|
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
|
|
|
HC COMP BURN GARM STOCKING TO THI
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS A6508
|
| Hospital Charge Code |
98300055
|
|
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 STOCKING TO THI
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS A6508
|
| Hospital Charge Code |
98300055
|
|
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 STOCK-KNEE/NO F
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.81 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna Commercial |
$52.70
|
| Rate for Payer: BCBS Trust/PPO |
$47.91
|
| Rate for Payer: BCN Commercial |
$47.91
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$53.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.60
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: PHP Commercial |
$52.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.56
|
| Rate for Payer: UHC Core |
$51.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.50
|
|
|
HC COMP BURN GARM STOCK-KNEE/NO F
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna Commercial |
$52.70
|
| Rate for Payer: Aetna Medicare |
$16.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.38
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: BCBS MAPPO |
$15.50
|
| Rate for Payer: BCBS Trust/PPO |
$48.20
|
| Rate for Payer: BCN Commercial |
$48.20
|
| Rate for Payer: BCN Medicare Advantage |
$15.50
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$53.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.50
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: PACE Senior Care Partners |
$14.72
|
| Rate for Payer: PACE SWMI |
$15.50
|
| Rate for Payer: PHP Commercial |
$52.70
|
| Rate for Payer: PHP Medicare Advantage |
$15.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.94
|
| Rate for Payer: Priority Health Medicare |
$15.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.81
|
| Rate for Payer: Railroad Medicare Medicare |
$15.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.56
|
| Rate for Payer: UHC Core |
$51.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.50
|
| Rate for Payer: UHC Medicare Advantage |
$15.96
|
| Rate for Payer: VA VA |
$15.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.50
|
|
|
HC COMP BURN GARM STRETCH INSERT
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
98300057
|
|
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 STRETCH INSERT
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
98300057
|
|
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 SUEDE/LEATHER G
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300058
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.69 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna Medicare |
$11.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.06
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS MAPPO |
$11.25
|
| Rate for Payer: BCBS Trust/PPO |
$34.99
|
| Rate for Payer: BCN Commercial |
$34.99
|
| Rate for Payer: BCN Medicare Advantage |
$11.25
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.25
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: PACE Senior Care Partners |
$10.69
|
| Rate for Payer: PACE SWMI |
$11.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: PHP Medicare Advantage |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.15
|
| Rate for Payer: Priority Health Medicare |
$11.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.45
|
| Rate for Payer: Railroad Medicare Medicare |
$11.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.60
|
| Rate for Payer: UHC Core |
$37.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.25
|
| Rate for Payer: UHC Medicare Advantage |
$11.59
|
| Rate for Payer: VA VA |
$11.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
HC COMP BURN GARM SUEDE/LEATHER G
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300058
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$34.78
|
| Rate for Payer: BCN Commercial |
$34.78
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.60
|
| Rate for Payer: UHC Core |
$37.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
HC COMP BURN GARM SUIT SLVD ABV K
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300059
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$90.25 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna Commercial |
$323.00
|
| Rate for Payer: Aetna Medicare |
$98.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.75
|
| Rate for Payer: BCBS Complete |
$152.00
|
| Rate for Payer: BCBS MAPPO |
$95.00
|
| Rate for Payer: BCBS Trust/PPO |
$295.45
|
| Rate for Payer: BCN Commercial |
$295.45
|
| Rate for Payer: BCN Medicare Advantage |
$95.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cofinity Commercial |
$326.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.00
|
| Rate for Payer: Healthscope Commercial |
$342.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$99.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.00
|
| Rate for Payer: PACE Senior Care Partners |
$90.25
|
| Rate for Payer: PACE SWMI |
$95.00
|
| Rate for Payer: PHP Commercial |
$323.00
|
| Rate for Payer: PHP Medicare Advantage |
$95.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$330.60
|
| Rate for Payer: Priority Health Medicare |
$95.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$231.76
|
| Rate for Payer: Railroad Medicare Medicare |
$95.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$334.40
|
| Rate for Payer: UHC Core |
$317.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.00
|
| Rate for Payer: UHC Medicare Advantage |
$97.85
|
| Rate for Payer: VA VA |
$95.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.00
|
|
|
HC COMP BURN GARM SUIT SLVD ABV K
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300059
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$231.76 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna Commercial |
$323.00
|
| Rate for Payer: BCBS Trust/PPO |
$293.66
|
| Rate for Payer: BCN Commercial |
$293.66
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cofinity Commercial |
$326.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.00
|
| Rate for Payer: Healthscope Commercial |
$342.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.00
|
| Rate for Payer: PHP Commercial |
$323.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$330.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$231.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$334.40
|
| Rate for Payer: UHC Core |
$317.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.00
|
|
|
