FAC|Code_Type|Code|CODE_DESC|Procedure|Procedure_Description|NDC|Rev_Code| Plan |IP_Expected_Reimbursement|IP_Expected_Reimbursement_MIN|IP_Expected_Reimbursement_MAX|IP_cash_price|Gross_ip_chg|OP_Expected_Reimbursement|OP_Expected_Reimbursement_MIN|OP_Expected_Reimbursement_MAX|OP_cash_price|Gross_op_chg|FDATE 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC166|166|Other respiratory system O.R. procedures with MCC||| 1100313001-BLUE CROSS NETWORK S |52950.00|52950.00|135291.32|103723.34|450971.05||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC166|166|Other respiratory system O.R. procedures with MCC||| 1100313002-BLUE CROSS BAPTIST EMPLOYEE |52950.00|52950.00|135291.32|103723.34|450971.05||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC166|166|Other respiratory system O.R. procedures with MCC||| 1100315001-BLUE CROSS ARKANSAS EXCHANGE |52950.00|52950.00|135291.32|103723.34|450971.05||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC166|166|Other respiratory system O.R. procedures with MCC||| 1100316001-BLUE CROSS TENNESSEE NETWORK P |52950.00|52950.00|135291.32|103723.34|450971.05||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC166|166|Other respiratory system O.R. procedures with MCC||| 1100330002-BLUE CROSS MISSISSIPPI |52950.00|52950.00|135291.32|103723.34|450971.05||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC166|166|Other respiratory system O.R. procedures with MCC||| 1100331002-BLUE CROSS ARKANSAS |60000.00|52950.00|135291.32|103723.34|450971.05||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC166|166|Other respiratory system O.R. procedures with MCC||| 1100332002-BLUE CROSS OUT OF STATE |52950.00|52950.00|135291.32|103723.34|450971.05||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC166|166|Other respiratory system O.R. procedures with MCC||| 1100335001-BLUE CROSS FEDERAL |52950.00|52950.00|135291.32|103723.34|450971.05||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC166|166|Other respiratory system O.R. procedures with MCC||| 1103161061-AETNA MAILHANDLERS BENEFIT 60054 |119507.33|52950.00|135291.32|103723.34|450971.05||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC166|166|Other respiratory system O.R. procedures with MCC||| 1103164001-AETNA 60054 |119507.33|52950.00|135291.32|103723.34|450971.05||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC166|166|Other respiratory system O.R. procedures with MCC||| 1104112001-MEDICARE ADVANTAGE HUMANA |94597.95|52950.00|135291.32|103723.34|450971.05||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC166|166|Other respiratory system O.R. procedures with MCC||| 1104119001-MEDICARE ADV CIGNA HEALTHSPRINGS |94597.95|52950.00|135291.32|103723.34|450971.05||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC166|166|Other respiratory system O.R. procedures with MCC||| 1104129001-MEDICARE ADVANTAGE BLUE CROSS |94597.95|52950.00|135291.32|103723.34|450971.05||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC166|166|Other respiratory system O.R. procedures with MCC||| 1104150001-AMERIGROUP AMERIVANTAGE SPECIALTY |94597.95|52950.00|135291.32|103723.34|450971.05||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC166|166|Other respiratory system O.R. procedures with MCC||| 1001583001-TRICARE |135291.32|52950.00|135291.32|103723.34|450971.05||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC177|177|Respiratory infections and inflammations with MCC*||| 1100313001-BLUE CROSS NETWORK S |18003.00|18003.00|33551.03|23661.78|102877.30||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC177|177|Respiratory infections and inflammations with MCC*||| 1100313002-BLUE CROSS BAPTIST EMPLOYEE |18003.00|18003.00|33551.03|23661.78|102877.30||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC177|177|Respiratory infections and inflammations with MCC*||| 1100315001-BLUE CROSS ARKANSAS EXCHANGE |18003.00|18003.00|33551.03|23661.78|102877.30||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC177|177|Respiratory infections and inflammations with MCC*||| 1100316001-BLUE CROSS TENNESSEE NETWORK P |18003.00|18003.00|33551.03|23661.78|102877.30||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC177|177|Respiratory infections and inflammations with MCC*||| 1100330002-BLUE CROSS MISSISSIPPI |18003.00|18003.00|33551.03|23661.78|102877.30||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC177|177|Respiratory infections and inflammations with MCC*||| 1100331002-BLUE CROSS ARKANSAS |20400.00|18003.00|33551.03|23661.78|102877.30||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC177|177|Respiratory infections and inflammations with MCC*||| 1100332002-BLUE CROSS OUT OF STATE |18003.00|18003.00|33551.03|23661.78|102877.30||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC177|177|Respiratory infections and inflammations with MCC*||| 1100335001-BLUE CROSS FEDERAL |18003.00|18003.00|33551.03|23661.78|102877.30||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC177|177|Respiratory infections and inflammations with MCC*||| 1103161061-AETNA MAILHANDLERS BENEFIT 60054 |27262.48|18003.00|33551.03|23661.78|102877.30||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC177|177|Respiratory infections and inflammations with MCC*||| 1103164001-AETNA 60054 |27262.48|18003.00|33551.03|23661.78|102877.30||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC177|177|Respiratory infections and inflammations with MCC*||| 1104112001-MEDICARE ADVANTAGE HUMANA |33551.03|18003.00|33551.03|23661.78|102877.30||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC177|177|Respiratory infections and inflammations with MCC*||| 1104119001-MEDICARE ADV CIGNA HEALTHSPRINGS |33551.03|18003.00|33551.03|23661.78|102877.30||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC177|177|Respiratory infections and inflammations with MCC*||| 1104129001-MEDICARE ADVANTAGE BLUE CROSS |33551.03|18003.00|33551.03|23661.78|102877.30||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC177|177|Respiratory infections and inflammations with MCC*||| 1104150001-AMERIGROUP AMERIVANTAGE SPECIALTY |33551.03|18003.00|33551.03|23661.78|102877.30||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC177|177|Respiratory infections and inflammations with MCC*||| 1001583001-TRICARE |30863.19|18003.00|33551.03|23661.78|102877.30||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC189|189|Pulmonary edema and respiratory failure||| 1100313001-BLUE CROSS NETWORK S |22239.00|22239.00|51592.66|39554.37|171975.53||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC189|189|Pulmonary edema and respiratory failure||| 1100313002-BLUE CROSS BAPTIST EMPLOYEE |22239.00|22239.00|51592.66|39554.37|171975.53||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC189|189|Pulmonary edema and respiratory failure||| 1100315001-BLUE CROSS ARKANSAS EXCHANGE |22239.00|22239.00|51592.66|39554.37|171975.53||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC189|189|Pulmonary edema and respiratory failure||| 1100316001-BLUE CROSS TENNESSEE NETWORK P |22239.00|22239.00|51592.66|39554.37|171975.53||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC189|189|Pulmonary edema and respiratory failure||| 1100330002-BLUE CROSS MISSISSIPPI |22239.00|22239.00|51592.66|39554.37|171975.53||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC189|189|Pulmonary edema and respiratory failure||| 1100331002-BLUE CROSS ARKANSAS |25200.00|22239.00|51592.66|39554.37|171975.53||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC189|189|Pulmonary edema and respiratory failure||| 1100332002-BLUE CROSS OUT OF STATE |22239.00|22239.00|51592.66|39554.37|171975.53||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC189|189|Pulmonary edema and respiratory failure||| 1100335001-BLUE CROSS FEDERAL |22239.00|22239.00|51592.66|39554.37|171975.53||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC189|189|Pulmonary edema