112.45
|
| Rate for Payer: Priority Health SBD |
$83.35
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
NDC 00904652261
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.16 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna Commercial |
$112.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Advantage |
$92.40
|
| Rate for Payer: Cofinity Commercial |
$113.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
| Rate for Payer: Healthscope Commercial |
$118.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.00
|
| Rate for Payer: PHP Commercial |
$112.20
|
| Rate for Payer: Priority Health SBD |
$83.16
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$44.52
|
|
|
Service Code
|
NDC 67618030020
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$40.07 |
| Rate for Payer: Aetna Commercial |
$37.84
|
| Rate for Payer: Aetna Medicare |
$22.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.94
|
| Rate for Payer: BCBS Complete |
$17.81
|
| Rate for Payer: Cash Price |
$35.62
|
| Rate for Payer: Cofinity Advantage |
$31.16
|
| Rate for Payer: Cofinity Commercial |
$38.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.62
|
| Rate for Payer: Healthscope Commercial |
$40.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.39
|
| Rate for Payer: PHP Commercial |
$37.84
|
| Rate for Payer: Priority Health SBD |
$28.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.94
|
| Rate for Payer: UHC Core |
$23.19
|
| Rate for Payer: UHC Exchange |
$17.50
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$149.10
|
|
|
Service Code
|
NDC 67618030010
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$134.19 |
| Rate for Payer: Aetna Commercial |
$126.73
|
| Rate for Payer: Aetna Medicare |
$74.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.92
|
| Rate for Payer: BCBS Complete |
$59.64
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Cofinity Advantage |
$104.37
|
| Rate for Payer: Cofinity Commercial |
$128.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.28
|
| Rate for Payer: Healthscope Commercial |
$134.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.83
|
| Rate for Payer: PHP Commercial |
$126.73
|
| Rate for Payer: Priority Health SBD |
$93.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.92
|
| Rate for Payer: UHC Core |
$77.68
|
| Rate for Payer: UHC Exchange |
$58.60
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
NDC 57896045401
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.61
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Advantage |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.33
|
| Rate for Payer: PHP Commercial |
$91.03
|
| Rate for Payer: Priority Health SBD |
$67.47
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
NDC 96295013289
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.95 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Aetna Commercial |
$103.70
|
| Rate for Payer: Aetna Medicare |
$61.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.30
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cofinity Advantage |
$85.40
|
| Rate for Payer: Cofinity Commercial |
$104.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.60
|
| Rate for Payer: Healthscope Commercial |
$109.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.50
|
| Rate for Payer: PHP Commercial |
$103.70
|
| Rate for Payer: Priority Health SBD |
$76.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.30
|
| Rate for Payer: UHC Core |
$63.56
|
| Rate for Payer: UHC Exchange |
$47.95
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$163.80
|
|
|
Service Code
|
NDC 51645085101
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.19 |
| Max. Negotiated Rate |
$147.42 |
| Rate for Payer: Aetna Commercial |
$139.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.47
|
| Rate for Payer: Cash Price |
$131.04
|
| Rate for Payer: Cofinity Advantage |
$114.66
|
| Rate for Payer: Cofinity Commercial |
$140.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.04
|
| Rate for Payer: Healthscope Commercial |
$147.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.85
|
| Rate for Payer: PHP Commercial |
$139.23
|
| Rate for Payer: Priority Health SBD |
$103.19
|
|
|
SEPTIC ARTHRITIS WITH CC
|
Facility
|
IP
|
$19,677.36
|
|
|
Service Code
|
MSDRG 549
|
| Min. Negotiated Rate |
$9,413.08 |
| Max. Negotiated Rate |
$19,677.36 |
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,677.36
|
| Rate for Payer: Aetna Medicare |
$10,304.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,385.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,385.64
|
| Rate for Payer: BCBS MAPPO |
$9,908.51
|
| Rate for Payer: BCBS Trust/PPO |
$16,720.33
|
| Rate for Payer: BCN Commercial |
$16,720.33
|
| Rate for Payer: BCN Medicare Advantage |
$9,908.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,908.51
|
| Rate for Payer: Mclaren Medicare |
$9,908.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,403.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,394.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,899.36