HC COMP BURN GARM SUIT SLVD TWO LEGS
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
HCPCS A6501
|
| Hospital Charge Code |
98300060
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$433.80 |
| Rate for Payer: Aetna Commercial |
$409.70
|
| Rate for Payer: Aetna Medicare |
$125.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.62
|
| Rate for Payer: BCBS Complete |
$192.80
|
| Rate for Payer: BCBS MAPPO |
$120.50
|
| Rate for Payer: BCBS Trust/PPO |
$374.76
|
| Rate for Payer: BCN Commercial |
$374.76
|
| Rate for Payer: BCN Medicare Advantage |
$120.50
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cofinity Commercial |
$414.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.50
|
| Rate for Payer: Healthscope Commercial |
$433.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$409.70
|
| Rate for Payer: PACE Senior Care Partners |
$114.48
|
| Rate for Payer: PACE SWMI |
$120.50
|
| Rate for Payer: PHP Commercial |
$409.70
|
| Rate for Payer: PHP Medicare Advantage |
$120.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$419.34
|
| Rate for Payer: Priority Health Medicare |
$120.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.97
|
| Rate for Payer: Railroad Medicare Medicare |
$120.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$424.16
|
| Rate for Payer: UHC Core |
$402.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.50
|
| Rate for Payer: UHC Medicare Advantage |
$124.12
|
| Rate for Payer: VA VA |
$120.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.50
|
|
|
HC COMP BURN GARM SUIT SLVD TWO LEGS
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
HCPCS A6501
|
| Hospital Charge Code |
98300060
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$293.97 |
| Max. Negotiated Rate |
$433.80 |
| Rate for Payer: Aetna Commercial |
$409.70
|
| Rate for Payer: BCBS Trust/PPO |
$372.49
|
| Rate for Payer: BCN Commercial |
$372.49
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cofinity Commercial |
$414.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.60
|
| Rate for Payer: Healthscope Commercial |
$433.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$409.70
|
| Rate for Payer: PHP Commercial |
$409.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$419.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$424.16
|
| Rate for Payer: UHC Core |
$402.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.50
|
|
|
HC COMP BURN GARM SUIT SLVLS ABV
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300061
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$191.51 |
| Max. Negotiated Rate |
$282.60 |
| Rate for Payer: Aetna Commercial |
$266.90
|
| Rate for Payer: BCBS Trust/PPO |
$242.66
|
| Rate for Payer: BCN Commercial |
$242.66
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Cofinity Commercial |
$270.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.20
|
| Rate for Payer: Healthscope Commercial |
$282.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$266.90
|
| Rate for Payer: PHP Commercial |
$266.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.32
|
| Rate for Payer: UHC Core |
$262.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.50
|
|
|
HC COMP BURN GARM SUIT SLVLS ABV
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300061
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$74.58 |
| Max. Negotiated Rate |
$282.60 |
| Rate for Payer: Aetna Commercial |
$266.90
|
| Rate for Payer: Aetna Medicare |
$81.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.12
|
| Rate for Payer: BCBS Complete |
$125.60
|
| Rate for Payer: BCBS MAPPO |
$78.50
|
| Rate for Payer: BCBS Trust/PPO |
$244.14
|
| Rate for Payer: BCN Commercial |
$244.14
|
| Rate for Payer: BCN Medicare Advantage |
$78.50
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Cofinity Commercial |
$270.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.50
|
| Rate for Payer: Healthscope Commercial |
$282.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$82.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$266.90
|
| Rate for Payer: PACE Senior Care Partners |
$74.58
|
| Rate for Payer: PACE SWMI |
$78.50
|
| Rate for Payer: PHP Commercial |
$266.90
|
| Rate for Payer: PHP Medicare Advantage |
$78.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.18
|
| Rate for Payer: Priority Health Medicare |
$78.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.51
|
| Rate for Payer: Railroad Medicare Medicare |
$78.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.32
|
| Rate for Payer: UHC Core |
$262.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.50
|
| Rate for Payer: UHC Medicare Advantage |
$80.86
|
| Rate for Payer: VA VA |
$78.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.50
|
|
|
HC COMP BURN GARM SUIT SLVLS-TWO LEGS
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300062
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$87.40 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$312.80
|
| Rate for Payer: Aetna Medicare |
$95.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$115.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$115.00
|
| Rate for Payer: BCBS Complete |
$147.20
|
| Rate for Payer: BCBS MAPPO |
$92.00
|
| Rate for Payer: BCBS Trust/PPO |
$286.12
|
| Rate for Payer: BCN Commercial |
$286.12
|
| Rate for Payer: BCN Medicare Advantage |
$92.00
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cofinity Commercial |
$316.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$331.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$96.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.80
|
| Rate for Payer: PACE Senior Care Partners |
$87.40
|
| Rate for Payer: PACE SWMI |
$92.00
|
| Rate for Payer: PHP Commercial |
$312.80
|
| Rate for Payer: PHP Medicare Advantage |
$92.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.16
|
| Rate for Payer: Priority Health Medicare |
$92.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$224.44
|
| Rate for Payer: Railroad Medicare Medicare |
$92.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.84
|
| Rate for Payer: UHC Core |
$307.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.00
|
| Rate for Payer: UHC Medicare Advantage |
$94.76
|
| Rate for Payer: VA VA |
$92.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.00
|
|
|
HC COMP BURN GARM SUIT SLVLS-TWO LEGS
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300062
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$224.44 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$312.80
|
| Rate for Payer: BCBS Trust/PPO |
$284.39
|
| Rate for Payer: BCN Commercial |
