|
SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
|
IP
|
$6,462.02
|
|
|
Service Code
|
APR-DRG 7203
|
| Min. Negotiated Rate |
$5,842.44 |
| Max. Negotiated Rate |
$6,462.02 |
| Rate for Payer: BCBS Complete |
$6,462.02
|
| Rate for Payer: Mclaren Medicaid |
$6,154.30
|
| Rate for Payer: Meridian Medicaid |
$6,462.02
|
| Rate for Payer: PHP Medicaid |
$5,842.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,154.30
|
| Rate for Payer: UHC Medicaid |
$6,154.30
|
| Rate for Payer: UHCCP Medicaid |
$6,154.30
|
|
|
SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
|
IP
|
$3,759.07
|
|
|
Service Code
|
APR-DRG 7201
|
| Min. Negotiated Rate |
$3,398.64 |
| Max. Negotiated Rate |
$3,759.07 |
| Rate for Payer: BCBS Complete |
$3,759.07
|
| Rate for Payer: Mclaren Medicaid |
$3,580.06
|
| Rate for Payer: Meridian Medicaid |
$3,759.07
|
| Rate for Payer: PHP Medicaid |
$3,398.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,580.06
|
| Rate for Payer: UHC Medicaid |
$3,580.06
|
| Rate for Payer: UHCCP Medicaid |
$3,580.06
|
|
|
SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
|
IP
|
$12,719.68
|
|
|
Service Code
|
APR-DRG 7204
|
| Min. Negotiated Rate |
$11,500.11 |
| Max. Negotiated Rate |
$12,719.68 |
| Rate for Payer: BCBS Complete |
$12,719.68
|
| Rate for Payer: Mclaren Medicaid |
$12,113.98
|
| Rate for Payer: Meridian Medicaid |
$12,719.68
|
| Rate for Payer: PHP Medicaid |
$11,500.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,113.98
|
| Rate for Payer: UHC Medicaid |
$12,113.98
|
| Rate for Payer: UHCCP Medicaid |
$12,113.98
|
|
|
SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
|
IP
|
$4,254.42
|
|
|
Service Code
|
APR-DRG 7202
|
| Min. Negotiated Rate |
$3,846.51 |
| Max. Negotiated Rate |
$4,254.42 |
| Rate for Payer: BCBS Complete |
$4,254.42
|
| Rate for Payer: Mclaren Medicaid |
$4,051.83
|
| Rate for Payer: Meridian Medicaid |
$4,254.42
|
| Rate for Payer: PHP Medicaid |
$3,846.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,051.83
|
| Rate for Payer: UHC Medicaid |
$4,051.83
|
| Rate for Payer: UHCCP Medicaid |
$4,051.83
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS
|
Facility
|
IP
|
$94,959.84
|
|
|
Service Code
|
MSDRG 870
|
| Min. Negotiated Rate |
$48,951.61 |
| Max. Negotiated Rate |
$94,959.84 |
| Rate for Payer: Aetna Medicare |
$51,528.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64,410.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64,410.01
|
| Rate for Payer: BCBS MAPPO |
$51,528.01
|
| Rate for Payer: BCN Medicare Advantage |
$51,528.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51,528.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$51,528.01
|
| Rate for Payer: Mclaren Medicare |
$51,528.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54,104.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59,257.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$56,680.81
|
| Rate for Payer: PACE Medicare |
$48,951.61
|
| Rate for Payer: PACE SWMI |
$51,528.01
|
| Rate for Payer: PHP Commercial |
$56,680.81
|
| Rate for Payer: PHP Medicare Advantage |
$51,528.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$94,959.84
|
| Rate for Payer: Priority Health Medicare |
$51,528.01
|
| Rate for Payer: Priority Health Narrow Network |
$75,967.87
|
| Rate for Payer: Railroad Medicare Medicare |
$51,528.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51,528.01
|
| Rate for Payer: UHC Exchange |
$79,868.42
|
| Rate for Payer: UHCCP DNSP |
$51,528.01
|
| Rate for Payer: VA VA |
$51,528.01
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC
|
Facility
|
IP
|
$26,687.62
|
|
|
Service Code
|
MSDRG 871
|
| Min. Negotiated Rate |
$14,955.74 |
| Max. Negotiated Rate |
$26,687.62 |
| Rate for Payer: Aetna Medicare |
$15,742.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,678.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,678.60
|
| Rate for Payer: BCBS MAPPO |
$15,742.88
|
| Rate for Payer: BCN Medicare Advantage |
$15,742.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,742.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,742.88
|
| Rate for Payer: Mclaren Medicare |
$15,742.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,530.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,104.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,317.17
|
| Rate for Payer: PACE Medicare |
