|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$103.62
|
|
|
Service Code
|
NDC 60258-951-06
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.28 |
| Max. Negotiated Rate |
$93.26 |
| Rate for Payer: Aetna Commercial |
$88.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.35
|
| Rate for Payer: Cash Price |
$82.90
|
| Rate for Payer: Cofinity Commercial |
$72.53
|
| Rate for Payer: Cofinity Commercial |
$89.11
|
| Rate for Payer: Healthscope Commercial |
$93.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.08
|
| Rate for Payer: PHP Commercial |
$88.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.53
|
| Rate for Payer: Priority Health SBD |
$65.28
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$101.20
|
|
|
Service Code
|
NDC 51645-850-99
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.76 |
| Max. Negotiated Rate |
$91.08 |
| Rate for Payer: Aetna Commercial |
$86.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.78
|
| Rate for Payer: Cash Price |
$80.96
|
| Rate for Payer: Cofinity Commercial |
$70.84
|
| Rate for Payer: Cofinity Commercial |
$87.03
|
| Rate for Payer: Healthscope Commercial |
$91.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.02
|
| Rate for Payer: PHP Commercial |
$86.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.84
|
| Rate for Payer: Priority Health SBD |
$63.76
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
NDC 63739-432-10
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.85
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$132.30
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$160.65
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.30
|
| Rate for Payer: Priority Health SBD |
$119.07
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$94.50
|
|
|
Service Code
|
NDC 70000-0526-1
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.54 |
| Max. Negotiated Rate |
$85.05 |
| Rate for Payer: Aetna Commercial |
$80.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.42
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cofinity Commercial |
$66.15
|
| Rate for Payer: Cofinity Commercial |
$81.27
|
| Rate for Payer: Healthscope Commercial |
$85.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.32
|
| Rate for Payer: PHP Commercial |
$80.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.15
|
| Rate for Payer: Priority Health SBD |
$59.54
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$145.20
|
|
|
Service Code
|
NDC 60687-622-01
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.48 |
| Max. Negotiated Rate |
$130.68 |
| Rate for Payer: Aetna Commercial |
$123.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.38
|
| Rate for Payer: Cash Price |
$116.16
|
| Rate for Payer: Cofinity Commercial |
$101.64
|
| Rate for Payer: Cofinity Commercial |
$124.87
|
| Rate for Payer: Healthscope Commercial |
$130.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.42
|
| Rate for Payer: PHP Commercial |
$123.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.64
|
| Rate for Payer: Priority Health SBD |
$91.48
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
NDC 96295-13289
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.86 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Aetna Commercial |
$103.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.30
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cofinity Commercial |
$104.92
|
| Rate for Payer: Cofinity Commercial |
$85.40
|
| Rate for Payer: Healthscope Commercial |
$109.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.70
|
| Rate for Payer: PHP Commercial |
$103.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.40
|
| Rate for Payer: Priority Health SBD |
$76.86
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$132.30
|
|
|
Service Code
|
NDC 0904-6725-59
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.35 |
| Max. Negotiated Rate |
$119.07 |
| Rate for Payer: Aetna Commercial |
$112.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.00
|
| Rate for Payer: Cash Price |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$113.78
|
| Rate for Payer: Cofinity Commercial |
$92.61
|
| Rate for Payer: Healthscope Commercial |
$119.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.46
|
| Rate for Payer: PHP Commercial |
$112.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.61
|
| Rate for Payer: Priority Health SBD |
$83.35
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
NDC 49483-080-10
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$357.21 |
| Max. Negotiated Rate |
$510.30 |
| Rate for Payer: Aetna Commercial |
$481.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$368.55
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cofinity Commercial |
$396.90
|
| Rate for Payer: Cofinity Commercial |
$487.62
|
| Rate for Payer: Healthscope Commercial |
$510.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$481.95
|
| Rate for Payer: PHP Commercial |
$481.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$396.90
|
| Rate for Payer: Priority Health SBD |
$357.21
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$119.70