and respiratory failure||| 1103161061-AETNA MAILHANDLERS BENEFIT 60054 |45573.52|22239.00|51592.66|39554.37|171975.53||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC189|189|Pulmonary edema and respiratory failure||| 1103164001-AETNA 60054 |45573.52|22239.00|51592.66|39554.37|171975.53||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC189|189|Pulmonary edema and respiratory failure||| 1104112001-MEDICARE ADVANTAGE HUMANA |38063.18|22239.00|51592.66|39554.37|171975.53||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC189|189|Pulmonary edema and respiratory failure||| 1104119001-MEDICARE ADV CIGNA HEALTHSPRINGS |38063.18|22239.00|51592.66|39554.37|171975.53||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC189|189|Pulmonary edema and respiratory failure||| 1104129001-MEDICARE ADVANTAGE BLUE CROSS |38063.18|22239.00|51592.66|39554.37|171975.53||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC189|189|Pulmonary edema and respiratory failure||| 1104150001-AMERIGROUP AMERIVANTAGE SPECIALTY |38063.18|22239.00|51592.66|39554.37|171975.53||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC189|189|Pulmonary edema and respiratory failure||| 1001583001-TRICARE |51592.66|22239.00|51592.66|39554.37|171975.53||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC207|207|Respiratory system diagnosis with ventilator support >96 hours||| 1100313001-BLUE CROSS NETWORK S |34947.00|34947.00|110254.08|84528.13|367513.61||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC207|207|Respiratory system diagnosis with ventilator support >96 hours||| 1100313002-BLUE CROSS BAPTIST EMPLOYEE |34947.00|34947.00|110254.08|84528.13|367513.61||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC207|207|Respiratory system diagnosis with ventilator support >96 hours||| 1100315001-BLUE CROSS ARKANSAS EXCHANGE |34947.00|34947.00|110254.08|84528.13|367513.61||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC207|207|Respiratory system diagnosis with ventilator support >96 hours||| 1100316001-BLUE CROSS TENNESSEE NETWORK P |34947.00|34947.00|110254.08|84528.13|367513.61||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC207|207|Respiratory system diagnosis with ventilator support >96 hours||| 1100330002-BLUE CROSS MISSISSIPPI |34947.00|34947.00|110254.08|84528.13|367513.61||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC207|207|Respiratory system diagnosis with ventilator support >96 hours||| 1100331002-BLUE CROSS ARKANSAS |39600.00|34947.00|110254.08|84528.13|367513.61||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC207|207|Respiratory system diagnosis with ventilator support >96 hours||| 1100332002-BLUE CROSS OUT OF STATE |34947.00|34947.00|110254.08|84528.13|367513.61||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC207|207|Respiratory system diagnosis with ventilator support >96 hours||| 1100335001-BLUE CROSS FEDERAL |34947.00|34947.00|110254.08|84528.13|367513.61||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC207|207|Respiratory system diagnosis with ventilator support >96 hours||| 1103161061-AETNA MAILHANDLERS BENEFIT 60054 |97391.11|34947.00|110254.08|84528.13|367513.61||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC207|207|Respiratory system diagnosis with ventilator support >96 hours||| 1103164001-AETNA 60054 |97391.11|34947.00|110254.08|84528.13|367513.61||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC207|207|Respiratory system diagnosis with ventilator support >96 hours||| 1104112001-MEDICARE ADVANTAGE HUMANA |75739.60|34947.00|110254.08|84528.13|367513.61||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC207|207|Respiratory system diagnosis with ventilator support >96 hours||| 1104119001-MEDICARE ADV CIGNA HEALTHSPRINGS |75739.60|34947.00|110254.08|84528.13|367513.61||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC207|207|Respiratory system diagnosis with ventilator support >96 hours||| 1104129001-MEDICARE ADVANTAGE BLUE CROSS |75739.60|34947.00|110254.08|84528.13|367513.61||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC207|207|Respiratory system diagnosis with ventilator support >96 hours||| 1104150001-AMERIGROUP AMERIVANTAGE SPECIALTY |75739.60|34947.00|110254.08|84528.13|367513.61||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC207|207|Respiratory system diagnosis with ventilator support >96 hours||| 1001583001-TRICARE |110254.08|34947.00|110254.08|84528.13|367513.61||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC208|208|Respiratory system diagnosis with ventilator support <=96 hours||| 1100313001-BLUE CROSS NETWORK S |30365.00|30365.00|51316.39|39342.57|171054.64||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC208|208|Respiratory system diagnosis with ventilator support <=96 hours||| 1100313002-BLUE CROSS BAPTIST EMPLOYEE |30365.00|30365.00|51316.39|39342.57|171054.64||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC208|208|Respiratory system diagnosis with ventilator support <=96 hours||| 1100315001-BLUE CROSS ARKANSAS EXCHANGE |32000.00|30365.00|51316.39|39342.57|171054.64||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC208|208|Respiratory system diagnosis with ventilator support <=96 hours||| 1100316001-BLUE CROSS TENNESSEE NETWORK P |32000.00|30365.00|51316.39|39342.57|171054.64||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC208|208|Respiratory system diagnosis with ventilator support <=96 hours||| 1100330002-BLUE CROSS MISSISSIPPI |32000.00|30365.00|51316.39|39342.57|171054.64||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC208|208|Respiratory system diagnosis with ventilator support <=96 hours||| 1100331002-BLUE CROSS ARKANSAS |42500.00|30365.00|51316.39|39342.57|171054.64||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC208|208|Respiratory system diagnosis with ventilator support <=96 hours||| 1100332002-BLUE CROSS OUT OF STATE |32000.00|30365.00|51316.39|39342.57|171054.64||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC208|208|Respiratory system diagnosis with ventilator support <=96 hours||| 1100335001-BLUE CROSS FEDERAL |32000.00|30365.00|51316.39|39342.57|171054.64||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC208|208|Respiratory system diagnosis with ventilator support <=96 hours||| 1103161061-AETNA MAILHANDLERS BENEFIT 60054 |45329.48|30365.00|51316.39|39342.57|171054.64||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC208|208|Respiratory system diagnosis with ventilator support <=96 hours||| 1103164001-AETNA 60054 |45329.48|30365.00|51316.39|39342.57|171054.64||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC208|208|Respiratory system diagnosis with ventilator support <=96 hours||| 1104112001-MEDICARE ADVANTAGE HUMANA |45935.26|30365.00|51316.39|39342.57|171054.64||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC208|208|Respiratory system diagnosis with ventilator support <=96 hours||| 1104119001-MEDICARE ADV CIGNA HEALTHSPRINGS |45935.26|30365.00|51316.39|39342.57|171054.64||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC208|208|Respiratory system diagnosis with ventilator support <=96 hours||| 1104129001-MEDICARE ADVANTAGE BLUE CROSS |45935.26|30365.00|51316.39|39342.57|171054.64||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC208|208|Respiratory system diagnosis with ventilator support <=96 hours||| 1104150001-AMERIGROUP AMERIVANTAGE SPECIALTY |45935.26|30365.00|51316.39|39342.57|171054.64||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC208|208|Respiratory system diagnosis with ventilator support <=96 hours||| 1001583001-TRICARE |51316.39|30365.00|51316.39|39342.57|171054.64||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC288|288|Acute and subacute endocarditis with MCC*||| 1100313001-BLUE CROSS NETWORK S |15064.00|15064.00|46060.15|32878.49|142949.97||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC288|288|Acute and subacute endocarditis