$14,955.74
|
| Rate for Payer: PACE SWMI |
$15,742.88
|
| Rate for Payer: PHP Commercial |
$17,317.17
|
| Rate for Payer: PHP Medicare Advantage |
$15,742.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$26,687.62
|
| Rate for Payer: Priority Health Medicare |
$15,742.88
|
| Rate for Payer: Priority Health Narrow Network |
$21,350.10
|
| Rate for Payer: Railroad Medicare Medicare |
$15,742.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,742.88
|
| Rate for Payer: UHC Exchange |
$24,401.46
|
| Rate for Payer: UHCCP DNSP |
$15,742.88
|
| Rate for Payer: VA VA |
$15,742.88
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC
|
Facility
|
IP
|
$14,141.42
|
|
|
Service Code
|
MSDRG 872
|
| Min. Negotiated Rate |
$8,667.33 |
| Max. Negotiated Rate |
$14,141.42 |
| Rate for Payer: Aetna Medicare |
$9,123.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,404.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,404.38
|
| Rate for Payer: BCBS MAPPO |
$9,123.50
|
| Rate for Payer: BCN Medicare Advantage |
$9,123.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,123.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,123.50
|
| Rate for Payer: Mclaren Medicare |
$9,123.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,579.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,492.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,035.85
|
| Rate for Payer: PACE Medicare |
$8,667.33
|
| Rate for Payer: PACE SWMI |
$9,123.50
|
| Rate for Payer: PHP Commercial |
$10,035.85
|
| Rate for Payer: PHP Medicare Advantage |
$9,123.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14,058.91
|
| Rate for Payer: Priority Health Medicare |
$9,123.50
|
| Rate for Payer: Priority Health Narrow Network |
$11,247.13
|
| Rate for Payer: Railroad Medicare Medicare |
$9,123.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,123.50
|
| Rate for Payer: UHC Exchange |
$14,141.42
|
| Rate for Payer: UHCCP DNSP |
$9,123.50
|
| Rate for Payer: VA VA |
$9,123.50
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
OP
|
$3.07
|
|
|
Service Code
|
NDC 60687024211
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Aetna Commercial |
$2.76
|
| Rate for Payer: Aetna Medicare |
$1.14
|
| Rate for Payer: ASR ASR |
$2.98
|
| Rate for Payer: BCBS Complete |
$1.23
|
| Rate for Payer: BCBS Trust/PPO |
$2.53
|
| Rate for Payer: BCN Commercial |
$2.53
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$2.98
|
| Rate for Payer: Healthscope Whirlpool |
$3.07
|
| Rate for Payer: Mclaren Commercial |
$2.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.61
|
| Rate for Payer: Nomi Health Commercial |
$2.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.69
|
| Rate for Payer: Priority Health Narrow Network |
$2.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.70
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$3.07
|
|
|
Service Code
|
NDC 60687024211
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Aetna Commercial |
$2.76
|
| Rate for Payer: ASR ASR |
$2.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.52
|
| Rate for Payer: BCN Commercial |
$2.52
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$2.98
|
| Rate for Payer: Healthscope Whirlpool |
$3.07
|
| Rate for Payer: Mclaren Commercial |
$2.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.61
|
| Rate for Payer: Nomi Health Commercial |
$2.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.70
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$306.85
|
|
|
Service Code
|
NDC 60687024201
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$230.14 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Aetna Commercial |
$276.17
|
| Rate for Payer: ASR ASR |
$297.64
|
| Rate for Payer: BCBS Trust/PPO |
$251.99
|
| Rate for Payer: BCN Commercial |
$251.99
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Commercial |
$288.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$297.64
|
| Rate for Payer: Healthscope Whirlpool |
$306.85
|
| Rate for Payer: Mclaren Commercial |
$276.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: Nomi Health Commercial |
$251.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.03
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$225.60
|
|
|
Service Code
|
NDC 59762490003
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$203.04
|
| Rate for Payer: ASR ASR |
$218.83
