|
HC COMM WORK REINTEGRATION EA 15 MIN
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
42000031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.94 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: BCBS Trust/PPO |
$73.42
|
| Rate for Payer: BCN Commercial |
$73.42
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Healthscope Commercial |
$85.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.75
|
| Rate for Payer: PHP Commercial |
$80.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.60
|
| Rate for Payer: UHC Core |
$79.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.25
|
|
|
HC COMPARTMENT PRESSURE CHECK
|
Facility
|
IP
|
$645.71
|
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$393.82 |
| Max. Negotiated Rate |
$581.14 |
| Rate for Payer: Aetna Commercial |
$548.85
|
| Rate for Payer: BCBS Trust/PPO |
$499.00
|
| Rate for Payer: BCN Commercial |
$499.00
|
| Rate for Payer: Cash Price |
$516.57
|
| Rate for Payer: Cofinity Commercial |
$555.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.57
|
| Rate for Payer: Healthscope Commercial |
$581.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$484.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$548.85
|
| Rate for Payer: PHP Commercial |
$548.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$561.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$393.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$568.22
|
| Rate for Payer: UHC Core |
$539.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$484.28
|
|
|
HC COMPARTMENT PRESSURE CHECK
|
Facility
|
OP
|
$645.71
|
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.36 |
| Max. Negotiated Rate |
$581.14 |
| Rate for Payer: Aetna Commercial |
$548.85
|
| Rate for Payer: Aetna Medicare |
$167.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$201.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$201.78
|
| Rate for Payer: BCBS Complete |
$258.28
|
| Rate for Payer: BCBS MAPPO |
$161.43
|
| Rate for Payer: BCBS Trust/PPO |
$502.04
|
| Rate for Payer: BCN Commercial |
$502.04
|
| Rate for Payer: BCN Medicare Advantage |
$161.43
|
| Rate for Payer: Cash Price |
$516.57
|
| Rate for Payer: Cofinity Commercial |
$555.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.43
|
| Rate for Payer: Healthscope Commercial |
$581.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$484.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$169.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$185.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$548.85
|
| Rate for Payer: PACE Senior Care Partners |
$153.36
|
| Rate for Payer: PACE SWMI |
$161.43
|
| Rate for Payer: PHP Commercial |
$548.85
|
| Rate for Payer: PHP Medicare Advantage |
$161.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$561.77
|
| Rate for Payer: Priority Health Medicare |
$161.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$393.82
|
| Rate for Payer: Railroad Medicare Medicare |
$161.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$568.22
|
| Rate for Payer: UHC Core |
$539.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.43
|
| Rate for Payer: UHC Medicare Advantage |
$166.27
|
| Rate for Payer: VA VA |
$161.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$484.28
|
|
|
HC COMP BURN GARM 2 LEGS-WAIST
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300142
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$142.72 |
| Max. Negotiated Rate |
$210.60 |
| Rate for Payer: Aetna Commercial |
$198.90
|
| Rate for Payer: BCBS Trust/PPO |
$180.84
|
| Rate for Payer: BCN Commercial |
$180.84
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cofinity Commercial |
$201.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.20
|
| Rate for Payer: Healthscope Commercial |
$210.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$198.90
|
| Rate for Payer: PHP Commercial |
$198.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$203.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.92
|
| Rate for Payer: UHC Core |
$195.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.50
|
|
|
HC COMP BURN GARM 2 LEGS-WAIST
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300142
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$55.58 |
| Max. Negotiated Rate |
$210.60 |
| Rate for Payer: Aetna Commercial |
$198.90
|
| Rate for Payer: Aetna Medicare |
$60.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.12
|
| Rate for Payer: BCBS Complete |
$93.60
|
| Rate for Payer: BCBS MAPPO |
$58.50
|
| Rate for Payer: BCBS Trust/PPO |
$181.94
|
| Rate for Payer: BCN Commercial |
$181.94
|
| Rate for Payer: BCN Medicare Advantage |
$58.50
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cofinity Commercial |
$201.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.50
|
| Rate for Payer: Healthscope Commercial |
$210.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$61.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$198.90
