|
HC COMP BURN GARM CHIN STRP W LIP
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS A6502
|
| Hospital Charge Code |
98300153
|
|
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
|
|
|
HC COMP BURN GARM CHIN STRP W LIP
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS A6502
|
| Hospital Charge Code |
98300153
|
|
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 COLLAR FOAM
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300154
|
|
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 COLLAR FOAM
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300154
|
|
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 COLLAR PILLOW
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300155
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: Aetna Medicare |
$17.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.25
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCBS MAPPO |
$17.00
|
| Rate for Payer: BCBS Trust/PPO |
$52.87
|
| Rate for Payer: BCN Commercial |
$52.87
|
| Rate for Payer: BCN Medicare Advantage |
$17.00
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.00
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PACE Senior Care Partners |
$16.15
|
| Rate for Payer: PACE SWMI |
$17.00
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: PHP Medicare Advantage |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.16
|
| Rate for Payer: Priority Health Medicare |
$17.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.47
|
| Rate for Payer: Railroad Medicare Medicare |
$17.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.84
|
| Rate for Payer: UHC Core |
$56.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.00
|
| Rate for Payer: UHC Medicare Advantage |
$17.51
|
| Rate for Payer: VA VA |
$17.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.00
|
|
|
HC COMP BURN GARM COLLAR PILLOW
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300155
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.47 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: BCBS Trust/PPO |
$52.55
|
| Rate for Payer: BCN Commercial |
$52.55
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.84
|
| Rate for Payer: UHC Core |
$56.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.00
|
|
|
HC COMP BURN GARM COLLAR TRACH
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300156
|
|
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 COLLAR TRACH
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300156
|
|
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 ELECTIVE ALTERA
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: BCBS Trust/PPO |
$15.46
|
| Rate for Payer: BCN Commercial |
$15.46
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.60
|
| Rate for Payer: UHC Core |
$16.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
|
HC COMP BURN GARM ELECTIVE ALTERA
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.25
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$15.55
|
| Rate for Payer: BCN Commercial |
$15.55
|
| Rate for Payer: BCN Medicare Advantage |
$5.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.00
|
| Rate for Payer: PACE Senior Care Partners |
$4.75
|
| Rate for Payer: PACE SWMI |
$5.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: PHP Medicare Advantage |
$5.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.40
|
| Rate for Payer: Priority Health Medicare |
$5.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.20
|
| Rate for Payer: Railroad Medicare Medicare |
$5.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.60
|
| Rate for Payer: UHC Core |
$16.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.00
|
| Rate for Payer: UHC Medicare Advantage |
$5.15
|
| Rate for Payer: VA VA |
$5.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
|
HC COMP BURN GARM EXPANSION PANEL
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna Commercial |
$23.80
|
| Rate for Payer: BCBS Trust/PPO |
$21.64
|
| Rate for Payer: BCN Commercial |
$21.64
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$24.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.40
|
| Rate for Payer: Healthscope Commercial |
$25.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.80
|
| Rate for Payer: PHP Commercial |
$23.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.64
|
| Rate for Payer: UHC Core |
$23.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.00
|
|
|
HC COMP BURN GARM EXPANSION PANEL
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna Commercial |
$23.80
|
| Rate for Payer: Aetna Medicare |
$7.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.75
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCBS MAPPO |
$7.00
|
| Rate for Payer: BCBS Trust/PPO |
$21.77
|
| Rate for Payer: BCN Commercial |
$21.77
|
| Rate for Payer: BCN Medicare Advantage |
$7.00
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$24.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.00
|
| Rate for Payer: Healthscope Commercial |
$25.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.80
|
| Rate for Payer: PACE Senior Care Partners |
$6.65
|
| Rate for Payer: PACE SWMI |
$7.00
|
| Rate for Payer: PHP Commercial |
$23.80
|
| Rate for Payer: PHP Medicare Advantage |
$7.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.36
|
| Rate for Payer: Priority Health Medicare |
$7.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.08
|
| Rate for Payer: Railroad Medicare Medicare |
$7.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.64
|
| Rate for Payer: UHC Core |
$23.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.00
|
| Rate for Payer: UHC Medicare Advantage |
$7.21
|
| Rate for Payer: VA VA |
$7.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.00
|
|
|
HC COMP BURN GARM FACE MASK
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
HCPCS A6503
|
| Hospital Charge Code |
98300159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$81.73 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$113.90
|
| Rate for Payer: BCBS Trust/PPO |
$103.56
|
| Rate for Payer: BCN Commercial |
$103.56
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cofinity Commercial |
$115.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.20