$284.39
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cofinity Commercial |
$316.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.40
|
| Rate for Payer: Healthscope Commercial |
$331.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.80
|
| Rate for Payer: PHP Commercial |
$312.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$224.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.84
|
| Rate for Payer: UHC Core |
$307.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.00
|
|
|
HC COMP BURN GARM SUSPENDERS ATTA
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300063
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$34.78
|
| Rate for Payer: BCN Commercial |
$34.78
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.60
|
| Rate for Payer: UHC Core |
$37.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
HC COMP BURN GARM SUSPENDERS ATTA
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300063
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.69 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna Medicare |
$11.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.06
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS MAPPO |
$11.25
|
| Rate for Payer: BCBS Trust/PPO |
$34.99
|
| Rate for Payer: BCN Commercial |
$34.99
|
| Rate for Payer: BCN Medicare Advantage |
$11.25
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.25
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: PACE Senior Care Partners |
$10.69
|
| Rate for Payer: PACE SWMI |
$11.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: PHP Medicare Advantage |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.15
|
| Rate for Payer: Priority Health Medicare |
$11.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.45
|
| Rate for Payer: Railroad Medicare Medicare |
$11.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.60
|
| Rate for Payer: UHC Core |
$37.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.25
|
| Rate for Payer: UHC Medicare Advantage |
$11.59
|
| Rate for Payer: VA VA |
$11.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
HC COMP BURN GARM SUSPENDERS REMO
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300064
|
|
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 SUSPENDERS REMO
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300064
|
|
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 TWO LEGS PREGNA
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300065
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$152.48 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$212.50
|
| Rate for Payer: BCBS Trust/PPO |
$193.20
|
| Rate for Payer: BCN Commercial |
$193.20
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$215.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.00
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.50
|
| Rate for Payer: PHP Commercial |
$212.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.00
|
| Rate for Payer: UHC Core |
$208.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.50
|
|
|
HC COMP BURN GARM TWO LEGS PREGNA
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300065
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.38 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$212.50
|
| Rate for Payer: Aetna Medicare |
$65.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.12
|
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: BCBS MAPPO |
$62.50
|
| Rate for Payer: BCBS Trust/PPO |
$194.38
|
| Rate for Payer: BCN Commercial |
$194.38
|
| Rate for Payer: BCN Medicare Advantage |
$62.50
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$215.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.50
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.50
|
| Rate for Payer: PACE Senior Care Partners |
$59.38
|
| Rate for Payer: PACE SWMI |
$62.50
|
| Rate for Payer: PHP Commercial |
$212.50
|
| Rate for Payer: PHP Medicare Advantage |
$62.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.50
|
| Rate for Payer: Priority Health Medicare |
$62.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.48
|
| Rate for Payer: Railroad Medicare Medicare |
$62.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.00
|
| Rate for Payer: UHC Core |
$208.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.50
|
| Rate for Payer: UHC Medicare Advantage |
$64.38
|
| Rate for Payer: VA VA |
$62.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.50
|
|
|
HC COMP BURN GARM VEST SLEEVED
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS A6509
|
| Hospital Charge Code |
98300066
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.38 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$212.50
|
| Rate for Payer: Aetna Medicare |
$65.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.12
|
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: BCBS MAPPO |
$62.50
|
| Rate for Payer: BCBS Trust/PPO |
$194.38
|
| Rate for Payer: BCN Commercial |
$194.38
|
| Rate for Payer: BCN Medicare Advantage |
$62.50
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$215.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.50
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.50
|
| Rate for Payer: PACE Senior Care Partners |
$59.38
|
| Rate for Payer: PACE SWMI |
$62.50
|
| Rate for Payer: PHP Commercial |
$212.50
|
| Rate for Payer: PHP Medicare Advantage |
$62.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.50
|
| Rate for Payer: Priority Health Medicare |
$62.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.48
|
| Rate for Payer: Railroad Medicare Medicare |
$62.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.00
|
| Rate for Payer: UHC Core |
$208.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.50
|
| Rate for Payer: UHC Medicare Advantage |
$64.38
|
| Rate for Payer: VA VA |
$62.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.50
|
|
|
HC COMP BURN GARM VEST SLEEVED
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS A6509
|
| Hospital Charge Code |
98300066
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$152.48 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$212.50
|
| Rate for Payer: BCBS Trust/PPO |
$193.20
|
| Rate for Payer: BCN Commercial |
$193.20
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$215.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.00
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.50
|
| Rate for Payer: PHP Commercial |
$212.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.00
|
| Rate for Payer: UHC Core |
$208.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.50
|
|