with MCC*||| 1100313002-BLUE CROSS BAPTIST EMPLOYEE |15064.00|15064.00|46060.15|32878.49|142949.97||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC288|288|Acute and subacute endocarditis with MCC*||| 1100315001-BLUE CROSS ARKANSAS EXCHANGE |15876.00|15064.00|46060.15|32878.49|142949.97||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC288|288|Acute and subacute endocarditis with MCC*||| 1100316001-BLUE CROSS TENNESSEE NETWORK P |15876.00|15064.00|46060.15|32878.49|142949.97||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC288|288|Acute and subacute endocarditis with MCC*||| 1100330002-BLUE CROSS MISSISSIPPI |15876.00|15064.00|46060.15|32878.49|142949.97||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC288|288|Acute and subacute endocarditis with MCC*||| 1100331002-BLUE CROSS ARKANSAS |23800.00|15064.00|46060.15|32878.49|142949.97||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC288|288|Acute and subacute endocarditis with MCC*||| 1100332002-BLUE CROSS OUT OF STATE |15876.00|15064.00|46060.15|32878.49|142949.97||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC288|288|Acute and subacute endocarditis with MCC*||| 1100335001-BLUE CROSS FEDERAL |15876.00|15064.00|46060.15|32878.49|142949.97||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC288|288|Acute and subacute endocarditis with MCC*||| 1103161061-AETNA MAILHANDLERS BENEFIT 60054 |37881.74|15064.00|46060.15|32878.49|142949.97||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC288|288|Acute and subacute endocarditis with MCC*||| 1103164001-AETNA 60054 |37881.74|15064.00|46060.15|32878.49|142949.97||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC288|288|Acute and subacute endocarditis with MCC*||| 1104112001-MEDICARE ADVANTAGE HUMANA |46060.15|15064.00|46060.15|32878.49|142949.97||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC288|288|Acute and subacute endocarditis with MCC*||| 1104119001-MEDICARE ADV CIGNA HEALTHSPRINGS |46060.15|15064.00|46060.15|32878.49|142949.97||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC288|288|Acute and subacute endocarditis with MCC*||| 1104129001-MEDICARE ADVANTAGE BLUE CROSS |46060.15|15064.00|46060.15|32878.49|142949.97||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC288|288|Acute and subacute endocarditis with MCC*||| 1104150001-AMERIGROUP AMERIVANTAGE SPECIALTY |46060.15|15064.00|46060.15|32878.49|142949.97||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC288|288|Acute and subacute endocarditis with MCC*||| 1001583001-TRICARE |42884.99|15064.00|46060.15|32878.49|142949.97||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC314|314|Other circulatory system diagnoses with MCC*||| 1100313001-BLUE CROSS NETWORK S |31770.00|31770.00|65554.21|50258.23|218514.02||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC314|314|Other circulatory system diagnoses with MCC*||| 1100313002-BLUE CROSS BAPTIST EMPLOYEE |31770.00|31770.00|65554.21|50258.23|218514.02||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC314|314|Other circulatory system diagnoses with MCC*||| 1100315001-BLUE CROSS ARKANSAS EXCHANGE |31770.00|31770.00|65554.21|50258.23|218514.02||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC314|314|Other circulatory system diagnoses with MCC*||| 1100316001-BLUE CROSS TENNESSEE NETWORK P |31770.00|31770.00|65554.21|50258.23|218514.02||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC314|314|Other circulatory system diagnoses with MCC*||| 1100330002-BLUE CROSS MISSISSIPPI |31770.00|31770.00|65554.21|50258.23|218514.02||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC314|314|Other circulatory system diagnoses with MCC*||| 1100331002-BLUE CROSS ARKANSAS |36000.00|31770.00|65554.21|50258.23|218514.02||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC314|314|Other circulatory system diagnoses with MCC*||| 1100332002-BLUE CROSS OUT OF STATE |31770.00|31770.00|65554.21|50258.23|218514.02||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC314|314|Other circulatory system diagnoses with MCC*||| 1100335001-BLUE CROSS FEDERAL |31770.00|31770.00|65554.21|50258.23|218514.02||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC314|314|Other circulatory system diagnoses with MCC*||| 1103161061-AETNA MAILHANDLERS BENEFIT 60054 |57906.22|31770.00|65554.21|50258.23|218514.02||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC314|314|Other circulatory system diagnoses with MCC*||| 1103164001-AETNA 60054 |57906.22|31770.00|65554.21|50258.23|218514.02||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC314|314|Other circulatory system diagnoses with MCC*||| 1104112001-MEDICARE ADVANTAGE HUMANA |42966.11|31770.00|65554.21|50258.23|218514.02||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC314|314|Other circulatory system diagnoses with MCC*||| 1104119001-MEDICARE ADV CIGNA HEALTHSPRINGS |42966.11|31770.00|65554.21|50258.23|218514.02||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC314|314|Other circulatory system diagnoses with MCC*||| 1104129001-MEDICARE ADVANTAGE BLUE CROSS |42966.11|31770.00|65554.21|50258.23|218514.02||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC314|314|Other circulatory system diagnoses with MCC*||| 1104150001-AMERIGROUP AMERIVANTAGE SPECIALTY |42966.11|31770.00|65554.21|50258.23|218514.02||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC314|314|Other circulatory system diagnoses with MCC*||| 1001583001-TRICARE |65554.21|31770.00|65554.21|50258.23|218514.02||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC391|391|Esophagitis gastroenteritis and miscellaneous digestive disorders with MCC||| 1100313001-BLUE CROSS NETWORK S |10590.00|10590.00|34723.38|21809.47|94823.76||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC391|391|Esophagitis gastroenteritis and miscellaneous digestive disorders with MCC||| 1100313002-BLUE CROSS BAPTIST EMPLOYEE |10590.00|10590.00|34723.38|21809.47|94823.76||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC391|391|Esophagitis gastroenteritis and miscellaneous digestive disorders with MCC||| 1100315001-BLUE CROSS ARKANSAS EXCHANGE |10590.00|10590.00|34723.38|21809.47|94823.76||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC391|391|Esophagitis gastroenteritis and miscellaneous digestive disorders with MCC||| 1100316001-BLUE CROSS TENNESSEE NETWORK P |10590.00|10590.00|34723.38|21809.47|94823.76||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC391|391|Esophagitis gastroenteritis and miscellaneous digestive disorders with MCC||| 1100330002-BLUE CROSS MISSISSIPPI |10590.00|10590.00|34723.38|21809.47|94823.76||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC391|391|Esophagitis gastroenteritis and miscellaneous digestive disorders with MCC||| 1100331002-BLUE CROSS ARKANSAS |12000.00|10590.00|34723.38|21809.47|94823.76||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC391|391|Esophagitis gastroenteritis and miscellaneous digestive disorders with MCC||| 1100332002-BLUE CROSS OUT OF STATE |10590.00|10590.00|34723.38|21809.47|94823.76||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC391|391|Esophagitis gastroenteritis and miscellaneous digestive disorders with MCC||| 1100335001-BLUE CROSS FEDERAL |10590.00|10590.00|34723.38|21809.47|94823.76||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC391|391|Esophagitis gastroenteritis and miscellaneous digestive disorders with MCC||| 1103161061-AETNA MAILHANDLERS BENEFIT 60054 |25128.30|10590.00|34723.38|21809.47|94823.76||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC391|391|Esophagitis gastroenteritis and miscellaneous digestive disorders with MCC||| 1103164001-AETNA 60054 |25128.30|10590.00|34723.38|21809.47|94823.76||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC391|391|Esophagitis gastroenteritis and miscellaneous digestive disorders with MCC||| 1104112001-MEDICARE ADVANTAGE HUMANA |34723.38|10590.00|34723.38|21809.47|94823.76||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC391|391|Esophagitis gastroenteritis and miscellaneous digestive disorders with MCC||| 1104119001-MEDICARE ADV CIGNA HEALTHSPRINGS |34723.38|10590.00|34723.38|21809.47|94823.76||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC391|391|Esophagitis gastroenteritis and miscellaneous digestive disorders with MCC||| 1104129001-MEDICARE ADVANTAGE BLUE CROSS |34723.38|10590.00|34723.38|21809.47|94823.76||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC391|391|Esophagitis gastroenteritis and miscellaneous digestive disorders with MCC||| 1104150001-AMERIGROUP AMERIVANTAGE SPECIALTY |34723.38|10590.00|34723.38|21809.47|94823.76||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC391|391|Esophagitis gastroenteritis and miscellaneous digestive disorders with MCC||| 1001583001-TRICARE |28447.13|10590.00|34723.38|21809.47|94823.76||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC500|500|Soft tissue procedures with MCC*||| 1100313001-BLUE CROSS NETWORK S |44478.00|44478.00|78868.46|60465.82|262894.87||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC500|500|Soft tissue procedures with MCC*||| 1100313002-BLUE CROSS BAPTIST EMPLOYEE |44478.00|44478.00|78868.46|60465.82|262894.87||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC500|500|Soft tissue procedures with MCC*||| 1100315001-BLUE CROSS ARKANSAS EXCHANGE |44478.00|44478.00|78868.46|60465.82|262894.87||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC500|500|Soft tissue procedures with MCC*||| 1100316001-BLUE CROSS TENNESSEE NETWORK P |44478.00|44478.00|78868.46|60465.82|262894.87||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC500|500|Soft tissue procedures with MCC*||| 1100330002-BLUE CROSS MISSISSIPPI |44478.00|44478.00|78868.46|60465.82|262894.87||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC500|500|Soft tissue procedures with MCC*||| 1100331002-BLUE CROSS ARKANSAS |50400.00|44478.00|78868.46|60465.82|262894.87||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC500|500|Soft tissue procedures with MCC*||| 1100332002-BLUE CROSS OUT OF STATE |44478.00|44478.00|78868.46|60465.82|262894.87||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC500|500|Soft tissue procedures with MCC*||| 1100335001-BLUE CROSS FEDERAL |44478.00|44478.00|78868.46|60465.82|262894.87||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC500|500|Soft tissue procedures with MCC*||| 1103161061-AETNA MAILHANDLERS BENEFIT 60054 |69667.14|44478.00|78868.46|60465.82|262894.87||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC500|500|Soft tissue procedures with MCC*||| 1103164001-AETNA 60054 |69667.14|44478.00|78868.46|60465.82|262894.87||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC500|500|Soft tissue procedures with MCC*||| 1104112001-MEDICARE ADVANTAGE HUMANA |51168.54|44478.00|78868.46|60465.82|262894.87||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC500|500|Soft tissue procedures with MCC*||| 1104119001-MEDICARE ADV CIGNA HEALTHSPRINGS |51168.54|44478.00|78868.46|60465.82|262894.87||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC500|500|Soft tissue procedures with MCC*||| 1104129001-MEDICARE ADVANTAGE BLUE CROSS |51168.54|44478.00|78868.46|60465.82|262894.87||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC500|500|Soft tissue procedures with MCC*||| 1104150001-AMERIGROUP AMERIVANTAGE SPECIALTY |51168.54|44478.00|78868.46|60465.82|262894.87||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC500|500|Soft tissue procedures with MCC*||| 1001583001-TRICARE |78868.46|44478.00|78868.46|60465.82|262894.87||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC539|539|Osteomyelitis with MCC||| 1100313001-BLUE CROSS NETWORK S |44478.00|43779.90|65950.50|50562.05|219834.99||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC539|539|Osteomyelitis with MCC||| 1100313002-BLUE CROSS BAPTIST EMPLOYEE |44478.00|43779.90|65950.50|50562.05|219834.99||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC539|539|Osteomyelitis with MCC||| 1100315001-BLUE CROSS ARKANSAS EXCHANGE |44478.00|43779.90|65950.50|50562.05|219834.99||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC539|539|Osteomyelitis with MCC||| 1100316001-BLUE CROSS TENNESSEE NETWORK P |44478.00|43779.90|65950.50|50562.05|219834.99||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC539|539|Osteomyelitis with MCC||| 1100330002-BLUE CROSS MISSISSIPPI |44478.00|43779.90|65950.50|50562.05|219834.99||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC539|539|Osteomyelitis with MCC||| 1100331002-BLUE CROSS ARKANSAS |50400.00|43779.90|65950.50|50562.05|219834.99||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC539|539|Osteomyelitis with MCC||| 1100332002-BLUE CROSS OUT OF STATE |44478.00|43779.90|65950.50|50562.05|219834.99||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC539|539|Osteomyelitis with MCC||| 1100335001-BLUE CROSS FEDERAL |44478.00|43779.90|65950.50|50562.05|219834.99||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC539|539|Osteomyelitis with MCC||| 1103161061-AETNA MAILHANDLERS BENEFIT 60054 |58256.27|43779.90|65950.50|50562.05|219834.99||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC539|539|Osteomyelitis with MCC||| 1103164001-AETNA 60054 |58256.27|43779.90|65950.50|50562.05|219834.99||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC539|539|Osteomyelitis with MCC||| 1104112001-MEDICARE ADVANTAGE HUMANA |43779.90|43779.90|65950.50|50562.05|219834.99||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC539|539|Osteomyelitis with MCC||| 1104119001-MEDICARE ADV CIGNA HEALTHSPRINGS |43779.90|43779.90|65950.50|50562.05|219834.99||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC539|539|Osteomyelitis with MCC||| 1104129001-MEDICARE ADVANTAGE BLUE CROSS |43779.90|43779.90|65950.50|50562.05|219834.99||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC539|539|Osteomyelitis with MCC||| 1104150001-AMERIGROUP AMERIVANTAGE SPECIALTY |43779.90|43779.90|65950.50|50562.05|219834.99||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC539|539|Osteomyelitis with MCC||| 1001583001-TRICARE |65950.50|43779.90|65950.50|50562.05|219834.99||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC579|579|Other skin subcutaneous tissue and breast procedures with MCC||| 1100313001-BLUE CROSS NETWORK S |36006.00|36006.00|96221.19|73769.58|320737.31||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC579|579|Other skin subcutaneous tissue and breast procedures with MCC||| 1100313002-BLUE CROSS BAPTIST EMPLOYEE |36006.00|36006.00|96221.19|73769.58|320737.31||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC579|579|Other skin subcutaneous tissue and breast procedures with MCC||| 1100315001-BLUE CROSS ARKANSAS EXCHANGE |36006.00|36006.00|96221.19|73769.58|320737.31||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC579|579|Other skin subcutaneous tissue and breast procedures with MCC||| 1100316001-BLUE CROSS TENNESSEE NETWORK P |36006.00|36006.00|96221.19|73769.58|320737.31||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC579|579|Other skin subcutaneous tissue and breast procedures with MCC||| 1100330002-BLUE CROSS MISSISSIPPI |36006.00|36006.00|96221.19|73769.58|320737.31||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC579|579|Other skin subcutaneous tissue and breast procedures with MCC||| 1100331002-BLUE CROSS ARKANSAS |40800.00|36006.00|96221.19|73769.58|320737.31||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC579|579|Other skin subcutaneous tissue and breast procedures with MCC||| 1100332002-BLUE CROSS OUT OF STATE |36006.00|36006.00|96221.19|73769.58|320737.31||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC579|579|Other skin subcutaneous tissue and breast procedures with MCC||| 1100335001-BLUE CROSS FEDERAL |36006.00|36006.00|96221.19|73769.58|320737.31||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC579|579|Other skin subcutaneous tissue and breast procedures with MCC||| 1103161061-AETNA MAILHANDLERS BENEFIT 60054 |84995.39|36006.00|96221.19|73769.58|320737.31||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC579|579|Other skin subcutaneous tissue and breast procedures with MCC||| 1103164001-AETNA 60054 |84995.39|36006.00|96221.19|73769.58|320737.31||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC579|579|Other skin subcutaneous tissue and breast procedures with MCC||| 1104112001-MEDICARE ADVANTAGE HUMANA |55555.80|36006.00|96221.19|73769.58|320737.31||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC579|579|Other skin subcutaneous tissue and breast procedures with MCC||| 1104119001-MEDICARE ADV CIGNA HEALTHSPRINGS |55555.80|36006.00|96221.19|73769.58|320737.31||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC579|579|Other skin subcutaneous tissue and breast procedures with MCC||| 1104129001-MEDICARE ADVANTAGE BLUE CROSS |55555.80|36006.00|96221.19|73769.58|320737.31||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC579|579|Other skin subcutaneous tissue and breast procedures with MCC||| 1104150001-AMERIGROUP AMERIVANTAGE SPECIALTY |55555.80|36006.00|96221.19|73769.58|320737.31||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC579|579|Other skin subcutaneous tissue and breast procedures with MCC||| 1001583001-TRICARE |96221.19|36006.00|96221.19|73769.58|320737.31||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC580|580|Other skin subcutaneous tissue and breast procedures with CC||| 1100313001-BLUE CROSS NETWORK S |24357.00|24357.00|47216.39|31689.12|137778.78||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC580|580|Other skin subcutaneous tissue and breast procedures with CC||| 1100313002-BLUE CROSS BAPTIST EMPLOYEE |24357.00|24357.00|47216.39|31689.12|137778.78||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC580|580|Other skin subcutaneous tissue and breast procedures with CC||| 1100315001-BLUE CROSS ARKANSAS EXCHANGE |24357.00|24357.00|47216.39|31689.12|137778.78||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC580|580|Other skin subcutaneous tissue and breast procedures with CC||| 1100316001-BLUE CROSS TENNESSEE NETWORK P |24357.00|24357.00|47216.39|31689.12|137778.78||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC580|580|Other skin subcutaneous tissue and breast procedures with CC||| 1100330002-BLUE CROSS MISSISSIPPI |24357.00|24357.00|47216.39|31689.12|137778.78||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC580|580|Other skin subcutaneous tissue and breast procedures with CC||| 1100331002-BLUE CROSS ARKANSAS |27600.00|24357.00|47216.39|31689.12|137778.78||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC580|580|Other skin subcutaneous tissue and breast procedures with CC||| 1100332002-BLUE CROSS OUT OF STATE |24357.00|24357.00|47216.39|31689.12|137778.78||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC580|580|Other skin subcutaneous tissue and breast procedures with CC||| 1100335001-BLUE CROSS FEDERAL |24357.00|24357.00|47216.39|31689.12|137778.78||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC580|580|Other skin subcutaneous tissue and breast procedures with CC||| 1103161061-AETNA MAILHANDLERS BENEFIT 60054 |36511.38|24357.00|47216.39|31689.12|137778.78||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC580|580|Other skin subcutaneous tissue and breast procedures with CC||| 1103164001-AETNA 60054 |36511.38|24357.00|47216.39|31689.12|137778.78||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC580|580|Other skin subcutaneous tissue and breast procedures with CC||| 1104112001-MEDICARE ADVANTAGE HUMANA |47216.39|24357.00|47216.39|31689.12|137778.78||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC580|580|Other skin subcutaneous tissue and breast procedures with CC||| 1104119001-MEDICARE ADV CIGNA HEALTHSPRINGS |47216.39|24357.00|47216.39|31689.12|137778.78||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC580|580|Other skin subcutaneous tissue and breast procedures with CC||| 1104129001-MEDICARE ADVANTAGE BLUE CROSS |47216.39|24357.00|47216.39|31689.12|137778.78||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC580|580|Other skin subcutaneous tissue and breast procedures with CC||| 1104150001-AMERIGROUP AMERIVANTAGE SPECIALTY |47216.39|24357.00|47216.39|31689.12|137778.78||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC580|580|Other skin subcutaneous tissue and breast procedures with CC||| 1001583001-TRICARE |41333.64|24357.00|47216.39|31689.12|137778.78||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC592|592|Skin ulcers with MCC*||| 1100313001-BLUE CROSS NETWORK S |23298.00|23298.00|45475.68|34864.69|151585.60||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC592|592|Skin ulcers with MCC*||| 1100313002-BLUE CROSS BAPTIST EMPLOYEE |23298.00|23298.00|45475.68|34864.69|151585.60||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC592|592|Skin ulcers with MCC*||| 1100315001-BLUE CROSS ARKANSAS EXCHANGE |23298.00|23298.00|45475.68|34864.69|151585.60||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC592|592|Skin ulcers with MCC*||| 1100316001-BLUE CROSS TENNESSEE NETWORK P |23298.00|23298.00|45475.68|34864.69|151585.60||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC592|592|Skin ulcers with MCC*||| 1100330002-BLUE CROSS MISSISSIPPI |23298.00|23298.00|45475.68|34864.69|151585.60||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC592|592|Skin ulcers with MCC*||| 1100331002-BLUE CROSS ARKANSAS |26400.00|23298.00|45475.68|34864.69|151585.60||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC592|592|Skin ulcers with MCC*||| 1100332002-BLUE CROSS OUT OF STATE |23298.00|23298.00|45475.68|34864.69|151585.60||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC592|592|Skin ulcers with MCC*||| 1100335001-BLUE CROSS FEDERAL |23298.00|23298.00|45475.68|34864.69|151585.60||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC592|592|Skin ulcers with MCC*||| 1103161061-AETNA MAILHANDLERS BENEFIT 60054 |40170.18|23298.00|45475.68|34864.69|151585.60||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC592|592|Skin ulcers with MCC*||| 1103164001-AETNA 60054 |40170.18|23298.00|45475.68|34864.69|151585.60||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC592|592|Skin ulcers with MCC*||| 1104112001-MEDICARE ADVANTAGE HUMANA |38997.84|23298.00|45475.68|34864.69|151585.60||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC592|592|Skin ulcers with MCC*||| 1104119001-MEDICARE ADV CIGNA HEALTHSPRINGS |38997.84|23298.00|45475.68|34864.69|151585.60||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC592|592|Skin ulcers with MCC*||| 1104129001-MEDICARE ADVANTAGE BLUE CROSS |38997.84|23298.00|45475.68|34864.69|151585.60||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC592|592|Skin ulcers with MCC*||| 1104150001-AMERIGROUP AMERIVANTAGE SPECIALTY |38997.84|23298.00|45475.68|34864.69|151585.60||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC592|592|Skin ulcers with MCC*||| 1001583001-TRICARE |45475.68|23298.00|45475.68|34864.69|151585.60||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC637|637|Diabetes with MCC||| 1100313001-BLUE CROSS NETWORK S |32829.00|32829.00|122424.64|93858.89|408082.14||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC637|637|Diabetes with MCC||| 1100313002-BLUE CROSS BAPTIST EMPLOYEE |32829.00|32829.00|122424.64|93858.89|408082.14||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC637|637|Diabetes with MCC||| 1100315001-BLUE CROSS ARKANSAS EXCHANGE |32829.00|32829.00|122424.64|93858.89|408082.14||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC637|637|Diabetes with MCC||| 1100316001-BLUE CROSS TENNESSEE NETWORK P |32829.00|32829.00|122424.64|93858.89|408082.14||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC637|637|Diabetes