|
| Rate for Payer: PACE Senior Care Partners |
$55.58
|
| Rate for Payer: PACE SWMI |
$58.50
|
| Rate for Payer: PHP Commercial |
$198.90
|
| Rate for Payer: PHP Medicare Advantage |
$58.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$203.58
|
| Rate for Payer: Priority Health Medicare |
$58.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.72
|
| Rate for Payer: Railroad Medicare Medicare |
$58.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.92
|
| Rate for Payer: UHC Core |
$195.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.50
|
| Rate for Payer: UHC Medicare Advantage |
$60.26
|
| Rate for Payer: VA VA |
$58.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.50
|
|
|
HC COMP BURN GARM 2 OR MORE FAB/C
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$9.27
|
| Rate for Payer: BCN Commercial |
$9.27
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.20
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.56
|
| Rate for Payer: UHC Core |
$10.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
HC COMP BURN GARM 2 OR MORE FAB/C
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Medicare |
$3.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.75
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS MAPPO |
$3.00
|
| Rate for Payer: BCBS Trust/PPO |
$9.33
|
| Rate for Payer: BCN Commercial |
$9.33
|
| Rate for Payer: BCN Medicare Advantage |
$3.00
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.00
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.20
|
| Rate for Payer: PACE Senior Care Partners |
$2.85
|
| Rate for Payer: PACE SWMI |
$3.00
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: PHP Medicare Advantage |
$3.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.44
|
| Rate for Payer: Priority Health Medicare |
$3.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.32
|
| Rate for Payer: Railroad Medicare Medicare |
$3.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.56
|
| Rate for Payer: UHC Core |
$10.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.00
|
| Rate for Payer: UHC Medicare Advantage |
$3.09
|
| Rate for Payer: VA VA |
$3.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
HC COMP BURN GARM ABD REINFOR DBL
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300144
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna Commercial |
$13.60
|
| Rate for Payer: BCBS Trust/PPO |
$12.36
|
| Rate for Payer: BCN Commercial |
$12.36
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$13.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.80
|
| Rate for Payer: Healthscope Commercial |
$14.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.60
|
| Rate for Payer: PHP Commercial |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.08
|
| Rate for Payer: UHC Core |
$13.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.00
|
|
|
HC COMP BURN GARM ABD REINFOR DBL
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300144
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna Commercial |
$13.60
|
| Rate for Payer: Aetna Medicare |
$4.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.00
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS MAPPO |
$4.00
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Medicare Advantage |
$4.00
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$13.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.00
|
| Rate for Payer: Healthscope Commercial |
$14.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.60
|
| Rate for Payer: PACE Senior Care Partners |
$3.80
|
| Rate for Payer: PACE SWMI |
$4.00
|
| Rate for Payer: PHP Commercial |
$13.60
|
| Rate for Payer: PHP Medicare Advantage |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.92
|
| Rate for Payer: Priority Health Medicare |
$4.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.76
|
| Rate for Payer: Railroad Medicare Medicare |
$4.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.08
|
| Rate for Payer: UHC Core |
$13.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.00
|
| Rate for Payer: UHC Medicare Advantage |
$4.12
|
| Rate for Payer: VA VA |
$4.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.00
|
|
|
HC COMP BURN GARM ANKLET
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300145
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna Commercial |
$52.70
|
| Rate for Payer: Aetna Medicare |
$16.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.38
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: BCBS MAPPO |
$15.50
|
| Rate for Payer: BCBS Trust/PPO |
$48.20
|
| Rate for Payer: BCN Commercial |
$48.20
|
| Rate for Payer: BCN Medicare Advantage |
$15.50
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$53.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.50
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: PACE Senior Care Partners |
$14.72
|
| Rate for Payer: PACE SWMI |
$15.50
|