|
|
|
Service Code
|
NDC 49483-080-01
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.41 |
| Max. Negotiated Rate |
$107.73 |
| Rate for Payer: Aetna Commercial |
$101.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.80
|
| Rate for Payer: Cash Price |
$95.76
|
| Rate for Payer: Cofinity Commercial |
$102.94
|
| Rate for Payer: Cofinity Commercial |
$83.79
|
| Rate for Payer: Healthscope Commercial |
$107.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.74
|
| Rate for Payer: PHP Commercial |
$101.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.79
|
| Rate for Payer: Priority Health SBD |
$75.41
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$149.10
|
|
|
Service Code
|
NDC 67618-300-10
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.93 |
| Max. Negotiated Rate |
$134.19 |
| Rate for Payer: Aetna Commercial |
$126.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.92
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Cofinity Commercial |
$104.37
|
| Rate for Payer: Cofinity Commercial |
$128.23
|
| Rate for Payer: Healthscope Commercial |
$134.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.74
|
| Rate for Payer: PHP Commercial |
$126.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.37
|
| Rate for Payer: Priority Health SBD |
$93.93
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$299.25
|
|
|
Service Code
|
NDC 96295-13519
|
| 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 Commercial |
$209.48
|
| Rate for Payer: Cofinity Commercial |
$257.36
|
| Rate for Payer: Healthscope Commercial |
$269.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.36
|
| Rate for Payer: PHP Commercial |
$254.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.48
|
| Rate for Payer: Priority Health SBD |
$188.53
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$44.52
|
|
|
Service Code
|
NDC 67618-300-20
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$40.07 |
| Rate for Payer: Aetna Commercial |
$37.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.94
|
| Rate for Payer: Cash Price |
$35.62
|
| Rate for Payer: Cofinity Commercial |
$31.16
|
| Rate for Payer: Cofinity Commercial |
$38.29
|
| Rate for Payer: Healthscope Commercial |
$40.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.84
|
| Rate for Payer: PHP Commercial |
$37.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.16
|
| Rate for Payer: Priority Health SBD |
$28.05
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
NDC 0904-7252-61
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna Commercial |
$119.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$120.40
|
| Rate for Payer: Cofinity Commercial |
$98.00
|
| Rate for Payer: Healthscope Commercial |
$126.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.00
|
| Rate for Payer: PHP Commercial |
$119.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.00
|
| Rate for Payer: Priority Health SBD |
$88.20
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
NDC 0904-6522-61
|
| 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 Commercial |
$113.52
|
| Rate for Payer: Cofinity Commercial |
$92.40
|
| Rate for Payer: Healthscope Commercial |
$118.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.20
|
| Rate for Payer: PHP Commercial |
$112.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.40
|
| Rate for Payer: Priority Health SBD |
$83.16
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
NDC 70000-0447-3
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.92 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna Commercial |
$156.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.60
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$158.24
|
| Rate for Payer: Healthscope Commercial |
$165.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.40
|
| Rate for Payer: PHP Commercial |
$156.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.80
|
| Rate for Payer: Priority Health SBD |
$115.92
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$88.20
|
|
|
Service Code
|
NDC 9629513956
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.57 |
| Max. Negotiated Rate |
$79.38 |
| Rate for Payer: Aetna Commercial |
$74.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.33
|
| Rate for Payer: Cash Price |
$70.56
|
| Rate for Payer: Cofinity Commercial |
$61.74
|
| Rate for Payer: Cofinity Commercial |
$75.85
|
| Rate for Payer: Healthscope Commercial |
$79.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.97
|
| Rate for Payer: PHP Commercial |
$74.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.74
|
| Rate for Payer: Priority Health SBD |
$55.57
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$163.80
|
|
|
Service Code
|
NDC 51645-851-01
|
| 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 Commercial |
$114.66
|
| Rate for Payer: Cofinity Commercial |
$140.87
|
| Rate for Payer: Healthscope Commercial |
$147.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.23
|
| Rate for Payer: PHP Commercial |
$139.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.66
|