|
| Rate for Payer: Healthscope Commercial |
$120.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.90
|
| Rate for Payer: PHP Commercial |
$113.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.92
|
| Rate for Payer: UHC Core |
$111.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.50
|
|
|
HC COMP BURN GARM FACE MASK
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
HCPCS A6503
|
| Hospital Charge Code |
98300159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.82 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$113.90
|
| Rate for Payer: Aetna Medicare |
$34.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.88
|
| Rate for Payer: BCBS Complete |
$53.60
|
| Rate for Payer: BCBS MAPPO |
$33.50
|
| Rate for Payer: BCBS Trust/PPO |
$104.18
|
| Rate for Payer: BCN Commercial |
$104.18
|
| Rate for Payer: BCN Medicare Advantage |
$33.50
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cofinity Commercial |
$115.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.50
|
| Rate for Payer: Healthscope Commercial |
$120.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.90
|
| Rate for Payer: PACE Senior Care Partners |
$31.82
|
| Rate for Payer: PACE SWMI |
$33.50
|
| Rate for Payer: PHP Commercial |
$113.90
|
| Rate for Payer: PHP Medicare Advantage |
$33.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.58
|
| Rate for Payer: Priority Health Medicare |
$33.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.73
|
| Rate for Payer: Railroad Medicare Medicare |
$33.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.92
|
| Rate for Payer: UHC Core |
$111.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.50
|
| Rate for Payer: UHC Medicare Advantage |
$34.50
|
| Rate for Payer: VA VA |
$33.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.50
|
|
|
HC COMP BURN GARM FOOT GAUNTLET
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300160
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$28.90
|
| Rate for Payer: Aetna Medicare |
$8.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.62
|
| Rate for Payer: BCBS Complete |
$13.60
|
| Rate for Payer: BCBS MAPPO |
$8.50
|
| Rate for Payer: BCBS Trust/PPO |
$26.44
|
| Rate for Payer: BCN Commercial |
$26.44
|
| Rate for Payer: BCN Medicare Advantage |
$8.50
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$29.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.50
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.90
|
| Rate for Payer: PACE Senior Care Partners |
$8.08
|
| Rate for Payer: PACE SWMI |
$8.50
|
| Rate for Payer: PHP Commercial |
$28.90
|
| Rate for Payer: PHP Medicare Advantage |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.58
|
| Rate for Payer: Priority Health Medicare |
$8.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.74
|
| Rate for Payer: Railroad Medicare Medicare |
$8.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.92
|
| Rate for Payer: UHC Core |
$28.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.50
|
| Rate for Payer: UHC Medicare Advantage |
$8.76
|
| Rate for Payer: VA VA |
$8.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.50
|
|
|
HC COMP BURN GARM FOOT GAUNTLET
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300160
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.74 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$28.90
|
| Rate for Payer: BCBS Trust/PPO |
$26.28
|
| Rate for Payer: BCN Commercial |
$26.28
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$29.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.20
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.90
|
| Rate for Payer: PHP Commercial |
$28.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.92
|
| Rate for Payer: UHC Core |
$28.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.50
|
|
|
HC COMP BURN GARM FOOT GLOVE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$67.09 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna Commercial |
$93.50
|
| Rate for Payer: BCBS Trust/PPO |
$85.01
|
| Rate for Payer: BCN Commercial |
$85.01
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$94.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.00
|
| Rate for Payer: Healthscope Commercial |
$99.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.50
|
| Rate for Payer: PHP Commercial |
$93.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.80
|
| Rate for Payer: UHC Core |
$91.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.50
|
|
|
HC COMP BURN GARM FOOT GLOVE
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.12 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna Commercial |
$93.50
|
| Rate for Payer: Aetna Medicare |
$28.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.38
|
| Rate for Payer: BCBS Complete |
$44.00
|
| Rate for Payer: BCBS MAPPO |
$27.50
|
| Rate for Payer: BCBS Trust/PPO |
$85.52
|
| Rate for Payer: BCN Commercial |
$85.52
|
| Rate for Payer: BCN Medicare Advantage |
$27.50
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$94.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.50
|
| Rate for Payer: Healthscope Commercial |
$99.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.50
|
| Rate for Payer: PACE Senior Care Partners |
$26.12
|
| Rate for Payer: PACE SWMI |
$27.50
|
| Rate for Payer: PHP Commercial |
$93.50
|
| Rate for Payer: PHP Medicare Advantage |
$27.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.70
|
| Rate for Payer: Priority Health Medicare |
$27.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.09
|
| Rate for Payer: Railroad Medicare Medicare |
$27.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.80
|
| Rate for Payer: UHC Core |
$91.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.50
|
| Rate for Payer: UHC Medicare Advantage |
$28.32
|
| Rate for Payer: VA VA |
$27.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.50
|
|
|
HC COMP BURN GARM FOOT MITTEN
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.38 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Medicare |
$23.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.12
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$22.50
|
| Rate for Payer: BCBS Trust/PPO |
$69.98
|
