|
HC COMP BURN GARM REINF SET HK&LO
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: Aetna Medicare |
$2.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.12
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$2.50
|
| Rate for Payer: BCBS Trust/PPO |
$7.78
|
| Rate for Payer: BCN Commercial |
$7.78
|
| Rate for Payer: BCN Medicare Advantage |
$2.50
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$8.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.50
|
| Rate for Payer: PACE Senior Care Partners |
$2.38
|
| Rate for Payer: PACE SWMI |
$2.50
|
| Rate for Payer: PHP Commercial |
$8.50
|
| Rate for Payer: PHP Medicare Advantage |
$2.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.70
|
| Rate for Payer: Priority Health Medicare |
$2.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.10
|
| Rate for Payer: Railroad Medicare Medicare |
$2.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.80
|
| Rate for Payer: UHC Core |
$8.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.50
|
| Rate for Payer: UHC Medicare Advantage |
$2.58
|
| Rate for Payer: VA VA |
$2.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.50
|
|
|
HC COMP BURN GARM REINF SET HK&LO
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: BCBS Trust/PPO |
$7.73
|
| Rate for Payer: BCN Commercial |
$7.73
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$8.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.00
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.50
|
| Rate for Payer: PHP Commercial |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.80
|
| Rate for Payer: UHC Core |
$8.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.50
|
|
|
HC COMP BURN GARM SHOULD FLAP REG
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300042
|
|
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 SHOULD FLAP REG
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300042
|
|
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 SILON-TEX P/D-G
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare |
$15.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.75
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS MAPPO |
$15.00
|
| Rate for Payer: BCBS Trust/PPO |
$46.65
|
| Rate for Payer: BCN Commercial |
$46.65
|
| Rate for Payer: BCN Medicare Advantage |
$15.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PACE Senior Care Partners |
$14.25
|
| Rate for Payer: PACE SWMI |
$15.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: PHP Medicare Advantage |
$15.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.20
|
| Rate for Payer: Priority Health Medicare |
$15.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.59
|
| Rate for Payer: Railroad Medicare Medicare |
$15.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.80
|
| Rate for Payer: UHC Core |
$50.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.00
|
| Rate for Payer: UHC Medicare Advantage |
$15.45
|
| Rate for Payer: VA VA |
$15.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC COMP BURN GARM SILON-TEX P/D-G
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.59 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: BCBS Trust/PPO |
$46.37
|
| Rate for Payer: BCN Commercial |
$46.37
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.80
|
| Rate for Payer: UHC Core |
$50.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC COMP BURN GARM SILON-TEX UP TO
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.25
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$9.00
|
| Rate for Payer: BCBS Trust/PPO |
$27.99
|
| Rate for Payer: BCN Commercial |
$27.99
|
| Rate for Payer: BCN Medicare Advantage |
$9.00
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$30.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.00
|
| Rate for Payer: Healthscope Commercial |
$32.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.60
|
| Rate for Payer: PACE Senior Care Partners |
$8.55
|
| Rate for Payer: PACE SWMI |
$9.00
|
| Rate for Payer: PHP Commercial |
$30.60
|
| Rate for Payer: PHP Medicare Advantage |
$9.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.32
|
| Rate for Payer: Priority Health Medicare |
$9.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.96
|
| Rate for Payer: Railroad Medicare Medicare |
$9.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.68
|
| Rate for Payer: UHC Core |
$30.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.00
|
| Rate for Payer: UHC Medicare Advantage |
$9.27
|
| Rate for Payer: VA VA |
$9.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.00
|
|
|
HC COMP BURN GARM SILON-TEX UP TO
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: BCBS Trust/PPO |
$27.82
|
| Rate for Payer: BCN Commercial |
$27.82
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$30.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.80
|
| Rate for Payer: Healthscope Commercial |
$32.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.60
|
| Rate for Payer: PHP Commercial |
$30.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.68
|
| Rate for Payer: UHC Core |
$30.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.00
|
|
|
HC COMP BURN GARM SILON-TEX WHOL
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300046
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.23 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna Commercial |
$71.40
|
| Rate for Payer: BCBS Trust/PPO |
$64.92
|
| Rate for Payer: BCN Commercial |
$64.92
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cofinity Commercial |