| Rate for Payer: Priority Health SBD |
$103.19
|
|
|
SENNOSIDES 8.6 MG TABLET
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
NDC 57896-454-01
|
| Hospital Charge Code |
11349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.62
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health SBD |
$67.47
|
|
|
SEPTIC ARTHRITIS WITH CC
|
Facility
|
IP
|
$18,399.37
|
|
|
Service Code
|
MS-DRG 549
|
| Min. Negotiated Rate |
$8,720.55 |
| Max. Negotiated Rate |
$18,399.37 |
| Rate for Payer: Aetna Medicare |
$9,546.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,474.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,474.41
|
| Rate for Payer: BCBS MAPPO |
$9,179.53
|
| Rate for Payer: BCBS Trust/PPO |
$15,685.31
|
| Rate for Payer: BCN Medicare Advantage |
$9,179.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,179.53
|
| Rate for Payer: Mclaren Medicare |
$9,179.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,638.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,556.46
|
| Rate for Payer: PACE Medicare |
$8,720.55
|
| Rate for Payer: PACE SWMI |
$9,179.53
|
| Rate for Payer: PHP Medicare Advantage |
$9,179.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,308.87
|
| Rate for Payer: Priority Health Medicare |
$9,179.53
|
| Rate for Payer: Priority Health Narrow Network |
$13,847.10
|
| Rate for Payer: Railroad Medicare Medicare |
$9,179.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,399.37
|
| Rate for Payer: UHC Core |
$11,290.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,179.53
|
| Rate for Payer: UHC Exchange |
$12,092.16
|
| Rate for Payer: UHC Medicare Advantage |
$9,454.92
|
| Rate for Payer: VA VA |
$9,179.53
|
|
|
SEPTIC ARTHRITIS WITH MCC
|
Facility
|
IP
|
$29,742.25
|
|
|
Service Code
|
MS-DRG 548
|
| Min. Negotiated Rate |
$13,808.04 |
| Max. Negotiated Rate |
$29,742.25 |
| Rate for Payer: Aetna Medicare |
$15,116.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,168.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,168.48
|
| Rate for Payer: BCBS MAPPO |
$14,534.78
|
| Rate for Payer: BCBS Trust/PPO |
$27,358.72
|
| Rate for Payer: BCN Medicare Advantage |
$14,534.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,534.78
|
| Rate for Payer: Mclaren Medicare |
$14,534.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,261.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,715.00
|
| Rate for Payer: PACE Medicare |
$13,808.04
|
| Rate for Payer: PACE SWMI |
$14,534.78
|
| Rate for Payer: PHP Medicare Advantage |
$14,534.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,979.47
|
| Rate for Payer: Priority Health Medicare |
$14,534.78
|
| Rate for Payer: Priority Health Narrow Network |
$22,383.58
|
| Rate for Payer: Railroad Medicare Medicare |
$14,534.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,742.25
|
| Rate for Payer: UHC Core |
$18,250.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,534.78
|
| Rate for Payer: UHC Exchange |
$19,546.75
|
| Rate for Payer: UHC Medicare Advantage |
$14,970.82
|
| Rate for Payer: VA VA |
$14,534.78
|
|
|
SEPTIC ARTHRITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$14,045.88
|
|
|
Service Code
|
MS-DRG 550
|
| Min. Negotiated Rate |
$6,923.25 |
| Max. Negotiated Rate |
$14,045.88 |
| Rate for Payer: Aetna Medicare |
$7,579.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,109.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,109.54
|
| Rate for Payer: BCBS MAPPO |
$7,287.63
|
| Rate for Payer: BCBS Trust/PPO |
$13,825.39
|
| Rate for Payer: BCN Medicare Advantage |
$7,287.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,287.63
|
| Rate for Payer: Mclaren Medicare |
$7,287.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,652.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,380.77
|
| Rate for Payer: PACE Medicare |
$6,923.25
|
| Rate for Payer: PACE SWMI |
$7,287.63
|
| Rate for Payer: PHP Medicare Advantage |
$7,287.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,213.41
|
| Rate for Payer: Priority Health Medicare |
$7,287.63
|
| Rate for Payer: Priority Health Narrow Network |
$10,570.73
|
| Rate for Payer: Railroad Medicare Medicare |
$7,287.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,045.88
|
| Rate for Payer: UHC Core |
$8,618.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,287.63
|
| Rate for Payer: UHC Exchange |
$9,231.02
|
| Rate for Payer: UHC Medicare Advantage |
$7,506.26
|
| Rate for Payer: VA VA |
$7,287.63
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS
|
Facility
|
IP
|
$117,838.58
|
|
|
Service Code
|
MS-DRG 870
|
| Min. Negotiated Rate |
$48,119.87 |
| Max. Negotiated Rate |
$117,838.58 |
| Rate for Payer: Aetna Medicare |
$52,678.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63,315.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63,315.61
|
| Rate for Payer: BCBS MAPPO |
$50,652.49
|
| Rate for Payer: BCBS Trust/PPO |
$117,838.58
|
| Rate for Payer: BCN Medicare Advantage |
$50,652.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50,652.49
|
| Rate for Payer: Mclaren Medicare |
