|
HC COMP BURN GARM GAUNTLET TO WRI
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300028
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.35 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: BCBS Trust/PPO |
$27.05
|
| Rate for Payer: BCN Commercial |
$27.05
|
| 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: Healthscope Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.75
|
| Rate for Payer: PHP Commercial |
$29.75
|
| 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 Narrow/Tiered Network |
$21.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.80
|
| Rate for Payer: UHC Core |
$29.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
HC COMP BURN GARM GLOVE-ELBOW
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS A6505
|
| Hospital Charge Code |
98300030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$41.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.00
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS MAPPO |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$124.40
|
| Rate for Payer: BCN Commercial |
$124.40
|
| Rate for Payer: BCN Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.00
|
| Rate for Payer: PACE Senior Care Partners |
$38.00
|
| Rate for Payer: PACE SWMI |
$40.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: PHP Medicare Advantage |
$40.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.20
|
| Rate for Payer: Priority Health Medicare |
$40.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.58
|
| Rate for Payer: Railroad Medicare Medicare |
$40.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.80
|
| Rate for Payer: UHC Core |
$133.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.00
|
| Rate for Payer: UHC Medicare Advantage |
$41.20
|
| Rate for Payer: VA VA |
$40.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC COMP BURN GARM GLOVE-ELBOW
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS A6505
|
| Hospital Charge Code |
98300030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$97.58 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: BCBS Trust/PPO |
$123.65
|
| Rate for Payer: BCN Commercial |
$123.65
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.80
|
| Rate for Payer: UHC Core |
$133.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC COMP BURN GARM GLOVE TO AXILLA
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS A6506
|
| Hospital Charge Code |
98300029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$107.34 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$149.60
|
| Rate for Payer: BCBS Trust/PPO |
$136.01
|
| Rate for Payer: BCN Commercial |
$136.01
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Commercial |
$151.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.80
|
| Rate for Payer: Healthscope Commercial |
$158.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.60
|
| Rate for Payer: PHP Commercial |
$149.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.88
|
| Rate for Payer: UHC Core |
$146.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.00
|
|
|
HC COMP BURN GARM GLOVE TO AXILLA
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS A6506
|
| Hospital Charge Code |
98300029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.80 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$149.60
|
| Rate for Payer: Aetna Medicare |
$45.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.00
|
| Rate for Payer: BCBS Complete |
$70.40
|
| Rate for Payer: BCBS MAPPO |
$44.00
|
| Rate for Payer: BCBS Trust/PPO |
$136.84
|
| Rate for Payer: BCN Commercial |
$136.84
|
| Rate for Payer: BCN Medicare Advantage |
$44.00
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Commercial |
$151.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.00
|
| Rate for Payer: Healthscope Commercial |
$158.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.60
|
| Rate for Payer: PACE Senior Care Partners |
$41.80
|
| Rate for Payer: PACE SWMI |
$44.00
|
| Rate for Payer: PHP Commercial |
$149.60
|
| Rate for Payer: PHP Medicare Advantage |
$44.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.12
|
| Rate for Payer: Priority Health Medicare |
$44.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.34
|
| Rate for Payer: Railroad Medicare Medicare |
$44.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.88
|
| Rate for Payer: UHC Core |
$146.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.00
|
| Rate for Payer: UHC Medicare Advantage |
$45.32
|
| Rate for Payer: VA VA |
$44.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.00
|
|
|
HC COMP BURN GARM GLOVE-WRIST
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS A6504
|
| Hospital Charge Code |
98300031
|
|
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 GLOVE-WRIST
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS A6504
|
| Hospital Charge Code |
98300031
|
|
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 HEAD BAND
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300032
|
|
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 HEAD BAND
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300032
|
|
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 HOOK&LOOP SNAP
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: BCBS Trust/PPO |
$10.82
|
| Rate for Payer: BCN Commercial |
$10.82
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Healthscope Commercial |
$12.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.90
|
| Rate for Payer: PHP Commercial |
$11.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.32
|
| Rate for Payer: UHC Core |
$11.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.50
|
|
|
HC COMP BURN GARM HOOK&LOOP SNAP
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: Aetna Medicare |
$3.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.38
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$3.50
|
| Rate for Payer: BCBS Trust/PPO |
$10.88
|
| Rate for Payer: BCN Commercial |
$10.88
|
| Rate for Payer: BCN Medicare Advantage |
$3.50
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$12.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.90
|
| Rate for Payer: PACE Senior Care Partners |
$3.32
|
| Rate for Payer: PACE SWMI |
$3.50
|
| Rate for Payer: PHP Commercial |
$11.90
|
| Rate for Payer: PHP Medicare Advantage |
$3.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.18
|
| Rate for Payer: Priority Health Medicare |
$3.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.54
|
| Rate for Payer: Railroad Medicare Medicare |
$3.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.32
|
| Rate for Payer: UHC Core |
$11.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.50
|
| Rate for Payer: UHC Medicare Advantage |
$3.60
|
| Rate for Payer: VA VA |
$3.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.50
|
|
|
HC COMP BURN GARM HOOK&LOOP TAB S
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Aetna Commercial |
$6.80
|
| Rate for Payer: Aetna Medicare |
$2.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.50
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$2.00
|
| Rate for Payer: BCBS Trust/PPO |
$6.22
|
| Rate for Payer: BCN Commercial |
$6.22
|
| Rate for Payer: BCN Medicare Advantage |
$2.00
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$6.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.00
|
| Rate for Payer: Healthscope Commercial |
$7.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.80
|
| Rate for Payer: PACE Senior Care Partners |
$1.90
|
| Rate for Payer: PACE SWMI |
$2.00
|
| Rate for Payer: PHP Commercial |
$6.80
|
| Rate for Payer: PHP Medicare Advantage |