| Rate for Payer: PHP Commercial |
$52.70
|
| Rate for Payer: PHP Medicare Advantage |
$15.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.94
|
| Rate for Payer: Priority Health Medicare |
$15.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.81
|
| Rate for Payer: Railroad Medicare Medicare |
$15.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.56
|
| Rate for Payer: UHC Core |
$51.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.50
|
| Rate for Payer: UHC Medicare Advantage |
$15.96
|
| Rate for Payer: VA VA |
$15.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.50
|
|
|
HC COMP BURN GARM ANKLET
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300145
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.81 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna Commercial |
$52.70
|
| Rate for Payer: BCBS Trust/PPO |
$47.91
|
| Rate for Payer: BCN Commercial |
$47.91
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$53.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.60
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: PHP Commercial |
$52.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.56
|
| Rate for Payer: UHC Core |
$51.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.50
|
|
|
HC COMP BURN GARM BDY BRF SLVD LE
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
HCPCS A6510
|
| Hospital Charge Code |
98300146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$202.49 |
| Max. Negotiated Rate |
$298.80 |
| Rate for Payer: Aetna Commercial |
$282.20
|
| Rate for Payer: BCBS Trust/PPO |
$256.57
|
| Rate for Payer: BCN Commercial |
$256.57
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cofinity Commercial |
$285.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.60
|
| Rate for Payer: Healthscope Commercial |
$298.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.20
|
| Rate for Payer: PHP Commercial |
$282.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.16
|
| Rate for Payer: UHC Core |
$277.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.00
|
|
|
HC COMP BURN GARM BDY BRF SLVD LE
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
HCPCS A6510
|
| Hospital Charge Code |
98300146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.85 |
| Max. Negotiated Rate |
$298.80 |
| Rate for Payer: Aetna Commercial |
$282.20
|
| Rate for Payer: Aetna Medicare |
$86.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.75
|
| Rate for Payer: BCBS Complete |
$132.80
|
| Rate for Payer: BCBS MAPPO |
$83.00
|
| Rate for Payer: BCBS Trust/PPO |
$258.13
|
| Rate for Payer: BCN Commercial |
$258.13
|
| Rate for Payer: BCN Medicare Advantage |
$83.00
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cofinity Commercial |
$285.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.00
|
| Rate for Payer: Healthscope Commercial |
$298.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.20
|
| Rate for Payer: PACE Senior Care Partners |
$78.85
|
| Rate for Payer: PACE SWMI |
$83.00
|
| Rate for Payer: PHP Commercial |
$282.20
|
| Rate for Payer: PHP Medicare Advantage |
$83.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.84
|
| Rate for Payer: Priority Health Medicare |
$83.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.49
|
| Rate for Payer: Railroad Medicare Medicare |
$83.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.16
|
| Rate for Payer: UHC Core |
$277.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.00
|
| Rate for Payer: UHC Medicare Advantage |
$85.49
|
| Rate for Payer: VA VA |
$83.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.00
|
|
|
HC COMP BURN GARM BELLY BAND
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: BCBS Trust/PPO |
$30.91
|
| Rate for Payer: BCN Commercial |
$30.91
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.20
|
| Rate for Payer: UHC Core |
$33.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
|
HC COMP BURN GARM BELLY BAND
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna Medicare |
$10.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.50
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS MAPPO |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$31.10
|
| Rate for Payer: BCN Commercial |
$31.10
|
| Rate for Payer: BCN Medicare Advantage |
$10.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.00
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
| Rate for Payer: PACE Senior Care Partners |
$9.50
|
| Rate for Payer: PACE SWMI |
$10.00
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: PHP Medicare Advantage |
$10.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.80
|
| Rate for Payer: Priority Health Medicare |
$10.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.40
|
| Rate for Payer: Railroad Medicare Medicare |
$10.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.20
|
| Rate for Payer: UHC Core |
$33.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.00
|
| Rate for Payer: UHC Medicare Advantage |