|
| Rate for Payer: Nomi Health Commercial |
$15,572.88
|
| Rate for Payer: PACE Medicare |
$9,413.08
|
| Rate for Payer: PACE SWMI |
$9,908.51
|
| Rate for Payer: PHP Medicare Advantage |
$9,908.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,462.65
|
| Rate for Payer: Priority Health Medicare |
$9,908.51
|
| Rate for Payer: Priority Health Tiered Network |
$15,570.12
|
| Rate for Payer: Railroad Medicare Medicare |
$9,908.51
|
| Rate for Payer: UHC Core |
$16,462.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,908.51
|
| Rate for Payer: UHC Exchange |
$13,444.59
|
| Rate for Payer: VA VA |
$9,908.51
|
|
|
SEPTIC ARTHRITIS WITH MCC
|
Facility
|
IP
|
$31,473.67
|
|
|
Service Code
|
MSDRG 548
|
| Min. Negotiated Rate |
$14,726.35 |
| Max. Negotiated Rate |
$31,473.67 |
| Rate for Payer: Aetna Medicare |
$16,121.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,376.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,376.78
|
| Rate for Payer: BCBS MAPPO |
$15,501.42
|
| Rate for Payer: BCBS Trust/PPO |
$29,164.03
|
| Rate for Payer: BCN Commercial |
$29,164.03
|
| Rate for Payer: BCN Medicare Advantage |
$15,501.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,501.42
|
| Rate for Payer: Mclaren Medicare |
$15,501.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,276.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,826.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,051.56
|
| Rate for Payer: Nomi Health Commercial |
$24,908.61
|
| Rate for Payer: PACE Medicare |
$14,726.35
|
| Rate for Payer: PACE SWMI |
$15,501.42
|
| Rate for Payer: PHP Medicare Advantage |
$15,501.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31,130.24
|
| Rate for Payer: Priority Health Medicare |
$15,501.42
|
| Rate for Payer: Priority Health Tiered Network |
$24,904.19
|
| Rate for Payer: Railroad Medicare Medicare |
$15,501.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,473.67
|
| Rate for Payer: UHC Core |
$26,331.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,501.42
|
| Rate for Payer: UHC Exchange |
$21,504.43
|
| Rate for Payer: VA VA |
$15,501.42
|
|
|
SEPTIC ARTHRITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$14,737.68
|
|
|
Service Code
|
MSDRG 550
|
| Min. Negotiated Rate |
$6,967.54 |
| Max. Negotiated Rate |
$14,737.68 |
| Rate for Payer: Aetna Medicare |
$7,627.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,167.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,167.81
|
| Rate for Payer: BCBS MAPPO |
$7,334.25
|
| Rate for Payer: BCBS Trust/PPO |
$14,737.68
|
| Rate for Payer: BCN Commercial |
$14,737.68
|
| Rate for Payer: BCN Medicare Advantage |
$7,334.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,334.25
|
| Rate for Payer: Mclaren Medicare |
$7,334.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,700.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,434.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,067.68
|
| Rate for Payer: Nomi Health Commercial |
$11,275.89
|
| Rate for Payer: PACE Medicare |
$6,967.54
|
| Rate for Payer: PACE SWMI |
$7,334.25
|
| Rate for Payer: PHP Medicare Advantage |
$7,334.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,092.36
|
| Rate for Payer: Priority Health Medicare |
$7,334.25
|
| Rate for Payer: Priority Health Tiered Network |
$11,273.89
|
| Rate for Payer: Railroad Medicare Medicare |
$7,334.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,247.83
|
| Rate for Payer: UHC Core |
$11,920.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,334.25
|
| Rate for Payer: UHC Exchange |
$9,734.85
|
| Rate for Payer: VA VA |
$7,334.25
|
|
|
SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
|
IP
|
$4,475.75
|
|
|
Service Code
|
APR-DRG 7202
|
| Min. Negotiated Rate |
$4,262.62 |
| Max. Negotiated Rate |
$4,475.75 |
| Rate for Payer: BCBS Complete |
$4,475.75
|
| Rate for Payer: Mclaren Medicaid |
$4,262.62
|
| Rate for Payer: Meridian Medicaid |
$4,475.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,262.62
|
| Rate for Payer: UHC Medicaid |
$4,262.62
|
| Rate for Payer: UHCCP Medicaid |
$4,262.62
|
|
|
SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
|
IP
|
$13,381.40
|
|
|
Service Code
|
APR-DRG 7204
|
| Min. Negotiated Rate |
$12,744.19 |
| Max. Negotiated Rate |
$13,381.40 |
| Rate for Payer: BCBS Complete |
$13,381.40
|
| Rate for Payer: Mclaren Medicaid |
$12,744.19
|
| Rate for Payer: Meridian Medicaid |
$13,381.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,744.19
|
| Rate for Payer: UHC Medicaid |
$12,744.19
|
| Rate for Payer: UHCCP Medicaid |
$12,744.19
|
|
|
SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
|
IP
|
$3,954.62
|
|
|
Service Code
|
APR-DRG 7201
|
| Min. Negotiated Rate |
$3,766.31 |
| Max. Negotiated Rate |
$3,954.62 |
| Rate for Payer: BCBS Complete |
$3,954.62
|
| Rate for Payer: Mclaren Medicaid |
$3,766.31
|
| Rate for Payer: Meridian Medicaid |
$3,954.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,766.31
|
| Rate for Payer: UHC Medicaid |
$3,766.31
|
| Rate for Payer: UHCCP Medicaid |
