|
HC COMP BURN GARM GAUNTLET TO WRI
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300028
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Advantage |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.31
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health SBD |
$22.94
|
|
|
HC COMP BURN GARM GAUNTLET TO WRI
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300028
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna Medicare |
$18.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: BCBS Complete |
$14.56
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Advantage |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.31
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.67
|
| Rate for Payer: UHC Core |
$18.97
|
| Rate for Payer: UHC Exchange |
$14.31
|
|
|
HC COMP BURN GARM GLOVE-ELBOW
|
Facility
|
IP
|
$166.46
|
|
|
Service Code
|
HCPCS A6505
|
| Hospital Charge Code |
98300030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$104.87 |
| Max. Negotiated Rate |
$149.81 |
| Rate for Payer: Aetna Commercial |
$141.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.20
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cofinity Advantage |
$116.52
|
| Rate for Payer: Cofinity Commercial |
$143.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.17
|
| Rate for Payer: Healthscope Commercial |
$149.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.84
|
| Rate for Payer: PHP Commercial |
$141.49
|
| Rate for Payer: Priority Health SBD |
$104.87
|
|
|
HC COMP BURN GARM GLOVE-ELBOW
|
Facility
|
OP
|
$166.46
|
|
|
Service Code
|
HCPCS A6505
|
| Hospital Charge Code |
98300030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$65.42 |
| Max. Negotiated Rate |
$400.28 |
| Rate for Payer: Aetna Commercial |
$141.49
|
| Rate for Payer: Aetna Medicare |
$83.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.20
|
| Rate for Payer: BCBS Complete |
$66.58
|
| Rate for Payer: BCBS Trust/PPO |
$400.28
|
| Rate for Payer: BCN Commercial |
$400.28
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cofinity Advantage |
$116.52
|
| Rate for Payer: Cofinity Commercial |
$143.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.17
|
| Rate for Payer: Healthscope Commercial |
$149.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.84
|
| Rate for Payer: PHP Commercial |
$141.49
|
| Rate for Payer: Priority Health SBD |
$104.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.20
|
| Rate for Payer: UHC Core |
$86.73
|
| Rate for Payer: UHC Exchange |
$65.42
|
|
|
HC COMP BURN GARM GLOVE TO AXILLA
|
Facility
|
OP
|
$183.11
|
|
|
Service Code
|
HCPCS A6506
|
| Hospital Charge Code |
98300029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$71.96 |
| Max. Negotiated Rate |
$425.29 |
| Rate for Payer: Aetna Commercial |
$155.64
|
| Rate for Payer: Aetna Medicare |
$91.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.02
|
| Rate for Payer: BCBS Complete |
$73.24
|
| Rate for Payer: BCBS Trust/PPO |
$425.29
|
| Rate for Payer: BCN Commercial |
$425.29
|
| Rate for Payer: Cash Price |
$146.49
|
| Rate for Payer: Cash Price |
$146.49
|
| Rate for Payer: Cofinity Advantage |
$128.18
|
| Rate for Payer: Cofinity Commercial |
$157.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.49
|
| Rate for Payer: Healthscope Commercial |
$164.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.33
|
| Rate for Payer: PHP Commercial |
$155.64
|
| Rate for Payer: Priority Health SBD |
$115.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.02
|
| Rate for Payer: UHC Core |
$95.40
|
| Rate for Payer: UHC Exchange |
$71.96
|
|
|
HC COMP BURN GARM GLOVE TO AXILLA
|
Facility
|
IP
|
$183.11
|
|
|
Service Code
|
HCPCS A6506
|
| Hospital Charge Code |
98300029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$115.36 |
| Max. Negotiated Rate |
$164.80 |
| Rate for Payer: Aetna Commercial |
$155.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.02
|
| Rate for Payer: Cash Price |
$146.49
|
| Rate for Payer: Cofinity Advantage |
$128.18
|
| Rate for Payer: Cofinity Commercial |
$157.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.49
|
| Rate for Payer: Healthscope Commercial |
$164.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.33
|
| Rate for Payer: PHP Commercial |
$155.64
|
| Rate for Payer: Priority Health SBD |
$115.36
|
|
|
HC COMP BURN GARM GLOVE-WRIST
|
Facility
|
IP
|
$114.44
|
|
|
Service Code
|
HCPCS A6504
|
| Hospital Charge Code |
98300031
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna Commercial |
$97.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.39
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cofinity Advantage |
$80.11
|
| Rate for Payer: Cofinity Commercial |
$98.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.55
|
| Rate for Payer: Healthscope Commercial |
$103.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.83
|
| Rate for Payer: PHP Commercial |
$97.27
|
| Rate for Payer: Priority Health SBD |
$72.10
|
|
|
HC COMP BURN GARM GLOVE-WRIST
|
Facility
|
OP
|
$114.44
|
|
|
Service Code
|
HCPCS A6504
|
| Hospital Charge Code |
98300031
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.97 |
| Max. Negotiated Rate |
$238.55 |
| Rate for Payer: Aetna Commercial |
$97.27
|
| Rate for Payer: Aetna Medicare |
$57.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.39
|
| Rate for Payer: BCBS Complete |
$45.78
|
| Rate for Payer: BCBS Trust/PPO |