$50,652.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53,185.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58,250.36
|
| Rate for Payer: PACE Medicare |
$48,119.87
|
| Rate for Payer: PACE SWMI |
$50,652.49
|
| Rate for Payer: PHP Medicare Advantage |
$50,652.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99,945.76
|
| Rate for Payer: Priority Health Medicare |
$50,652.49
|
| Rate for Payer: Priority Health Narrow Network |
$79,956.61
|
| Rate for Payer: Railroad Medicare Medicare |
$50,652.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106,242.58
|
| Rate for Payer: UHC Core |
$65,191.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$50,652.49
|
| Rate for Payer: UHC Exchange |
$69,823.12
|
| Rate for Payer: UHC Medicare Advantage |
$52,172.06
|
| Rate for Payer: VA VA |
$50,652.49
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC
|
Facility
|
IP
|
$30,242.58
|
|
|
Service Code
|
MS-DRG 871
|
| Min. Negotiated Rate |
$14,032.46 |
| Max. Negotiated Rate |
$30,242.58 |
| Rate for Payer: Aetna Medicare |
$15,361.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,463.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,463.76
|
| Rate for Payer: BCBS MAPPO |
$14,771.01
|
| Rate for Payer: BCBS Trust/PPO |
$29,111.05
|
| Rate for Payer: BCN Medicare Advantage |
$14,771.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,771.01
|
| Rate for Payer: Mclaren Medicare |
$14,771.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,509.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,986.66
|
| Rate for Payer: PACE Medicare |
$14,032.46
|
| Rate for Payer: PACE SWMI |
$14,771.01
|
| Rate for Payer: PHP Medicare Advantage |
$14,771.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,450.15
|
| Rate for Payer: Priority Health Medicare |
$14,771.01
|
| Rate for Payer: Priority Health Narrow Network |
$22,760.12
|
| Rate for Payer: Railroad Medicare Medicare |
$14,771.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30,242.58
|
| Rate for Payer: UHC Core |
$18,557.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,771.01
|
| Rate for Payer: UHC Exchange |
$19,875.57
|
| Rate for Payer: UHC Medicare Advantage |
$15,214.14
|
| Rate for Payer: VA VA |
$14,771.01
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC
|
Facility
|
IP
|
$15,710.09
|
|
|
Service Code
|
MS-DRG 872
|
| Min. Negotiated Rate |
$7,514.37 |
| Max. Negotiated Rate |
$15,710.09 |
| Rate for Payer: Aetna Medicare |
$8,226.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,887.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,887.32
|
| Rate for Payer: BCBS MAPPO |
$7,909.86
|
| Rate for Payer: BCBS Trust/PPO |
$13,471.85
|
| Rate for Payer: BCN Medicare Advantage |
$7,909.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,909.86
|
| Rate for Payer: Mclaren Medicare |
$7,909.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,305.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,096.34
|
| Rate for Payer: PACE Medicare |
$7,514.37
|
| Rate for Payer: PACE SWMI |
$7,909.86
|
| Rate for Payer: PHP Medicare Advantage |
$7,909.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,778.98
|
| Rate for Payer: Priority Health Medicare |
$7,909.86
|
| Rate for Payer: Priority Health Narrow Network |
$11,823.18
|
| Rate for Payer: Railroad Medicare Medicare |
$7,909.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,710.09
|
| Rate for Payer: UHC Core |
$9,639.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,909.86
|
| Rate for Payer: UHC Exchange |
$10,324.75
|
| Rate for Payer: UHC Medicare Advantage |
$8,147.16
|
| Rate for Payer: VA VA |
$7,909.86
|
|
|
SEPTOPLASTY OR SUBMUCOUS RESECTION, WITH OR WITHOUT CARTILAGE SCORING, CONTOURING OR REPLACEMENT WITH GRAFT
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 30520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$668.96 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,979.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,580.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,580.99
|
| Rate for Payer: BCBS Complete |
$1,645.54
|
| Rate for Payer: BCBS MAPPO |
$2,864.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,839.35
|
| Rate for Payer: BCN Medicare Advantage |
$2,864.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,864.79
|
| Rate for Payer: Mclaren Medicaid |
$1,567.04
|
| Rate for Payer: Mclaren Medicare |
$2,864.79
|
| Rate for Payer: Meridian Medicaid |
$1,645.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,008.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,294.51
|
| Rate for Payer: PACE Medicare |
$2,721.55
|
| Rate for Payer: PACE SWMI |
$2,864.79
|
| Rate for Payer: PHP Medicare Advantage |
$2,864.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,567.04
|
| Rate for Payer: Priority Health Medicare |
$2,864.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2,864.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$735.86
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,864.79
|
| Rate for Payer: UHC Exchange |
$668.96
|
| Rate for Payer: UHC Medicare Advantage |
$2,950.73
|
| Rate for Payer: VA VA |
$2,864.79
|
|