$10.30
|
| Rate for Payer: VA VA |
$10.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
|
HC COMP BURN GARM BODY BRF SLEEVE
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.05 |
| Max. Negotiated Rate |
$212.40 |
| Rate for Payer: Aetna Commercial |
$200.60
|
| Rate for Payer: Aetna Medicare |
$61.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.75
|
| Rate for Payer: BCBS Complete |
$94.40
|
| Rate for Payer: BCBS MAPPO |
$59.00
|
| Rate for Payer: BCBS Trust/PPO |
$183.49
|
| Rate for Payer: BCN Commercial |
$183.49
|
| Rate for Payer: BCN Medicare Advantage |
$59.00
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cofinity Commercial |
$202.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.00
|
| Rate for Payer: Healthscope Commercial |
$212.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$61.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.60
|
| Rate for Payer: PACE Senior Care Partners |
$56.05
|
| Rate for Payer: PACE SWMI |
$59.00
|
| Rate for Payer: PHP Commercial |
$200.60
|
| Rate for Payer: PHP Medicare Advantage |
$59.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.32
|
| Rate for Payer: Priority Health Medicare |
$59.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.94
|
| Rate for Payer: Railroad Medicare Medicare |
$59.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.68
|
| Rate for Payer: UHC Core |
$197.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.00
|
| Rate for Payer: UHC Medicare Advantage |
$60.77
|
| Rate for Payer: VA VA |
$59.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.00
|
|
|
HC COMP BURN GARM BODY BRF SLEEVE
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$143.94 |
| Max. Negotiated Rate |
$212.40 |
| Rate for Payer: Aetna Commercial |
$200.60
|
| Rate for Payer: BCBS Trust/PPO |
$182.38
|
| Rate for Payer: BCN Commercial |
$182.38
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cofinity Commercial |
$202.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.80
|
| Rate for Payer: Healthscope Commercial |
$212.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.60
|
| Rate for Payer: PHP Commercial |
$200.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.68
|
| Rate for Payer: UHC Core |
$197.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.00
|
|
|
HC COMP BURN GARM BRF 2 LEGS ABV
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Medicare |
$39.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.88
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS MAPPO |
$37.50
|
| Rate for Payer: BCBS Trust/PPO |
$116.62
|
| Rate for Payer: BCN Commercial |
$116.62
|
| Rate for Payer: BCN Medicare Advantage |
$37.50
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.50
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PACE Senior Care Partners |
$35.62
|
| Rate for Payer: PACE SWMI |
$37.50
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: PHP Medicare Advantage |
$37.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.50
|
| Rate for Payer: Priority Health Medicare |
$37.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.48
|
| Rate for Payer: Railroad Medicare Medicare |
$37.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.00
|
| Rate for Payer: UHC Core |
$125.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.50
|
| Rate for Payer: UHC Medicare Advantage |
$38.62
|
| Rate for Payer: VA VA |
$37.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.50
|
|
|
HC COMP BURN GARM BRF 2 LEGS ABV
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$91.48 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: BCBS Trust/PPO |
$115.92
|
| Rate for Payer: BCN Commercial |
$115.92
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.00
|
| Rate for Payer: UHC Core |
$125.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.50
|
|
|
HC COMP BURN GARM BRF&CHAP,LG-MID
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.51 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna Commercial |
$112.20
|
| Rate for Payer: BCBS Trust/PPO |
$102.01
|
| Rate for Payer: BCN Commercial |
$102.01
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$113.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
| Rate for Payer: Healthscope Commercial |
$118.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.20
|
| Rate for Payer: PHP Commercial |
$112.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.16
|
| Rate for Payer: UHC Core |
$110.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.00
|
|
|
HC COMP BURN GARM BRF&CHAP,LG-MID
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna Commercial |
$112.20
|
| Rate for Payer: Aetna Medicare |
$34.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.25
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS MAPPO |
$33.00
|
| Rate for Payer: BCBS Trust/PPO |
$102.63
|
| Rate for Payer: BCN Commercial |
$102.63
|
| Rate for Payer: BCN Medicare Advantage |
$33.00
