|
HC COMP BURN GARM STOCKING TO KNE
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
HCPCS A6507
|
| Hospital Charge Code |
98300054
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.62 |
| Max. Negotiated Rate |
$162.61 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna Medicare |
$36.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: BCBS Complete |
$29.13
|
| Rate for Payer: BCBS Trust/PPO |
$162.61
|
| Rate for Payer: BCN Commercial |
$162.61
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Advantage |
$50.98
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: Priority Health SBD |
$45.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.34
|
| Rate for Payer: UHC Core |
$37.94
|
| Rate for Payer: UHC Exchange |
$28.62
|
|
|
HC COMP BURN GARM STOCKING TO KNE
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
HCPCS A6507
|
| Hospital Charge Code |
98300054
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Advantage |
$50.98
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: Priority Health SBD |
$45.88
|
|
|
HC COMP BURN GARM STOCKING TO THI
|
Facility
|
OP
|
$95.72
|
|
|
Service Code
|
HCPCS A6508
|
| Hospital Charge Code |
98300055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.62 |
| Max. Negotiated Rate |
$193.27 |
| Rate for Payer: Cofinity Advantage |
$67.00
|
| Rate for Payer: Aetna Commercial |
$81.36
|
| Rate for Payer: Aetna Medicare |
$47.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.22
|
| Rate for Payer: BCBS Complete |
$38.29
|
| Rate for Payer: BCBS Trust/PPO |
$193.27
|
| Rate for Payer: BCN Commercial |
$193.27
|
| Rate for Payer: Cash Price |
$76.58
|
| Rate for Payer: Cash Price |
$76.58
|
| Rate for Payer: Cofinity Commercial |
$82.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.58
|
| Rate for Payer: Healthscope Commercial |
$86.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.79
|
| Rate for Payer: PHP Commercial |
$81.36
|
| Rate for Payer: Priority Health SBD |
$60.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.22
|
| Rate for Payer: UHC Core |
$49.87
|
| Rate for Payer: UHC Exchange |
$37.62
|
|
|
HC COMP BURN GARM STOCKING TO THI
|
Facility
|
IP
|
$95.72
|
|
|
Service Code
|
HCPCS A6508
|
| Hospital Charge Code |
98300055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$60.30 |
| Max. Negotiated Rate |
$86.15 |
| Rate for Payer: Aetna Commercial |
$81.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.22
|
| Rate for Payer: Cash Price |
$76.58
|
| Rate for Payer: Cofinity Advantage |
$67.00
|
| Rate for Payer: Cofinity Commercial |
$82.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.58
|
| Rate for Payer: Healthscope Commercial |
$86.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.79
|
| Rate for Payer: PHP Commercial |
$81.36
|
| Rate for Payer: Priority Health SBD |
$60.30
|
|
|
HC COMP BURN GARM STOCK-KNEE/NO F
|
Facility
|
OP
|
$64.50
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$54.83
|
| Rate for Payer: Aetna Medicare |
$32.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.92
|
| Rate for Payer: BCBS Complete |
$25.80
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Advantage |
$45.15
|
| Rate for Payer: Cofinity Commercial |
$55.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$58.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.38
|
| Rate for Payer: PHP Commercial |
$54.83
|
| Rate for Payer: Priority Health SBD |
$40.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.92
|
| Rate for Payer: UHC Core |
$33.60
|
| Rate for Payer: UHC Exchange |
$25.35
|
|
|
HC COMP BURN GARM STOCK-KNEE/NO F
|
Facility
|
IP
|
$64.50
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.63 |
| Max. Negotiated Rate |
$58.05 |
| Rate for Payer: Aetna Commercial |
$54.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.92
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Advantage |
$45.15
|
| Rate for Payer: Cofinity Commercial |
$55.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$58.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.38
|
| Rate for Payer: PHP Commercial |
$54.83
|
| Rate for Payer: Priority Health SBD |
$40.63
|
|
|
HC COMP BURN GARM STRETCH INSERT
|
Facility
|
IP
|
$12.73
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
98300057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$11.46 |
| Rate for Payer: Aetna Commercial |
$10.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.27
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cofinity Advantage |
$8.91
|
| Rate for Payer: Cofinity Commercial |
$10.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$11.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.55
|
| Rate for Payer: PHP Commercial |
$10.82
|
| Rate for Payer: Priority Health SBD |
$8.02
|
|
|
HC COMP BURN GARM STRETCH INSERT
|
Facility
|
OP
|
$12.73
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
98300057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$377.01 |
| Rate for Payer: Aetna Commercial |
$10.82
|
| Rate for Payer: Aetna Medicare |
$6.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.27
|
| Rate for Payer: BCBS Complete |
$5.09
|
| Rate for Payer: BCBS Trust/PPO |
$377.01
|
| Rate for Payer: BCN Commercial |
$377.01
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cofinity Advantage |
$8.91
|
| Rate for Payer: Cofinity Commercial |
$10.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$11.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.55
|
| Rate for Payer: PHP Commercial |
$10.82
|
| Rate for Payer: Priority Health SBD |
$8.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.27
|
| Rate for Payer: UHC Core |
$6.63
|
| Rate for Payer: UHC Exchange |
$5.00
|
|
|
HC COMP BURN GARM SUEDE/LEATHER G