$2.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.96
|
| Rate for Payer: Priority Health Medicare |
$2.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.88
|
| Rate for Payer: Railroad Medicare Medicare |
$2.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.04
|
| Rate for Payer: UHC Core |
$6.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.00
|
| Rate for Payer: UHC Medicare Advantage |
$2.06
|
| Rate for Payer: VA VA |
$2.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.00
|
|
|
HC COMP BURN GARM HOOK&LOOP TAB S
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Aetna Commercial |
$6.80
|
| Rate for Payer: BCBS Trust/PPO |
$6.18
|
| Rate for Payer: BCN Commercial |
$6.18
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$6.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.40
|
| Rate for Payer: Healthscope Commercial |
$7.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.80
|
| Rate for Payer: PHP Commercial |
$6.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.04
|
| Rate for Payer: UHC Core |
$6.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.00
|
|
|
HC COMP BURN GARM LEG&CHAP TO WAI
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300036
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.86 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: BCBS Trust/PPO |
$160.74
|
| Rate for Payer: BCN Commercial |
$160.74
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.80
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.04
|
| Rate for Payer: UHC Core |
$173.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.00
|
|
|
HC COMP BURN GARM LEG&CHAP TO WAI
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300036
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: Aetna Medicare |
$54.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.00
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: BCBS MAPPO |
$52.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.72
|
| Rate for Payer: BCN Commercial |
$161.72
|
| Rate for Payer: BCN Medicare Advantage |
$52.00
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$54.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.80
|
| Rate for Payer: PACE Senior Care Partners |
$49.40
|
| Rate for Payer: PACE SWMI |
$52.00
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: PHP Medicare Advantage |
$52.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.96
|
| Rate for Payer: Priority Health Medicare |
$52.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.86
|
| Rate for Payer: Railroad Medicare Medicare |
$52.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.04
|
| Rate for Payer: UHC Core |
$173.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.00
|
| Rate for Payer: UHC Medicare Advantage |
$53.56
|
| Rate for Payer: VA VA |
$52.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.00
|
|
|
HC COMP BURN GARM LEG & PANTY
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$135.40 |
| Max. Negotiated Rate |
$199.80 |
| Rate for Payer: Aetna Commercial |
$188.70
|
| Rate for Payer: BCBS Trust/PPO |
$171.56
|
| Rate for Payer: BCN Commercial |
$171.56
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cofinity Commercial |
$190.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.60
|
| Rate for Payer: Healthscope Commercial |
$199.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.70
|
| Rate for Payer: PHP Commercial |
$188.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.36
|
| Rate for Payer: UHC Core |
$185.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.50
|
|
|
HC COMP BURN GARM LEG & PANTY
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.72 |
| Max. Negotiated Rate |
$199.80 |
| Rate for Payer: Aetna Commercial |
$188.70
|
| Rate for Payer: Aetna Medicare |
$57.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.38
|
| Rate for Payer: BCBS Complete |
$88.80
|
| Rate for Payer: BCBS MAPPO |
$55.50
|
| Rate for Payer: BCBS Trust/PPO |
$172.60
|
| Rate for Payer: BCN Commercial |
$172.60
|
| Rate for Payer: BCN Medicare Advantage |
$55.50
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cofinity Commercial |
$190.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.50
|
| Rate for Payer: Healthscope Commercial |
$199.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$58.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.70
|
| Rate for Payer: PACE Senior Care Partners |
$52.72
|
| Rate for Payer: PACE SWMI |
$55.50
|
| Rate for Payer: PHP Commercial |
$188.70
|
| Rate for Payer: PHP Medicare Advantage |
$55.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.14
|
| Rate for Payer: Priority Health Medicare |
$55.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.40
|
| Rate for Payer: Railroad Medicare Medicare |
$55.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.36
|
| Rate for Payer: UHC Core |
$185.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.50
|
| Rate for Payer: UHC Medicare Advantage |
$57.16
|
| Rate for Payer: VA VA |
$55.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.50
|
|
|
HC COMP BURN GARM LINING,POCKET,F
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300037
|
|
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 LINING,POCKET,F
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300037
|
|
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 MITTEN TO WRIST
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300038
|
|
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 MITTEN TO WRIST
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300038
|
|
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 POCKET & PAD CO
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300039
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: BCBS Trust/PPO |
$10.82
|
| Rate for Payer: BCN Commercial |
$10.82
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Healthscope Commercial |
$12.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.90
|
| Rate for Payer: PHP Commercial |
$11.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.32
|
| Rate for Payer: UHC Core |
$11.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.50
|
|
|
HC COMP BURN GARM POCKET & PAD CO
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300039
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: Aetna Medicare |
$3.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.38
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$3.50
|
| Rate for Payer: BCBS Trust/PPO |
$10.88
|
| Rate for Payer: BCN Commercial |
$10.88
|
| Rate for Payer: BCN Medicare Advantage |
$3.50
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$12.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.90
|
| Rate for Payer: PACE Senior Care Partners |
$3.32
|
| Rate for Payer: PACE SWMI |
$3.50
|
| Rate for Payer: PHP Commercial |
$11.90
|
| Rate for Payer: PHP Medicare Advantage |
$3.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.18
|
| Rate for Payer: Priority Health Medicare |
$3.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.54
|
| Rate for Payer: Railroad Medicare Medicare |
$3.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.32
|
| Rate for Payer: UHC Core |
$11.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.50
|
| Rate for Payer: UHC Medicare Advantage |
$3.60
|
| Rate for Payer: VA VA |
$3.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.50
|
|
|
HC COMP BURN GARM REINFORCEMENTS
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300041
|
|
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 REINFORCEMENTS
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300041
|
|
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
|
|