with MCC||| 1100330002-BLUE CROSS MISSISSIPPI |32829.00|32829.00|122424.64|93858.89|408082.14||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC637|637|Diabetes with MCC||| 1100331002-BLUE CROSS ARKANSAS |37200.00|32829.00|122424.64|93858.89|408082.14||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC637|637|Diabetes with MCC||| 1100332002-BLUE CROSS OUT OF STATE |32829.00|32829.00|122424.64|93858.89|408082.14||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC637|637|Diabetes with MCC||| 1100335001-BLUE CROSS FEDERAL |32829.00|32829.00|122424.64|93858.89|408082.14||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC637|637|Diabetes with MCC||| 1103161061-AETNA MAILHANDLERS BENEFIT 60054 |108141.77|32829.00|122424.64|93858.89|408082.14||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC637|637|Diabetes with MCC||| 1103164001-AETNA 60054 |108141.77|32829.00|122424.64|93858.89|408082.14||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC637|637|Diabetes with MCC||| 1104112001-MEDICARE ADVANTAGE HUMANA |40017.10|32829.00|122424.64|93858.89|408082.14||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC637|637|Diabetes with MCC||| 1104119001-MEDICARE ADV CIGNA HEALTHSPRINGS |40017.10|32829.00|122424.64|93858.89|408082.14||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC637|637|Diabetes with MCC||| 1104129001-MEDICARE ADVANTAGE BLUE CROSS |40017.10|32829.00|122424.64|93858.89|408082.14||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC637|637|Diabetes with MCC||| 1104150001-AMERIGROUP AMERIVANTAGE SPECIALTY |40017.10|32829.00|122424.64|93858.89|408082.14||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC637|637|Diabetes with MCC||| 1001583001-TRICARE |122424.64|32829.00|122424.64|93858.89|408082.14||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC856|856|Postoperative or post-traumatic infections with O.R. procedures with MCC||| 1100313001-BLUE CROSS NETWORK S |38124.00|38124.00|90135.54|69103.91|300451.79||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC856|856|Postoperative or post-traumatic infections with O.R. procedures with MCC||| 1100313002-BLUE CROSS BAPTIST EMPLOYEE |38124.00|38124.00|90135.54|69103.91|300451.79||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC856|856|Postoperative or post-traumatic infections with O.R. procedures with MCC||| 1100315001-BLUE CROSS ARKANSAS EXCHANGE |38124.00|38124.00|90135.54|69103.91|300451.79||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC856|856|Postoperative or post-traumatic infections with O.R. procedures with MCC||| 1100316001-BLUE CROSS TENNESSEE NETWORK P |38124.00|38124.00|90135.54|69103.91|300451.79||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC856|856|Postoperative or post-traumatic infections with O.R. procedures with MCC||| 1100330002-BLUE CROSS MISSISSIPPI |38124.00|38124.00|90135.54|69103.91|300451.79||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC856|856|Postoperative or post-traumatic infections with O.R. procedures with MCC||| 1100331002-BLUE CROSS ARKANSAS |43200.00|38124.00|90135.54|69103.91|300451.79||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC856|856|Postoperative or post-traumatic infections with O.R. procedures with MCC||| 1100332002-BLUE CROSS OUT OF STATE |38124.00|38124.00|90135.54|69103.91|300451.79||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC856|856|Postoperative or post-traumatic infections with O.R. procedures with MCC||| 1100335001-BLUE CROSS FEDERAL |38124.00|38124.00|90135.54|69103.91|300451.79||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC856|856|Postoperative or post-traumatic infections with O.R. procedures with MCC||| 1103161061-AETNA MAILHANDLERS BENEFIT 60054 |79619.72|38124.00|90135.54|69103.91|300451.79||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC856|856|Postoperative or post-traumatic infections with O.R. procedures with MCC||| 1103164001-AETNA 60054 |79619.72|38124.00|90135.54|69103.91|300451.79||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC856|856|Postoperative or post-traumatic infections with O.R. procedures with MCC||| 1104112001-MEDICARE ADVANTAGE HUMANA |57417.06|38124.00|90135.54|69103.91|300451.79||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC856|856|Postoperative or post-traumatic infections with O.R. procedures with MCC||| 1104119001-MEDICARE ADV CIGNA HEALTHSPRINGS |57417.06|38124.00|90135.54|69103.91|300451.79||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC856|856|Postoperative or post-traumatic infections with O.R. procedures with MCC||| 1104129001-MEDICARE ADVANTAGE BLUE CROSS |57417.06|38124.00|90135.54|69103.91|300451.79||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC856|856|Postoperative or post-traumatic infections with O.R. procedures with MCC||| 1104150001-AMERIGROUP AMERIVANTAGE SPECIALTY |57417.06|38124.00|90135.54|69103.91|300451.79||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC856|856|Postoperative or post-traumatic infections with O.R. procedures with MCC||| 1001583001-TRICARE |90135.54|38124.00|90135.54|69103.91|300451.79||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC862|862|Postoperative and post-traumatic infections with MCC||| 1100313001-BLUE CROSS NETWORK S |34249.00|34249.00|87841.55|67345.19|292805.17||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC862|862|Postoperative and post-traumatic infections with MCC||| 1100313002-BLUE CROSS BAPTIST EMPLOYEE |34249.00|34249.00|87841.55|67345.19|292805.17||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC862|862|Postoperative and post-traumatic infections with MCC||| 1100315001-BLUE CROSS ARKANSAS EXCHANGE |34439.00|34249.00|87841.55|67345.19|292805.17||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC862|862|Postoperative and post-traumatic infections with MCC||| 1100316001-BLUE CROSS TENNESSEE NETWORK P |34439.00|34249.00|87841.55|67345.19|292805.17||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC862|862|Postoperative and post-traumatic infections with MCC||| 1100330002-BLUE CROSS MISSISSIPPI |34439.00|34249.00|87841.55|67345.19|292805.17||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC862|862|Postoperative and post-traumatic infections with MCC||| 1100331002-BLUE CROSS ARKANSAS |38200.00|34249.00|87841.55|67345.19|292805.17||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC862|862|Postoperative and post-traumatic infections with MCC||| 1100332002-BLUE CROSS OUT OF STATE |34439.00|34249.00|87841.55|67345.19|292805.17||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC862|862|Postoperative and post-traumatic infections with MCC||| 1100335001-BLUE CROSS FEDERAL |34439.00|34249.00|87841.55|67345.19|292805.17||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC862|862|Postoperative and post-traumatic infections with MCC||| 1103161061-AETNA MAILHANDLERS BENEFIT 60054 |77593.37|34249.00|87841.55|67345.19|292805.17||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC862|862|Postoperative and post-traumatic infections with MCC||| 1103164001-AETNA 60054 |77593.37|34249.00|87841.55|67345.19|292805.17||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC862|862|Postoperative and post-traumatic infections with MCC||| 1104112001-MEDICARE ADVANTAGE HUMANA |43816.16|34249.00|87841.55|67345.19|292805.17||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC862|862|Postoperative and post-traumatic infections with MCC||| 1104119001-MEDICARE ADV CIGNA HEALTHSPRINGS |43816.16|34249.00|87841.55|67345.19|292805.17||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC862|862|Postoperative and post-traumatic infections with MCC||| 1104129001-MEDICARE ADVANTAGE BLUE CROSS |43816.16|34249.00|87841.55|67345.19|292805.17||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC862|862|Postoperative and post-traumatic infections with MCC||| 1104150001-AMERIGROUP AMERIVANTAGE SPECIALTY |43816.16|34249.00|87841.55|67345.19|292805.17||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC862|862|Postoperative and post-traumatic infections with MCC||| 1001583001-TRICARE |87841.55|34249.00|87841.55|67345.19|292805.17||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC863|863|Postoperative and post-traumatic infections without MCC||| 1100313001-BLUE CROSS NETWORK S |26475.00|26475.00|39654.41|30401.71|132181.36||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC863|863|Postoperative and post-traumatic infections without MCC||| 1100313002-BLUE CROSS BAPTIST EMPLOYEE |26475.00|26475.00|39654.41|30401.71|132181.36||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC863|863|Postoperative and post-traumatic infections without MCC||| 1100315001-BLUE CROSS ARKANSAS EXCHANGE |26475.00|26475.00|39654.41|30401.71|132181.36||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC863|863|Postoperative and post-traumatic infections without MCC||| 1100316001-BLUE CROSS TENNESSEE NETWORK P |26475.00|26475.00|39654.41|30401.71|132181.36||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC863|863|Postoperative and post-traumatic infections without MCC||| 1100330002-BLUE CROSS MISSISSIPPI |26475.00|26475.00|39654.41|30401.71|132181.36||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC863|863|Postoperative and post-traumatic infections without MCC||| 1100331002-BLUE CROSS ARKANSAS |30000.00|26475.00|39654.41|30401.71|132181.36||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC863|863|Postoperative and post-traumatic infections without MCC||| 1100332002-BLUE CROSS OUT OF STATE |26475.00|26475.00|39654.41|30401.71|132181.36||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC863|863|Postoperative and post-traumatic infections without MCC||| 1100335001-BLUE CROSS FEDERAL |26475.00|26475.00|39654.41|30401.71|132181.36||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC863|863|Postoperative and post-traumatic infections without MCC||| 1103161061-AETNA MAILHANDLERS BENEFIT 60054 |35028.06|26475.00|39654.41|30401.71|132181.36||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC863|863|Postoperative and post-traumatic infections without MCC||| 1103164001-AETNA 60054 |35028.06|26475.00|39654.41|30401.71|132181.36||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC863|863|Postoperative and post-traumatic infections without MCC||| 1104112001-MEDICARE ADVANTAGE HUMANA |29433.70|26475.00|39654.41|30401.71|132181.36||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC863|863|Postoperative and post-traumatic infections without MCC||| 1104119001-MEDICARE ADV CIGNA HEALTHSPRINGS |29433.70|26475.00|39654.41|30401.71|132181.36||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC863|863|Postoperative and post-traumatic infections without MCC||| 1104129001-MEDICARE ADVANTAGE BLUE CROSS |29433.70|26475.00|39654.41|30401.71|132181.36||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC863|863|Postoperative and post-traumatic infections without MCC||| 1104150001-AMERIGROUP AMERIVANTAGE SPECIALTY |29433.70|26475.00|39654.41|30401.71|132181.36||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC863|863|Postoperative and post-traumatic infections without MCC||| 1001583001-TRICARE |39654.41|26475.00|39654.41|30401.71|132181.36||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC871|871|Septicemia or severe sepsis without MV >96 hours with MCC||| 1100313001-BLUE CROSS NETWORK S |21520.00|21520.00|71332.93|54688.58|237776.43||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC871|871|Septicemia or severe sepsis without MV >96 hours with MCC||| 1100313002-BLUE CROSS BAPTIST EMPLOYEE |21520.00|21520.00|71332.93|54688.58|237776.43||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC871|871|Septicemia or severe sepsis without MV >96 hours with MCC||| 1100315001-BLUE CROSS ARKANSAS EXCHANGE |22680.00|21520.00|71332.93|54688.58|237776.43||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC871|871|Septicemia or severe sepsis without MV >96 hours with MCC||| 1100316001-BLUE CROSS TENNESSEE NETWORK P |22680.00|21520.00|71332.93|54688.58|237776.43||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC871|871|Septicemia or severe sepsis without MV >96 hours with MCC||| 1100330002-BLUE CROSS MISSISSIPPI |22680.00|21520.00|71332.93|54688.58|237776.43||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC871|871|Septicemia or severe sepsis without MV >96 hours with MCC||| 1100331002-BLUE CROSS ARKANSAS |34000.00|21520.00|71332.93|54688.58|237776.43||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC871|871|Septicemia or severe sepsis without MV >96 hours with MCC||| 1100332002-BLUE CROSS OUT OF STATE |22680.00|21520.00|71332.93|54688.58|237776.43||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC871|871|Septicemia or severe sepsis without MV >96 hours with MCC||| 1100335001-BLUE CROSS FEDERAL |22680.00|21520.00|71332.93|54688.58|237776.43||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC871|871|Septicemia or severe sepsis without MV >96 hours with MCC||| 1103161061-AETNA MAILHANDLERS BENEFIT 60054 |63010.75|21520.00|71332.93|54688.58|237776.43||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC871|871|Septicemia or severe sepsis without MV >96 hours with MCC||| 1103164001-AETNA 60054 |63010.75|21520.00|71332.93|54688.58|237776.43||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC871|871|Septicemia or severe sepsis without MV >96 hours with MCC||| 1104112001-MEDICARE ADVANTAGE HUMANA |37547.50|21520.00|71332.93|54688.58|237776.43||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC871|871|Septicemia or severe sepsis without MV >96 hours with MCC||| 1104119001-MEDICARE ADV CIGNA HEALTHSPRINGS |37547.50|21520.00|71332.93|54688.58|237776.43||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC871|871|Septicemia or severe sepsis without MV >96 hours with MCC||| 1104129001-MEDICARE ADVANTAGE BLUE CROSS |37547.50|21520.00|71332.93|54688.58|237776.43||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC871|871|Septicemia or severe sepsis without MV >96 hours with MCC||| 1104150001-AMERIGROUP AMERIVANTAGE SPECIALTY |37547.50|21520.00|71332.93|54688.58|237776.43||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC871|871|Septicemia or severe sepsis without MV >96 hours with MCC||| 1001583001-TRICARE |71332.93|21520.00|71332.93|54688.58|237776.43||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC969|969|HIV with extensive O.R. procedures with MCC||| 1100313001-BLUE CROSS NETWORK S |43419.00|43419.00|105968.86|81242.80|353229.55||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC969|969|HIV with extensive O.R. procedures with MCC||| 1100313002-BLUE CROSS BAPTIST EMPLOYEE |43419.00|43419.00|105968.86|81242.80|353229.55||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC969|969|HIV with extensive O.R. procedures with MCC||| 1100315001-BLUE CROSS ARKANSAS EXCHANGE |43419.00|43419.00|105968.86|81242.80|353229.55||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC969|969|HIV with extensive O.R. procedures with MCC||| 1100316001-BLUE CROSS TENNESSEE NETWORK P |43419.00|43419.00|105968.86|81242.80|353229.55||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC969|969|HIV with extensive O.R. procedures with MCC||| 1100330002-BLUE CROSS MISSISSIPPI |43419.00|43419.00|105968.86|81242.80|353229.55||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC969|969|HIV with extensive O.R. procedures with MCC||| 1100331002-BLUE CROSS ARKANSAS |49200.00|43419.00|105968.86|81242.80|353229.55||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC969|969|HIV with extensive O.R. procedures with MCC||| 1100332002-BLUE CROSS OUT OF STATE |43419.00|43419.00|105968.86|81242.80|353229.55||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC969|969|HIV with extensive O.R. procedures with MCC||| 1100335001-BLUE CROSS FEDERAL |43419.00|43419.00|105968.86|81242.80|353229.55||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC969|969|HIV with extensive O.R. procedures with MCC||| 1103161061-AETNA MAILHANDLERS BENEFIT 60054 |93605.83|43419.00|105968.86|81242.80|353229.55||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC969|969|HIV with extensive O.R. procedures with MCC||| 1103164001-AETNA 60054 |93605.83|43419.00|105968.86|81242.80|353229.55||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC969|969|HIV with extensive O.R. procedures with MCC||| 1104112001-MEDICARE ADVANTAGE HUMANA |70429.77|43419.00|105968.86|81242.80|353229.55||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC969|969|HIV with extensive O.R. procedures with MCC||| 1104119001-MEDICARE ADV CIGNA HEALTHSPRINGS |70429.77|43419.00|105968.86|81242.80|353229.55||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC969|969|HIV with extensive O.R. procedures with MCC||| 1104129001-MEDICARE ADVANTAGE BLUE CROSS |70429.77|43419.00|105968.86|81242.80|353229.55||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC969|969|HIV with extensive O.R. procedures with MCC||| 1104150001-AMERIGROUP AMERIVANTAGE SPECIALTY |70429.77|43419.00|105968.86|81242.80|353229.55||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC969|969|HIV with extensive O.R. procedures with MCC||| 1001583001-TRICARE |105968.86|43419.00|105968.86|81242.80|353229.55||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC981|981|Extensive O.R. procedures unrelated to principal diagnosis with MCC*||| 1100313001-BLUE CROSS NETWORK S |46596.00|46596.00|120542.65|92416.03|401808.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC981|981|Extensive O.R. procedures unrelated to principal diagnosis with MCC*||| 1100313002-BLUE CROSS BAPTIST EMPLOYEE |46596.00|46596.00|120542.65|92416.03|401808.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC981|981|Extensive O.R. procedures unrelated to principal diagnosis with MCC*||| 1100315001-BLUE CROSS ARKANSAS EXCHANGE |46596.00|46596.00|120542.65|92416.03|401808.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC981|981|Extensive O.R. procedures unrelated to principal diagnosis with MCC*||| 1100316001-BLUE CROSS TENNESSEE NETWORK P |46596.00|46596.00|120542.65|92416.03|401808.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC981|981|Extensive O.R. procedures unrelated to principal diagnosis with MCC*||| 1100330002-BLUE CROSS MISSISSIPPI |46596.00|46596.00|120542.65|92416.03|401808.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC981|981|Extensive O.R. procedures unrelated to principal diagnosis with MCC*||| 1100331002-BLUE CROSS ARKANSAS |52800.00|46596.00|120542.65|92416.03|401808.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC981|981|Extensive O.R. procedures unrelated to principal diagnosis with MCC*||| 1100332002-BLUE CROSS OUT OF STATE |46596.00|46596.00|120542.65|92416.03|401808.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC981|981|Extensive O.R. procedures unrelated to principal diagnosis with MCC*||| 1100335001-BLUE CROSS FEDERAL |46596.00|46596.00|120542.65|92416.03|401808.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC981|981|Extensive O.R. procedures unrelated to principal diagnosis with MCC*||| 1103161061-AETNA MAILHANDLERS BENEFIT 60054 |106479.34|46596.00|120542.65|92416.03|401808.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC981|981|Extensive O.R. procedures unrelated to principal diagnosis with MCC*||| 1103164001-AETNA 60054 |106479.34|46596.00|120542.65|92416.03|401808.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC981|981|Extensive O.R. procedures unrelated to principal diagnosis with MCC*||| 1104112001-MEDICARE ADVANTAGE HUMANA |91592.54|46596.00|120542.65|92416.03|401808.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC981|981|Extensive O.R. procedures unrelated to principal diagnosis with MCC*||| 1104119001-MEDICARE ADV CIGNA HEALTHSPRINGS |91592.54|46596.00|120542.65|92416.03|401808.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC981|981|Extensive O.R. procedures unrelated to principal diagnosis with MCC*||| 1104129001-MEDICARE ADVANTAGE BLUE CROSS |91592.54|46596.00|120542.65|92416.03|401808.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC981|981|Extensive O.R. procedures unrelated to principal diagnosis with MCC*||| 1104150001-AMERIGROUP AMERIVANTAGE SPECIALTY |91592.54|46596.00|120542.65|92416.03|401808.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC981|981|Extensive O.R. procedures unrelated to principal diagnosis with MCC*||| 1001583001-TRICARE |120542.65|46596.00|120542.65|92416.03|401808.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC987|987|Non-extensive O.R. procedures unrelated to principal diagnosis with MCC||| 1100313001-BLUE CROSS NETWORK S |43419.00|43419.00|89739.25|68800.09|299130.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC987|987|Non-extensive O.R. procedures unrelated to principal diagnosis with MCC||| 1100313002-BLUE CROSS BAPTIST EMPLOYEE |43419.00|43419.00|89739.25|68800.09|299130.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC987|987|Non-extensive O.R. procedures unrelated to principal diagnosis with MCC||| 1100315001-BLUE CROSS ARKANSAS EXCHANGE |43419.00|43419.00|89739.25|68800.09|299130.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC987|987|Non-extensive O.R. procedures unrelated to principal diagnosis with MCC||| 1100316001-BLUE CROSS TENNESSEE NETWORK P |43419.00|43419.00|89739.25|68800.09|299130.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC987|987|Non-extensive O.R. procedures unrelated to principal diagnosis with MCC||| 1100330002-BLUE CROSS MISSISSIPPI |43419.00|43419.00|89739.25|68800.09|299130.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC987|987|Non-extensive O.R. procedures unrelated to principal diagnosis with MCC||| 1100331002-BLUE CROSS ARKANSAS |49200.00|43419.00|89739.25|68800.09|299130.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC987|987|Non-extensive O.R. procedures unrelated to principal diagnosis with MCC||| 1100332002-BLUE CROSS OUT OF STATE |43419.00|43419.00|89739.25|68800.09|299130.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC987|987|Non-extensive O.R. procedures unrelated to principal diagnosis with MCC||| 1100335001-BLUE CROSS FEDERAL |43419.00|43419.00|89739.25|68800.09|299130.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC987|987|Non-extensive O.R. procedures unrelated to principal diagnosis with MCC||| 1103161061-AETNA MAILHANDLERS BENEFIT 60054 |79269.67|43419.00|89739.25|68800.09|299130.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC987|987|Non-extensive O.R. procedures unrelated to principal diagnosis with MCC||| 1103164001-AETNA 60054 |79269.67|43419.00|89739.25|68800.09|299130.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC987|987|Non-extensive O.R. procedures unrelated to principal diagnosis with MCC||| 1104112001-MEDICARE ADVANTAGE HUMANA |74551.13|43419.00|89739.25|68800.09|299130.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC987|987|Non-extensive O.R. procedures unrelated to principal diagnosis with MCC||| 1104119001-MEDICARE ADV CIGNA HEALTHSPRINGS |74551.13|43419.00|89739.25|68800.09|299130.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC987|987|Non-extensive O.R. procedures unrelated to principal diagnosis with MCC||| 1104129001-MEDICARE ADVANTAGE BLUE CROSS |74551.13|43419.00|89739.25|68800.09|299130.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC987|987|Non-extensive O.R. procedures unrelated to principal diagnosis with MCC||| 1104150001-AMERIGROUP AMERIVANTAGE SPECIALTY |74551.13|43419.00|89739.25|68800.09|299130.84||||||20211028 212140|MS-LTC-DRG|MS-LTC-DRG V39 (FY 2022)|MS-LTC987|987|Non-extensive O.R. procedures unrelated to principal diagnosis with MCC||| 1001583001-TRICARE |89739.25|43419.00|89739.25|68800.09|299130.84||||||20211028