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300058
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$23.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: BCBS Complete |
$18.73
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Advantage |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.12
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health SBD |
$29.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.43
|
| Rate for Payer: UHC Core |
$24.39
|
| Rate for Payer: UHC Exchange |
$18.40
|
|
|
HC COMP BURN GARM SUEDE/LEATHER G
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300058
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Advantage |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.12
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health SBD |
$29.50
|
|
|
HC COMP BURN GARM SUIT SLVD ABV K
|
Facility
|
IP
|
$395.35
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300059
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$249.07 |
| Max. Negotiated Rate |
$355.81 |
| Rate for Payer: Aetna Commercial |
$336.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.98
|
| Rate for Payer: Cash Price |
$316.28
|
| Rate for Payer: Cofinity Advantage |
$276.75
|
| Rate for Payer: Cofinity Commercial |
$340.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.28
|
| Rate for Payer: Healthscope Commercial |
$355.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$296.51
|
| Rate for Payer: PHP Commercial |
$336.05
|
| Rate for Payer: Priority Health SBD |
$249.07
|
|
|
HC COMP BURN GARM SUIT SLVD ABV K
|
Facility
|
OP
|
$395.35
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300059
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$155.37 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$336.05
|
| Rate for Payer: Aetna Medicare |
$197.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.98
|
| Rate for Payer: BCBS Complete |
$158.14
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$316.28
|
| Rate for Payer: Cash Price |
$316.28
|
| Rate for Payer: Cofinity Advantage |
$276.75
|
| Rate for Payer: Cofinity Commercial |
$340.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.28
|
| Rate for Payer: Healthscope Commercial |
$355.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$316.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$296.51
|
| Rate for Payer: PHP Commercial |
$336.05
|
| Rate for Payer: Priority Health SBD |
$249.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.98
|
| Rate for Payer: UHC Core |
$205.98
|
| Rate for Payer: UHC Exchange |
$155.37
|
|
|
HC COMP BURN GARM SUIT SLVD TWO LEGS
|
Facility
|
IP
|
$501.47
|
|
|
Service Code
|
HCPCS A6501
|
| Hospital Charge Code |
98300060
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$315.93 |
| Max. Negotiated Rate |
$451.32 |
| Rate for Payer: Aetna Commercial |
$426.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.96
|
| Rate for Payer: Cash Price |
$401.18
|
| Rate for Payer: Cofinity Advantage |
$351.03
|
| Rate for Payer: Cofinity Commercial |
$431.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.18
|
| Rate for Payer: Healthscope Commercial |
$451.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$376.10
|
| Rate for Payer: PHP Commercial |
$426.25
|
| Rate for Payer: Priority Health SBD |
$315.93
|
|
|
HC COMP BURN GARM SUIT SLVD TWO LEGS
|
Facility
|
OP
|
$501.47
|
|
|
Service Code
|
HCPCS A6501
|
| Hospital Charge Code |
98300060
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$197.08 |
| Max. Negotiated Rate |
$1,063.24 |
| Rate for Payer: Aetna Commercial |
$426.25
|
| Rate for Payer: Aetna Medicare |
$250.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.96
|
| Rate for Payer: BCBS Complete |
$200.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,063.24
|
| Rate for Payer: BCN Commercial |
$1,063.24
|
| Rate for Payer: Cash Price |
$401.18
|
| Rate for Payer: Cash Price |
$401.18
|
| Rate for Payer: Cofinity Advantage |
$351.03
|
| Rate for Payer: Cofinity Commercial |
$431.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.18
|
| Rate for Payer: Healthscope Commercial |
$451.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$401.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$376.10
|
| Rate for Payer: PHP Commercial |
$426.25
|
| Rate for Payer: Priority Health SBD |
$315.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$325.96
|
| Rate for Payer: UHC Core |
$261.27
|
| Rate for Payer: UHC Exchange |
$197.08
|
|
|
HC COMP BURN GARM SUIT SLVLS ABV
|
Facility
|
OP
|
$326.69
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300061
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$128.39 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$277.69
|
| Rate for Payer: Aetna Medicare |
$163.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.35
|
| Rate for Payer: BCBS Complete |
$130.68
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$261.35
|
| Rate for Payer: Cash Price |
$261.35
|
| Rate for Payer: Cofinity Advantage |
$228.68
|
| Rate for Payer: Cofinity Commercial |
$280.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.35
|
| Rate for Payer: Healthscope Commercial |
$294.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.02
|
| Rate for Payer: PHP Commercial |
$277.69
|
| Rate for Payer: Priority Health SBD |
$205.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.35
|
| Rate for Payer: UHC Core |
$170.21
|
| Rate for Payer: UHC Exchange |
$128.39
|
|
|
HC COMP BURN GARM SUIT SLVLS ABV
|
Facility
|
IP
|
$326.69
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300061
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$205.81 |
| Max. Negotiated Rate |
$294.02 |
| Rate for Payer: Aetna Commercial |
$277.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.35