$3,766.31
|
|
|
SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
|
IP
|
$6,798.19
|
|
|
Service Code
|
APR-DRG 7203
|
| Min. Negotiated Rate |
$6,474.47 |
| Max. Negotiated Rate |
$6,798.19 |
| Rate for Payer: BCBS Complete |
$6,798.19
|
| Rate for Payer: Mclaren Medicaid |
$6,474.47
|
| Rate for Payer: Meridian Medicaid |
$6,798.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,474.47
|
| Rate for Payer: UHC Medicaid |
$6,474.47
|
| Rate for Payer: UHCCP Medicaid |
$6,474.47
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS
|
Facility
|
IP
|
$125,614.35
|
|
|
Service Code
|
MSDRG 870
|
| Min. Negotiated Rate |
$51,295.20 |
| Max. Negotiated Rate |
$125,614.35 |
| Rate for Payer: Aetna Medicare |
$56,154.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67,493.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67,493.69
|
| Rate for Payer: BCBS MAPPO |
$53,994.95
|
| Rate for Payer: BCBS Trust/PPO |
$125,614.35
|
| Rate for Payer: BCN Commercial |
$125,614.35
|
| Rate for Payer: BCN Medicare Advantage |
$53,994.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53,994.95
|
| Rate for Payer: Mclaren Medicare |
$53,994.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56,694.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62,094.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$59,394.44
|
| Rate for Payer: Nomi Health Commercial |
$89,162.22
|
| Rate for Payer: PACE Medicare |
$51,295.20
|
| Rate for Payer: PACE SWMI |
$53,994.95
|
| Rate for Payer: PHP Medicare Advantage |
$53,994.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$111,433.01
|
| Rate for Payer: Priority Health Medicare |
$53,994.95
|
| Rate for Payer: Priority Health Tiered Network |
$89,146.39
|
| Rate for Payer: Railroad Medicare Medicare |
$53,994.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112,662.34
|
| Rate for Payer: UHC Core |
$94,256.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$53,994.95
|
| Rate for Payer: UHC Exchange |
$76,976.72
|
| Rate for Payer: VA VA |
$53,994.95
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC
|
Facility
|
IP
|
$31,662.75
|
|
|
Service Code
|
MSDRG 871
|
| Min. Negotiated Rate |
$14,811.53 |
| Max. Negotiated Rate |
$31,662.75 |
| Rate for Payer: Aetna Medicare |
$16,214.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,488.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,488.85
|
| Rate for Payer: BCBS MAPPO |
$15,591.08
|
| Rate for Payer: BCBS Trust/PPO |
$31,022.62
|
| Rate for Payer: BCN Commercial |
$31,022.62
|
| Rate for Payer: BCN Medicare Advantage |
$15,591.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,591.08
|
| Rate for Payer: Mclaren Medicare |
$15,591.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,370.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,929.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,150.19
|
| Rate for Payer: Nomi Health Commercial |
$25,058.25
|
| Rate for Payer: PACE Medicare |
$14,811.53
|
| Rate for Payer: PACE SWMI |
$15,591.08
|
| Rate for Payer: PHP Medicare Advantage |
$15,591.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31,317.26
|
| Rate for Payer: Priority Health Medicare |
$15,591.08
|
| Rate for Payer: Priority Health Tiered Network |
$25,053.80
|
| Rate for Payer: Railroad Medicare Medicare |
$15,591.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,662.75
|
| Rate for Payer: UHC Core |
$26,489.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,591.08
|
| Rate for Payer: UHC Exchange |
$21,633.62
|
| Rate for Payer: VA VA |
$15,591.08
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC
|
Facility
|
IP
|
$16,679.79
|
|
|
Service Code
|
MSDRG 872
|
| Min. Negotiated Rate |
$8,062.94 |
| Max. Negotiated Rate |
$16,679.79 |
| Rate for Payer: Aetna Medicare |
$8,826.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,609.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,609.12
|
| Rate for Payer: BCBS MAPPO |
$8,487.30
|
| Rate for Payer: BCBS Trust/PPO |
$14,344.42
|
| Rate for Payer: BCN Commercial |
$14,344.42
|
| Rate for Payer: BCN Medicare Advantage |
$8,487.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,487.30
|
| Rate for Payer: Mclaren Medicare |
$8,487.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,911.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,760.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,336.03
|
| Rate for Payer: Nomi Health Commercial |
$13,200.57
|
| Rate for Payer: PACE Medicare |
$8,062.94
|
| Rate for Payer: PACE SWMI |
$8,487.30
|
| Rate for Payer: PHP Medicare Advantage |
$8,487.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,497.79
|
| Rate for Payer: Priority Health Medicare |
$8,487.30
|
| Rate for Payer: Priority Health Tiered Network |
$13,198.23
|
| Rate for Payer: Railroad Medicare Medicare |
$8,487.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,679.79
|
| Rate for Payer: UHC Core |
$13,954.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,487.30
|
| Rate for Payer: UHC Exchange |
$11,396.49
|
| Rate for Payer: VA VA |
$8,487.30
|
|