$72.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.20
|
| Rate for Payer: Healthscope Commercial |
$75.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.40
|
| Rate for Payer: PHP Commercial |
$71.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.92
|
| Rate for Payer: UHC Core |
$70.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.00
|
|
|
HC COMP BURN GARM SILON-TEX WHOL
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300046
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna Commercial |
$71.40
|
| Rate for Payer: Aetna Medicare |
$21.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.25
|
| Rate for Payer: BCBS Complete |
$33.60
|
| Rate for Payer: BCBS MAPPO |
$21.00
|
| Rate for Payer: BCBS Trust/PPO |
$65.31
|
| Rate for Payer: BCN Commercial |
$65.31
|
| Rate for Payer: BCN Medicare Advantage |
$21.00
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cofinity Commercial |
$72.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.00
|
| Rate for Payer: Healthscope Commercial |
$75.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.40
|
| Rate for Payer: PACE Senior Care Partners |
$19.95
|
| Rate for Payer: PACE SWMI |
$21.00
|
| Rate for Payer: PHP Commercial |
$71.40
|
| Rate for Payer: PHP Medicare Advantage |
$21.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.08
|
| Rate for Payer: Priority Health Medicare |
$21.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.23
|
| Rate for Payer: Railroad Medicare Medicare |
$21.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.92
|
| Rate for Payer: UHC Core |
$70.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.00
|
| Rate for Payer: UHC Medicare Advantage |
$21.63
|
| Rate for Payer: VA VA |
$21.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.00
|
|
|
HC COMP BURN GARM SLEEVE WRIST/AX
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300047
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.69 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: BCBS Trust/PPO |
$54.10
|
| Rate for Payer: BCN Commercial |
$54.10
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.60
|
| Rate for Payer: UHC Core |
$58.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
HC COMP BURN GARM SLEEVE WRIST/AX
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300047
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.62 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna Medicare |
$18.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.88
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCBS MAPPO |
$17.50
|
| Rate for Payer: BCBS Trust/PPO |
$54.42
|
| Rate for Payer: BCN Commercial |
$54.42
|
| Rate for Payer: BCN Medicare Advantage |
$17.50
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PACE Senior Care Partners |
$16.62
|
| Rate for Payer: PACE SWMI |
$17.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: PHP Medicare Advantage |
$17.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.90
|
| Rate for Payer: Priority Health Medicare |
$17.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.69
|
| Rate for Payer: Railroad Medicare Medicare |
$17.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.60
|
| Rate for Payer: UHC Core |
$58.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.50
|
| Rate for Payer: UHC Medicare Advantage |
$18.02
|
| Rate for Payer: VA VA |
$17.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
HC COMP BURN GARM SLV WRST-ELB/EL
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300048
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.59 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: BCBS Trust/PPO |
$46.37
|
| Rate for Payer: BCN Commercial |
$46.37
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.80
|
| Rate for Payer: UHC Core |
$50.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC COMP BURN GARM SLV WRST-ELB/EL
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300048
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare |
$15.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.75
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS MAPPO |
$15.00
|
| Rate for Payer: BCBS Trust/PPO |
$46.65
|
| Rate for Payer: BCN Commercial |
$46.65
|
| Rate for Payer: BCN Medicare Advantage |
$15.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PACE Senior Care Partners |
$14.25
|
| Rate for Payer: PACE SWMI |
$15.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: PHP Medicare Advantage |
$15.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.20
|
| Rate for Payer: Priority Health Medicare |
$15.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.59
|
| Rate for Payer: Railroad Medicare Medicare |
$15.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.80
|
| Rate for Payer: UHC Core |
$50.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.00
|
| Rate for Payer: UHC Medicare Advantage |
$15.45
|
| Rate for Payer: VA VA |
$15.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC COMP BURN GARM STERNAL STRAP
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300049
|
|
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 STERNAL STRAP
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300049
|
|
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 STKNG KNEE TO T
|
Facility
|
OP
|
$70.40
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$59.84
|
| Rate for Payer: Aetna Medicare |
$18.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.00
|
| Rate for Payer: BCBS Complete |
$28.16
|
| Rate for Payer: BCBS MAPPO |
$17.60
|