|
| Rate for Payer: BCBS Trust/PPO |
$185.26
|
| Rate for Payer: BCN Commercial |
$185.26
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$212.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Healthscope Commercial |
$218.83
|
| Rate for Payer: Healthscope Whirlpool |
$225.60
|
| Rate for Payer: Mclaren Commercial |
$203.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.76
|
| Rate for Payer: Nomi Health Commercial |
$184.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.53
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
OP
|
$5,125.98
|
|
|
Service Code
|
NDC 49490041
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,896.61 |
| Max. Negotiated Rate |
$5,125.98 |
| Rate for Payer: Aetna Commercial |
$4,613.38
|
| Rate for Payer: Aetna Medicare |
$1,896.61
|
| Rate for Payer: ASR ASR |
$4,972.20
|
| Rate for Payer: BCBS Complete |
$2,050.39
|
| Rate for Payer: BCBS Trust/PPO |
$4,226.37
|
| Rate for Payer: BCN Commercial |
$4,226.37
|
| Rate for Payer: Cash Price |
$4,100.78
|
| Rate for Payer: Cofinity Commercial |
$4,818.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,100.78
|
| Rate for Payer: Healthscope Commercial |
$4,972.20
|
| Rate for Payer: Healthscope Whirlpool |
$5,125.98
|
| Rate for Payer: Mclaren Commercial |
$4,613.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,100.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,357.08
|
| Rate for Payer: Nomi Health Commercial |
$4,203.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,844.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,491.38
|
| Rate for Payer: Priority Health Narrow Network |
$3,593.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,510.86
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
OP
|
$225.60
|
|
|
Service Code
|
NDC 59762490003
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.47 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$203.04
|
| Rate for Payer: Aetna Medicare |
$83.47
|
| Rate for Payer: ASR ASR |
$218.83
|
| Rate for Payer: BCBS Complete |
$90.24
|
| Rate for Payer: BCBS Trust/PPO |
$186.01
|
| Rate for Payer: BCN Commercial |
$186.01
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$212.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Healthscope Commercial |
$218.83
|
| Rate for Payer: Healthscope Whirlpool |
$225.60
|
| Rate for Payer: Mclaren Commercial |
$203.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$180.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.76
|
| Rate for Payer: Nomi Health Commercial |
$184.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$197.67
|
| Rate for Payer: Priority Health Narrow Network |
$158.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.53
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
OP
|
$306.85
|
|
|
Service Code
|
NDC 60687024201
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.53 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Aetna Commercial |
$276.17
|
| Rate for Payer: Aetna Medicare |
$113.53
|
| Rate for Payer: ASR ASR |
$297.64
|
| Rate for Payer: BCBS Complete |
$122.74
|
| Rate for Payer: BCBS Trust/PPO |
$253.00
|
| Rate for Payer: BCN Commercial |
$253.00
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Commercial |
$288.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$297.64
|
| Rate for Payer: Healthscope Whirlpool |
$306.85
|
| Rate for Payer: Mclaren Commercial |
$276.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$245.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: Nomi Health Commercial |
$251.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$268.86
|
| Rate for Payer: Priority Health Narrow Network |
$215.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.03
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
OP
|
$36.66
|
|
|
Service Code
|
NDC 68180035206
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.56 |
| Max. Negotiated Rate |
$36.66 |
| Rate for Payer: Aetna Commercial |
$32.99
|
| Rate for Payer: Aetna Medicare |
$13.56
|
| Rate for Payer: ASR ASR |
$35.56
|
| Rate for Payer: BCBS Complete |
$14.66
|
| Rate for Payer: BCBS Trust/PPO |
$30.23
|
| Rate for Payer: BCN Commercial |
$30.23
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cofinity Commercial |
$34.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.33
|
| Rate for Payer: Healthscope Commercial |
$35.56
|