$238.55
|
| Rate for Payer: BCN Commercial |
$238.55
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cofinity Advantage |
$80.11
|
| Rate for Payer: Cofinity Commercial |
$98.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.55
|
| Rate for Payer: Healthscope Commercial |
$103.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.83
|
| Rate for Payer: PHP Commercial |
$97.27
|
| Rate for Payer: Priority Health SBD |
$72.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.39
|
| Rate for Payer: UHC Core |
$59.62
|
| Rate for Payer: UHC Exchange |
$44.97
|
|
|
HC COMP BURN GARM HEAD BAND
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300032
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Advantage |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health SBD |
$26.22
|
|
|
HC COMP BURN GARM HEAD BAND
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300032
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$20.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: BCBS Complete |
$16.65
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Advantage |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.05
|
| Rate for Payer: UHC Core |
$21.68
|
| Rate for Payer: UHC Exchange |
$16.36
|
|
|
HC COMP BURN GARM HOOK&LOOP SNAP
|
Facility
|
IP
|
$14.57
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.47
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Advantage |
$10.20
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.93
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: Priority Health SBD |
$9.18
|
|
|
HC COMP BURN GARM HOOK&LOOP SNAP
|
Facility
|
OP
|
$14.57
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: Aetna Medicare |
$7.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.47
|
| Rate for Payer: BCBS Complete |
$5.83
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Advantage |
$10.20
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.93
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: Priority Health SBD |
$9.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.47
|
| Rate for Payer: UHC Core |
$7.59
|
| Rate for Payer: UHC Exchange |
$5.73
|
|
|
HC COMP BURN GARM HOOK&LOOP TAB S
|
Facility
|
IP
|
$8.32
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$7.49 |
| Rate for Payer: Aetna Commercial |
$7.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.41
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cofinity Advantage |
$5.82
|
| Rate for Payer: Cofinity Commercial |
$7.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Healthscope Commercial |
$7.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.24
|
| Rate for Payer: PHP Commercial |
$7.07
|
| Rate for Payer: Priority Health SBD |
$5.24
|
|
|
HC COMP BURN GARM HOOK&LOOP TAB S
|
Facility
|
OP
|
$8.32
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$7.07
|
| Rate for Payer: Aetna Medicare |
$4.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.41
|
| Rate for Payer: BCBS Complete |
$3.33
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cofinity Advantage |
$5.82
|
| Rate for Payer: Cofinity Commercial |
$7.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Healthscope Commercial |
$7.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.24
|
| Rate for Payer: PHP Commercial |
$7.07
|
| Rate for Payer: Priority Health SBD |
$5.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.41
|
| Rate for Payer: UHC Core |
$4.33
|
| Rate for Payer: UHC Exchange |
$3.27
|
|
|
HC COMP BURN GARM LEG&CHAP TO WAI
|
Facility
|
OP
|
$216.40
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300036
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$85.05 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$183.94
|
| Rate for Payer: Aetna Medicare |
$108.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.66
|
| Rate for Payer: BCBS Complete |
$86.56
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$173.12
|
| Rate for Payer: Cash Price |
$173.12
|
| Rate for Payer: Cofinity Advantage |
$151.48
|
| Rate for Payer: Cofinity Commercial |
$186.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.12
|
| Rate for Payer: Healthscope Commercial |
$194.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.30
|
| Rate for Payer: PHP Commercial |
$183.94
|
| Rate for Payer: Priority Health SBD |
$136.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.66
|
| Rate for Payer: UHC Core |
$112.74
|
| Rate for Payer: UHC Exchange |
$85.05
|
|
|
HC COMP BURN GARM LEG&CHAP TO WAI
|
Facility
|
IP
|
$216.40
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300036
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$136.33 |
| Max. Negotiated Rate |
$194.76 |
| Rate for Payer: Aetna Commercial |
$183.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.66
|
| Rate for Payer: Cash Price |
$173.12
|
| Rate for Payer: Cofinity Advantage |
$151.48
|
| Rate for Payer: Cofinity Commercial |
$186.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.12
|
| Rate for Payer: Healthscope Commercial |
$194.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.30
|
| Rate for Payer: PHP Commercial |
$183.94
|
| Rate for Payer: Priority Health SBD |
$136.33
|
|
|
HC COMP BURN GARM LEG & PANTY
|
Facility
|
IP
|
$230.97
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$145.51 |
| Max. Negotiated Rate |
$207.87 |
| Rate for Payer: Aetna Commercial |
$196.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.13