| Rate for Payer: BCBS Trust/PPO |
$54.74
|
| Rate for Payer: BCN Commercial |
$54.74
|
| Rate for Payer: BCN Medicare Advantage |
$17.60
|
| Rate for Payer: Cash Price |
$56.32
|
| Rate for Payer: Cofinity Commercial |
$60.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.60
|
| Rate for Payer: Healthscope Commercial |
$63.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.84
|
| Rate for Payer: PACE Senior Care Partners |
$16.72
|
| Rate for Payer: PACE SWMI |
$17.60
|
| Rate for Payer: PHP Commercial |
$59.84
|
| Rate for Payer: PHP Medicare Advantage |
$17.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.25
|
| Rate for Payer: Priority Health Medicare |
$17.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.94
|
| Rate for Payer: Railroad Medicare Medicare |
$17.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.95
|
| Rate for Payer: UHC Core |
$58.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.60
|
| Rate for Payer: UHC Medicare Advantage |
$18.13
|
| Rate for Payer: VA VA |
$17.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.80
|
|
|
HC COMP BURN GARM STKNG KNEE TO T
|
Facility
|
IP
|
$70.40
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.94 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$59.84
|
| Rate for Payer: BCBS Trust/PPO |
$54.41
|
| Rate for Payer: BCN Commercial |
$54.41
|
| Rate for Payer: Cash Price |
$56.32
|
| Rate for Payer: Cofinity Commercial |
$60.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.32
|
| Rate for Payer: Healthscope Commercial |
$63.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.84
|
| Rate for Payer: PHP Commercial |
$59.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.95
|
| Rate for Payer: UHC Core |
$58.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.80
|
|
|
HC COMP BURN GARM STKNG TO THI NO
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300051
|
|
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 STKNG TO THI NO
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300051
|
|
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 STMP CLS ORNG P
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
98300052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna Medicare |
$3.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.82
|
| Rate for Payer: BCBS Complete |
$4.90
|
| Rate for Payer: BCBS MAPPO |
$3.06
|
| Rate for Payer: BCBS Trust/PPO |
$9.52
|
| Rate for Payer: BCN Commercial |
$9.52
|
| Rate for Payer: BCN Medicare Advantage |
$3.06
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.40
|
| Rate for Payer: PACE Senior Care Partners |
$2.91
|
| Rate for Payer: PACE SWMI |
$3.06
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: PHP Medicare Advantage |
$3.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.65
|
| Rate for Payer: Priority Health Medicare |
$3.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.47
|
| Rate for Payer: Railroad Medicare Medicare |
$3.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.77
|
| Rate for Payer: UHC Core |
$10.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.06
|
| Rate for Payer: UHC Medicare Advantage |
$3.15
|
| Rate for Payer: VA VA |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
HC COMP BURN GARM STMP CLS ORNG P
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
98300052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$9.46
|
| Rate for Payer: BCN Commercial |
$9.46
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.77
|
| Rate for Payer: UHC Core |
$10.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
HC COMP BURN GARM STMP CLS STRCH
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
98300053
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$9.46
|
| Rate for Payer: BCN Commercial |
$9.46
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.77
|
| Rate for Payer: UHC Core |
$10.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
HC COMP BURN GARM STMP CLS STRCH
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
98300053
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna Medicare |
$3.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.82
|
| Rate for Payer: BCBS Complete |
$4.90
|
| Rate for Payer: BCBS MAPPO |
$3.06
|
| Rate for Payer: BCBS Trust/PPO |
$9.52
|
| Rate for Payer: BCN Commercial |
$9.52
|
| Rate for Payer: BCN Medicare Advantage |
$3.06
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.40
|
| Rate for Payer: PACE Senior Care Partners |
$2.91
|
| Rate for Payer: PACE SWMI |
$3.06
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: PHP Medicare Advantage |
$3.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.65
|
| Rate for Payer: Priority Health Medicare |
$3.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.47
|
| Rate for Payer: Railroad Medicare Medicare |
$3.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.77
|
| Rate for Payer: UHC Core |
$10.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.06
|
| Rate for Payer: UHC Medicare Advantage |
$3.15
|
| Rate for Payer: VA VA |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
HC COMP BURN GARM STOCKING TO KNE
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS A6507
|
| Hospital Charge Code |
98300054
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.69 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: BCBS Trust/PPO |
$54.10
|
| Rate for Payer: BCN Commercial |
$54.10
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.60
|
| Rate for Payer: UHC Core |
$58.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