|
| Rate for Payer: Cash Price |
$261.35
|
| Rate for Payer: Cofinity Advantage |
$228.68
|
| Rate for Payer: Cofinity Commercial |
$280.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.35
|
| Rate for Payer: Healthscope Commercial |
$294.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.02
|
| Rate for Payer: PHP Commercial |
$277.69
|
| Rate for Payer: Priority Health SBD |
$205.81
|
|
|
HC COMP BURN GARM SUIT SLVLS-TWO LEGS
|
Facility
|
OP
|
$382.87
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300062
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$150.47 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$325.44
|
| Rate for Payer: Aetna Medicare |
$191.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.87
|
| Rate for Payer: BCBS Complete |
$153.15
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cofinity Advantage |
$268.01
|
| Rate for Payer: Cofinity Commercial |
$329.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.30
|
| Rate for Payer: Healthscope Commercial |
$344.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$306.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.15
|
| Rate for Payer: PHP Commercial |
$325.44
|
| Rate for Payer: Priority Health SBD |
$241.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.87
|
| Rate for Payer: UHC Core |
$199.48
|
| Rate for Payer: UHC Exchange |
$150.47
|
|
|
HC COMP BURN GARM SUIT SLVLS-TWO LEGS
|
Facility
|
IP
|
$382.87
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300062
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$241.21 |
| Max. Negotiated Rate |
$344.58 |
| Rate for Payer: Aetna Commercial |
$325.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.87
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cofinity Advantage |
$268.01
|
| Rate for Payer: Cofinity Commercial |
$329.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.30
|
| Rate for Payer: Healthscope Commercial |
$344.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.15
|
| Rate for Payer: PHP Commercial |
$325.44
|
| Rate for Payer: Priority Health SBD |
$241.21
|
|
|
HC COMP BURN GARM SUSPENDERS ATTA
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300063
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Advantage |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.12
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health SBD |
$29.50
|
|
|
HC COMP BURN GARM SUSPENDERS ATTA
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300063
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$23.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: BCBS Complete |
$18.73
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Advantage |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.12
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health SBD |
$29.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.43
|
| Rate for Payer: UHC Core |
$24.39
|
| Rate for Payer: UHC Exchange |
$18.40
|
|
|
HC COMP BURN GARM SUSPENDERS REMO
|
Facility
|
OP
|
$12.48
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300064
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.23 |
| 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: 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 SUSPENDERS REMO
|
Facility
|
IP
|
$12.48
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300064
|
|
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 TWO LEGS PREGNA
|
Facility
|
OP
|
$260.10
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300065
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$102.22 |
| Max. Negotiated Rate |
$435.30 |
| Rate for Payer: Aetna Commercial |
$221.09
|
| Rate for Payer: Aetna Medicare |
$130.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.06
|
| Rate for Payer: BCBS Complete |
$104.04
|
| Rate for Payer: BCBS Trust/PPO |
$435.30
|
| Rate for Payer: BCN Commercial |
$435.30
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Advantage |
$182.07
|
| Rate for Payer: Cofinity Commercial |
$223.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Healthscope Commercial |
$234.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.07
|
| Rate for Payer: PHP Commercial |
$221.09
|
| Rate for Payer: Priority Health SBD |
$163.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.06
|
| Rate for Payer: UHC Core |
$135.51
|
| Rate for Payer: UHC Exchange |
$102.22
|
|
|
HC COMP BURN GARM TWO LEGS PREGNA
|
Facility
|
IP
|
$260.10
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300065
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$163.86 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna Commercial |
$221.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.06
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Advantage |
$182.07
|
| Rate for Payer: Cofinity Commercial |
$223.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Healthscope Commercial |
$234.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.07
|
| Rate for Payer: PHP Commercial |
$221.09
|
| Rate for Payer: Priority Health SBD |
$163.86
|
|
|
HC COMP BURN GARM VEST SLEEVED
|
Facility
|
IP
|
$260.10
|
|
|
Service Code
|
HCPCS A6509
|
| Hospital Charge Code |
98300066
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$163.86 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna Commercial |
$221.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.06
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Advantage |
$182.07
|
| Rate for Payer: Cofinity Commercial |
$223.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Healthscope Commercial |
$234.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.07
|
| Rate for Payer: PHP Commercial |
$221.09
|
| Rate for Payer: Priority Health SBD |
$163.86
|
|