|
| Rate for Payer: Cash Price |
$184.78
|
| Rate for Payer: Cofinity Advantage |
$161.68
|
| Rate for Payer: Cofinity Commercial |
$198.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.78
|
| Rate for Payer: Healthscope Commercial |
$207.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.23
|
| Rate for Payer: PHP Commercial |
$196.32
|
| Rate for Payer: Priority Health SBD |
$145.51
|
|
|
HC COMP BURN GARM LEG & PANTY
|
Facility
|
OP
|
$230.97
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$90.77 |
| Max. Negotiated Rate |
$300.21 |
| Rate for Payer: Aetna Commercial |
$196.32
|
| Rate for Payer: Aetna Medicare |
$115.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.13
|
| Rate for Payer: BCBS Complete |
$92.39
|
| Rate for Payer: BCBS Trust/PPO |
$300.21
|
| Rate for Payer: BCN Commercial |
$300.21
|
| Rate for Payer: Cash Price |
$184.78
|
| Rate for Payer: Cash Price |
$184.78
|
| Rate for Payer: Cofinity Advantage |
$161.68
|
| Rate for Payer: Cofinity Commercial |
$198.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.78
|
| Rate for Payer: Healthscope Commercial |
$207.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.23
|
| Rate for Payer: PHP Commercial |
$196.32
|
| Rate for Payer: Priority Health SBD |
$145.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.13
|
| Rate for Payer: UHC Core |
$120.34
|
| Rate for Payer: UHC Exchange |
$90.77
|
|
|
HC COMP BURN GARM LINING,POCKET,F
|
Facility
|
IP
|
$12.48
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300037
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$11.23 |
| Rate for Payer: Aetna Commercial |
$10.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.11
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Advantage |
$8.74
|
| Rate for Payer: Cofinity Commercial |
$10.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$11.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.36
|
| Rate for Payer: PHP Commercial |
$10.61
|
| Rate for Payer: Priority Health SBD |
$7.86
|
|
|
HC COMP BURN GARM LINING,POCKET,F
|
Facility
|
OP
|
$12.48
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300037
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$10.61
|
| Rate for Payer: Aetna Medicare |
$6.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.11
|
| Rate for Payer: BCBS Complete |
$4.99
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Advantage |
$8.74
|
| Rate for Payer: Cofinity Commercial |
$10.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$11.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.36
|
| Rate for Payer: PHP Commercial |
$10.61
|
| Rate for Payer: Priority Health SBD |
$7.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.11
|
| Rate for Payer: UHC Core |
$6.50
|
| Rate for Payer: UHC Exchange |
$4.90
|
|
|
HC COMP BURN GARM MITTEN TO WRIST
|
Facility
|
IP
|
$70.75
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300038
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.57 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Advantage |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: Priority Health SBD |
$44.57
|
|
|
HC COMP BURN GARM MITTEN TO WRIST
|
Facility
|
OP
|
$70.75
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300038
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna Medicare |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: BCBS Complete |
$28.30
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Advantage |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: Priority Health SBD |
$44.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.99
|
| Rate for Payer: UHC Core |
$36.86
|
| Rate for Payer: UHC Exchange |
$27.80
|
|
|
HC COMP BURN GARM POCKET & PAD CO
|
Facility
|
IP
|
$14.57
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300039
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.47
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Advantage |
$10.20
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.93
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: Priority Health SBD |
$9.18
|
|
|
HC COMP BURN GARM POCKET & PAD CO
|
Facility
|
OP
|
$14.57
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300039
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: Aetna Medicare |
$7.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.47
|
| Rate for Payer: BCBS Complete |
$5.83
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Advantage |
$10.20
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.93
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: Priority Health SBD |
$9.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.47
|
| Rate for Payer: UHC Core |
$7.59
|
| Rate for Payer: UHC Exchange |
$5.73
|
|
|
HC COMP BURN GARM REINFORCEMENTS
|
Facility
|
OP
|
$12.48
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$10.61
|
| Rate for Payer: Aetna Medicare |
$6.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.11
|
| Rate for Payer: BCBS Complete |
$4.99
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Advantage |
$8.74
|
| Rate for Payer: Cofinity Commercial |
$10.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$11.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.36
|
| Rate for Payer: PHP Commercial |
$10.61
|
| Rate for Payer: Priority Health SBD |
$7.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.11
|
| Rate for Payer: UHC Core |
$6.50
|
| Rate for Payer: UHC Exchange |
$4.90
|
|