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$113.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.00
|
| Rate for Payer: Healthscope Commercial |
$118.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.20
|
| Rate for Payer: PACE Senior Care Partners |
$31.35
|
| Rate for Payer: PACE SWMI |
$33.00
|
| Rate for Payer: PHP Commercial |
$112.20
|
| Rate for Payer: PHP Medicare Advantage |
$33.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.84
|
| Rate for Payer: Priority Health Medicare |
$33.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.51
|
| Rate for Payer: Railroad Medicare Medicare |
$33.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.16
|
| Rate for Payer: UHC Core |
$110.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.00
|
| Rate for Payer: UHC Medicare Advantage |
$33.99
|
| Rate for Payer: VA VA |
$33.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.00
|
|
|
HC COMP BURN GARM BRIEF
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.51 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna Commercial |
$112.20
|
| Rate for Payer: BCBS Trust/PPO |
$102.01
|
| Rate for Payer: BCN Commercial |
$102.01
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$113.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
| Rate for Payer: Healthscope Commercial |
$118.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.20
|
| Rate for Payer: PHP Commercial |
$112.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.16
|
| Rate for Payer: UHC Core |
$110.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.00
|
|
|
HC COMP BURN GARM BRIEF
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna Commercial |
$112.20
|
| Rate for Payer: Aetna Medicare |
$34.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.25
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS MAPPO |
$33.00
|
| Rate for Payer: BCBS Trust/PPO |
$102.63
|
| Rate for Payer: BCN Commercial |
$102.63
|
| Rate for Payer: BCN Medicare Advantage |
$33.00
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$113.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.00
|
| Rate for Payer: Healthscope Commercial |
$118.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.20
|
| Rate for Payer: PACE Senior Care Partners |
$31.35
|
| Rate for Payer: PACE SWMI |
$33.00
|
| Rate for Payer: PHP Commercial |
$112.20
|
| Rate for Payer: PHP Medicare Advantage |
$33.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.84
|
| Rate for Payer: Priority Health Medicare |
$33.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.51
|
| Rate for Payer: Railroad Medicare Medicare |
$33.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.16
|
| Rate for Payer: UHC Core |
$110.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.00
|
| Rate for Payer: UHC Medicare Advantage |
$33.99
|
| Rate for Payer: VA VA |
$33.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.00
|
|
|
HC COMP BURN GARM CHIN STRAP REGU
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS A6502
|
| Hospital Charge Code |
98300152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.57 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna Commercial |
$66.30
|
| Rate for Payer: BCBS Trust/PPO |
$60.28
|
| Rate for Payer: BCN Commercial |
$60.28
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.40
|
| Rate for Payer: Healthscope Commercial |
$70.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.30
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.64
|
| Rate for Payer: UHC Core |
$65.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.50
|
|
|
HC COMP BURN GARM CHIN STRAP REGU
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS A6502
|
| Hospital Charge Code |
98300152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna Commercial |
$66.30
|
| Rate for Payer: Aetna Medicare |
$20.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.38
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: BCBS MAPPO |
$19.50
|
| Rate for Payer: BCBS Trust/PPO |
$60.64
|
| Rate for Payer: BCN Commercial |
$60.64
|
| Rate for Payer: BCN Medicare Advantage |
$19.50
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.50
|
| Rate for Payer: Healthscope Commercial |
$70.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.30
|
| Rate for Payer: PACE Senior Care Partners |
$18.52
|
| Rate for Payer: PACE SWMI |
$19.50
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: PHP Medicare Advantage |
$19.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.86
|
| Rate for Payer: Priority Health Medicare |
$19.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.57
|
| Rate for Payer: Railroad Medicare Medicare |
$19.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.64
|
| Rate for Payer: UHC Core |
$65.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.50
|
| Rate for Payer: UHC Medicare Advantage |
$20.08
|
| Rate for Payer: VA VA |
$19.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.50
|
|