| Rate for Payer: Healthscope Whirlpool |
$36.66
|
| Rate for Payer: Mclaren Commercial |
$32.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.16
|
| Rate for Payer: Nomi Health Commercial |
$30.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$32.12
|
| Rate for Payer: Priority Health Narrow Network |
$25.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.26
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$5,125.98
|
|
|
Service Code
|
NDC 49490041
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,844.49 |
| Max. Negotiated Rate |
$5,125.98 |
| Rate for Payer: Aetna Commercial |
$4,613.38
|
| Rate for Payer: ASR ASR |
$4,972.20
|
| Rate for Payer: BCBS Trust/PPO |
$4,209.45
|
| Rate for Payer: BCN Commercial |
$4,209.45
|
| Rate for Payer: Cash Price |
$4,100.78
|
| Rate for Payer: Cofinity Commercial |
$4,818.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,100.78
|
| Rate for Payer: Healthscope Commercial |
$4,972.20
|
| Rate for Payer: Healthscope Whirlpool |
$5,125.98
|
| Rate for Payer: Mclaren Commercial |
$4,613.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,357.08
|
| Rate for Payer: Nomi Health Commercial |
$4,203.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,844.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,510.86
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
OP
|
$279.30
|
|
|
Service Code
|
NDC 904692561
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.34 |
| Max. Negotiated Rate |
$279.30 |
| Rate for Payer: Aetna Commercial |
$251.37
|
| Rate for Payer: Aetna Medicare |
$103.34
|
| Rate for Payer: ASR ASR |
$270.92
|
| Rate for Payer: BCBS Complete |
$111.72
|
| Rate for Payer: BCBS Trust/PPO |
$230.28
|
| Rate for Payer: BCN Commercial |
$230.28
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$262.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$270.92
|
| Rate for Payer: Healthscope Whirlpool |
$279.30
|
| Rate for Payer: Mclaren Commercial |
$251.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.41
|
| Rate for Payer: Nomi Health Commercial |
$229.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$244.72
|
| Rate for Payer: Priority Health Narrow Network |
$195.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.78
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$279.30
|
|
|
Service Code
|
NDC 904692561
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.47 |
| Max. Negotiated Rate |
$279.30 |
| Rate for Payer: Aetna Commercial |
$251.37
|
| Rate for Payer: ASR ASR |
$270.92
|
| Rate for Payer: BCBS Trust/PPO |
$229.36
|
| Rate for Payer: BCN Commercial |
$229.36
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$262.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$270.92
|
| Rate for Payer: Healthscope Whirlpool |
$279.30
|
| Rate for Payer: Mclaren Commercial |
$251.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.41
|
| Rate for Payer: Nomi Health Commercial |
$229.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.78
|
|
|
SERTRALINE 50 MG TABLET
|
Facility
|
IP
|
$36.66
|
|
|
Service Code
|
NDC 68180035206
|
| Hospital Charge Code |
11351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$36.66 |
| Rate for Payer: Aetna Commercial |
$32.99
|
| Rate for Payer: ASR ASR |
$35.56
|
| Rate for Payer: BCBS Trust/PPO |
$30.11
|
| Rate for Payer: BCN Commercial |
$30.11
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cofinity Commercial |
$34.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.33
|
| Rate for Payer: Healthscope Commercial |
$35.56
|
| Rate for Payer: Healthscope Whirlpool |
$36.66
|
| Rate for Payer: Mclaren Commercial |
$32.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.16
|
| Rate for Payer: Nomi Health Commercial |
$30.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.26
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
|
IP
|
$22,549.49
|
|
|
Service Code
|
APR-DRG 3224
|
| Min. Negotiated Rate |
$20,387.43 |
| Max. Negotiated Rate |
$22,549.49 |
| Rate for Payer: BCBS Complete |
$22,549.49
|
| Rate for Payer: Mclaren Medicaid |
$21,475.70
|
| Rate for Payer: Meridian Medicaid |
$22,549.49
|
| Rate for Payer: PHP Medicaid |
$20,387.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,475.70
|
| Rate for Payer: UHC Medicaid |
$21,475.70
|
| Rate for Payer: UHCCP Medicaid |
$21,475.70
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