| Rate for Payer: BCN Commercial |
$69.98
|
| Rate for Payer: BCN Medicare Advantage |
$22.50
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.50
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PACE Senior Care Partners |
$21.38
|
| Rate for Payer: PACE SWMI |
$22.50
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: PHP Medicare Advantage |
$22.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.30
|
| Rate for Payer: Priority Health Medicare |
$22.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.89
|
| Rate for Payer: Railroad Medicare Medicare |
$22.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.20
|
| Rate for Payer: UHC Core |
$75.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.50
|
| Rate for Payer: UHC Medicare Advantage |
$23.18
|
| Rate for Payer: VA VA |
$22.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.50
|
|
|
HC COMP BURN GARM FOOT MITTEN
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.89 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: BCBS Trust/PPO |
$69.55
|
| Rate for Payer: BCN Commercial |
$69.55
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.20
|
| Rate for Payer: UHC Core |
$75.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.50
|
|
|
HC COMP BURN GARM FULLY LINED GAR
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna Commercial |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.77
|
| Rate for Payer: BCN Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.80
|
| Rate for Payer: Healthscope Commercial |
$0.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.85
|
| Rate for Payer: PHP Commercial |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.88
|
| Rate for Payer: UHC Core |
$0.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.75
|
|
|
HC COMP BURN GARM FULLY LINED GAR
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna Commercial |
$0.85
|
| Rate for Payer: Aetna Medicare |
$0.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.31
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.78
|
| Rate for Payer: BCN Commercial |
$0.78
|
| Rate for Payer: BCN Medicare Advantage |
$0.25
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.25
|
| Rate for Payer: Healthscope Commercial |
$0.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.85
|
| Rate for Payer: PACE Senior Care Partners |
$0.24
|
| Rate for Payer: PACE SWMI |
$0.25
|
| Rate for Payer: PHP Commercial |
$0.85
|
| Rate for Payer: PHP Medicare Advantage |
$0.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.87
|
| Rate for Payer: Priority Health Medicare |
$0.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.61
|
| Rate for Payer: Railroad Medicare Medicare |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.88
|
| Rate for Payer: UHC Core |
$0.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.25
|
| Rate for Payer: UHC Medicare Advantage |
$0.26
|
| Rate for Payer: VA VA |
$0.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.75
|
|
|
HC COMP BURN GARM GAUNTLET TO AXI
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.11 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna Commercial |
$78.20
|
| Rate for Payer: BCBS Trust/PPO |
$71.10
|
| Rate for Payer: BCN Commercial |
$71.10
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$79.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.60
|
| Rate for Payer: Healthscope Commercial |
$82.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.20
|
| Rate for Payer: PHP Commercial |
$78.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.96
|
| Rate for Payer: UHC Core |
$76.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.00
|
|
|
HC COMP BURN GARM GAUNTLET TO AXI
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna Commercial |
$78.20
|
| Rate for Payer: Aetna Medicare |
$23.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.75
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: BCBS MAPPO |
$23.00
|
| Rate for Payer: BCBS Trust/PPO |
$71.53
|
| Rate for Payer: BCN Commercial |
$71.53
|
| Rate for Payer: BCN Medicare Advantage |
$23.00
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$79.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.00
|
| Rate for Payer: Healthscope Commercial |
$82.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.20
|
| Rate for Payer: PACE Senior Care Partners |
$21.85
|
| Rate for Payer: PACE SWMI |
$23.00
|
| Rate for Payer: PHP Commercial |
$78.20
|
| Rate for Payer: PHP Medicare Advantage |
$23.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.04
|
| Rate for Payer: Priority Health Medicare |
$23.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.11
|
| Rate for Payer: Railroad Medicare Medicare |
$23.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.96
|
| Rate for Payer: UHC Core |
$76.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.00
|
| Rate for Payer: UHC Medicare Advantage |
$23.69
|
| Rate for Payer: VA VA |
$23.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.00
|
|
|
HC COMP BURN GARM GAUNTLET TO WRI
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300028
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: Aetna Medicare |
$9.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.94
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS MAPPO |
$8.75
|
| Rate for Payer: BCBS Trust/PPO |
$27.21
|
| Rate for Payer: BCN Commercial |
$27.21
|
| Rate for Payer: BCN Medicare Advantage |
$8.75
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.75
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.75
|
| Rate for Payer: PACE Senior Care Partners |
$8.31
|
| Rate for Payer: PACE SWMI |
$8.75
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: PHP Medicare Advantage |
$8.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.45
|
| Rate for Payer: Priority Health Medicare |
$8.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.35
|
| Rate for Payer: Railroad Medicare Medicare |
$8.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.80
|
| Rate for Payer: UHC Core |
$29.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.75
|
| Rate for Payer: UHC Medicare Advantage |
$9.01
|
| Rate for Payer: VA VA |
$8.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