|
IP
|
$9,649.97
|
|
|
Service Code
|
APR-DRG 3221
|
| Min. Negotiated Rate |
$8,724.73 |
| Max. Negotiated Rate |
$9,649.97 |
| Rate for Payer: BCBS Complete |
$9,649.97
|
| Rate for Payer: Mclaren Medicaid |
$9,190.45
|
| Rate for Payer: Meridian Medicaid |
$9,649.97
|
| Rate for Payer: PHP Medicaid |
$8,724.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,190.45
|
| Rate for Payer: UHC Medicaid |
$9,190.45
|
| Rate for Payer: UHCCP Medicaid |
$9,190.45
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
|
IP
|
$15,790.47
|
|
|
Service Code
|
APR-DRG 3223
|
| Min. Negotiated Rate |
$14,276.48 |
| Max. Negotiated Rate |
$15,790.47 |
| Rate for Payer: BCBS Complete |
$15,790.47
|
| Rate for Payer: Mclaren Medicaid |
$15,038.54
|
| Rate for Payer: Meridian Medicaid |
$15,790.47
|
| Rate for Payer: PHP Medicaid |
$14,276.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,038.54
|
| Rate for Payer: UHC Medicaid |
$15,038.54
|
| Rate for Payer: UHCCP Medicaid |
$15,038.54
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
|
IP
|
$11,945.30
|
|
|
Service Code
|
APR-DRG 3222
|
| Min. Negotiated Rate |
$10,799.98 |
| Max. Negotiated Rate |
$11,945.30 |
| Rate for Payer: BCBS Complete |
$11,945.30
|
| Rate for Payer: Mclaren Medicaid |
$11,376.48
|
| Rate for Payer: Meridian Medicaid |
$11,945.30
|
| Rate for Payer: PHP Medicaid |
$10,799.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,376.48
|
| Rate for Payer: UHC Medicaid |
$11,376.48
|
| Rate for Payer: UHCCP Medicaid |
$11,376.48
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC
|
Facility
|
IP
|
$28,568.46
|
|
|
Service Code
|
MSDRG 511
|
| Min. Negotiated Rate |
$15,892.29 |
| Max. Negotiated Rate |
$28,568.46 |
| Rate for Payer: Aetna Medicare |
$16,728.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,910.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,910.91
|
| Rate for Payer: BCBS MAPPO |
$16,728.73
|
| Rate for Payer: BCN Medicare Advantage |
$16,728.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,728.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,728.73
|
| Rate for Payer: Mclaren Medicare |
$16,728.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,565.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,238.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,401.60
|
| Rate for Payer: PACE Medicare |
$15,892.29
|
| Rate for Payer: PACE SWMI |
$16,728.73
|
| Rate for Payer: PHP Commercial |
$18,401.60
|
| Rate for Payer: PHP Medicare Advantage |
$16,728.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28,568.46
|
| Rate for Payer: Priority Health Medicare |
$16,728.73
|
| Rate for Payer: Priority Health Narrow Network |
$22,854.77
|
| Rate for Payer: Railroad Medicare Medicare |
$16,728.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,728.73
|
| Rate for Payer: UHC Exchange |
$25,929.53
|
| Rate for Payer: UHCCP DNSP |
$16,728.73
|
| Rate for Payer: VA VA |
$16,728.73
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC
|
Facility
|
IP
|
$41,498.05
|
|
|
Service Code
|
MSDRG 510
|
| Min. Negotiated Rate |
$22,330.53 |
| Max. Negotiated Rate |
$41,498.05 |
| Rate for Payer: Aetna Medicare |
$23,505.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,382.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,382.28
|
| Rate for Payer: BCBS MAPPO |
$23,505.82
|
| Rate for Payer: BCN Medicare Advantage |
$23,505.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,505.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$23,505.82
|
| Rate for Payer: Mclaren Medicare |
$23,505.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24,681.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,031.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$25,856.40
|
| Rate for Payer: PACE Medicare |
$22,330.53
|
| Rate for Payer: PACE SWMI |
$23,505.82
|
| Rate for Payer: PHP Commercial |
$25,856.40
|
| Rate for Payer: PHP Medicare Advantage |
$23,505.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41,498.05
|
| Rate for Payer: Priority Health Medicare |
$23,505.82
|
| Rate for Payer: Priority Health Narrow Network |
$33,198.44
|
| Rate for Payer: Railroad Medicare Medicare |
$23,505.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23,505.82
|
| Rate for Payer: UHC Exchange |
$36,434.02
|
| Rate for Payer: UHCCP DNSP |
$23,505.82
|
| Rate for Payer: VA VA |
$23,505.82
|
|
