|
HC COMMON REED IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200080
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC COMMON REED IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200080
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC COMM WORK REINTEGRATION EA 15 MIN
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
42000031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$62.98 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: BCBS Trust/PPO |
$79.10
|
| Rate for Payer: BCN Commercial |
$74.88
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: Nomi Health Commercial |
$79.46
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health HMO/PPO |
$84.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.27
|
| Rate for Payer: UHC Core |
$80.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.67
|
|
|
HC COMM WORK REINTEGRATION EA 15 MIN
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
42000031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.01 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna Medicare |
$25.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.28
|
| Rate for Payer: BCBS Complete |
$38.76
|
| Rate for Payer: BCBS MAPPO |
$24.23
|
| Rate for Payer: BCBS Trust/PPO |
$79.66
|
| Rate for Payer: BCN Commercial |
$75.34
|
| Rate for Payer: BCN Medicare Advantage |
$24.23
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.23
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: Nomi Health Commercial |
$79.46
|
| Rate for Payer: PACE Senior Care Partners |
$23.01
|
| Rate for Payer: PACE SWMI |
$24.23
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: PHP Medicare Advantage |
$24.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health HMO/PPO |
$84.30
|
| Rate for Payer: Priority Health Medicare |
$24.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.92
|
| Rate for Payer: Railroad Medicare Medicare |
$24.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.27
|
| Rate for Payer: UHC Core |
$80.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.23
|
| Rate for Payer: UHC Exchange |
$24.23
|
| Rate for Payer: UHC Medicare Advantage |
$24.23
|
| Rate for Payer: VA VA |
$24.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.67
|
|
|
HC COMPARTMENT PRESSURE CHECK
|
Facility
|
OP
|
$658.62
|
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$156.42 |
| Max. Negotiated Rate |
$592.76 |
| Rate for Payer: Aetna Commercial |
$559.83
|
| Rate for Payer: Aetna Medicare |
$171.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$205.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$205.82
|
| Rate for Payer: BCBS Complete |
$263.45
|
| Rate for Payer: BCBS MAPPO |
$164.66
|
| Rate for Payer: BCBS Trust/PPO |
$541.45
|
| Rate for Payer: BCN Commercial |
$512.08
|
| Rate for Payer: BCN Medicare Advantage |
$164.66
|
| Rate for Payer: Cash Price |
$526.90
|
| Rate for Payer: Cofinity Commercial |
$566.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.66
|
| Rate for Payer: Healthscope Commercial |
$592.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$189.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.83
|
| Rate for Payer: Nomi Health Commercial |
$540.07
|
| Rate for Payer: PACE Senior Care Partners |
$156.42
|
| Rate for Payer: PACE SWMI |
$164.66
|
| Rate for Payer: PHP Commercial |
$559.83
|
| Rate for Payer: PHP Medicare Advantage |
$164.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.10
|
| Rate for Payer: Priority Health HMO/PPO |
$573.00
|
| Rate for Payer: Priority Health Medicare |
$166.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$441.28
|
| Rate for Payer: Railroad Medicare Medicare |
$164.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$579.59
|
| Rate for Payer: UHC Core |
$549.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.66
|
| Rate for Payer: UHC Exchange |
$164.66
|
| Rate for Payer: UHC Medicare Advantage |
$164.66
|
| Rate for Payer: VA VA |
$164.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.96
|
|
|
HC COMPARTMENT PRESSURE CHECK
|
Facility
|
IP
|
$658.62
|
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$428.10 |
| Max. Negotiated Rate |
$592.76 |
| Rate for Payer: Aetna Commercial |
$559.83
|
| Rate for Payer: BCBS Trust/PPO |
$537.63
|
| Rate for Payer: BCN Commercial |
$508.98
|
| Rate for Payer: Cash Price |
$526.90
|
| Rate for Payer: Cofinity Commercial |
$566.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.90
|
| Rate for Payer: Healthscope Commercial |
$592.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.83
|
| Rate for Payer: Nomi Health Commercial |
$540.07
|
| Rate for Payer: PHP Commercial |
$559.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.10
|
| Rate for Payer: Priority Health HMO/PPO |
$573.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$441.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$579.59
|
| Rate for Payer: UHC Core |
$549.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.96
|
|
|
HC COMP BURN GARM 2 LEGS-WAIST
|
Facility
|
OP
|
$238.68
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300142
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.69 |
| Max. Negotiated Rate |
$214.81 |
| Rate for Payer: Aetna Commercial |
$202.88
|
| Rate for Payer: Aetna Medicare |
$62.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.59
|
| Rate for Payer: BCBS Complete |
$95.47
|
| Rate for Payer: BCBS MAPPO |
$59.67
|
| Rate for Payer: BCBS Trust/PPO |
$196.22
|
| Rate for Payer: BCN Commercial |
$185.57
|
| Rate for Payer: BCN Medicare Advantage |
$59.67
|
| Rate for Payer: Cash Price |
$190.94
|
| Rate for Payer: Cofinity Commercial |
$205.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.67
|
| Rate for Payer: Healthscope Commercial |
$214.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.88
|
| Rate for Payer: Nomi Health Commercial |
$195.72
|
| Rate for Payer: PACE Senior Care Partners |
$56.69
|
| Rate for Payer: PACE SWMI |
$59.67
|
| Rate for Payer: PHP Commercial |
$202.88
|
| Rate for Payer: PHP Medicare Advantage |
$59.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.14
|
| Rate for Payer: Priority Health HMO/PPO |
$207.65
|
| Rate for Payer: Priority Health Medicare |
$60.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.92
|
| Rate for Payer: Railroad Medicare Medicare |
$59.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.04
|
| Rate for Payer: UHC Core |
$199.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.67
|
| Rate for Payer: UHC Exchange |
$59.67
|
| Rate for Payer: UHC Medicare Advantage |
$59.67
|
| Rate for Payer: VA VA |
$59.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.01
|
|
|
HC COMP BURN GARM 2 LEGS-WAIST
|
Facility
|
IP
|
$238.68
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300142
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$155.14 |
| Max. Negotiated Rate |
$214.81 |
| Rate for Payer: Aetna Commercial |
$202.88
|
| Rate for Payer: BCBS Trust/PPO |
$194.83
|
| Rate for Payer: BCN Commercial |
$184.45
|
| Rate for Payer: Cash Price |
$190.94
|
| Rate for Payer: Cofinity Commercial |
$205.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.94
|
| Rate for Payer: Healthscope Commercial |
$214.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.88
|
| Rate for Payer: Nomi Health Commercial |
$195.72
|
| Rate for Payer: PHP Commercial |
$202.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.14
|
| Rate for Payer: Priority Health HMO/PPO |
$207.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.04
|
| Rate for Payer: UHC Core |
$199.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.01
|
|
|
HC COMP BURN GARM 2 OR MORE FAB/C
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300143
|
|
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 |
$3.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.83
|
| Rate for Payer: BCBS Complete |
$4.90
|
| Rate for Payer: BCBS MAPPO |
$3.06
|
| Rate for Payer: BCBS Trust/PPO |
$10.06
|
| 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 Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Nomi Health Commercial |
$10.04
|
| 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 |
$7.96
|
| Rate for Payer: Priority Health HMO/PPO |
$10.65
|
| Rate for Payer: Priority Health Medicare |
$3.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.20
|
| 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 Exchange |
$3.06
|
| Rate for Payer: UHC Medicare Advantage |
$3.06
|
| Rate for Payer: VA VA |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
HC COMP BURN GARM 2 OR MORE FAB/C
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$9.99
|
| 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 Commercial |
$10.40
|
| Rate for Payer: Nomi Health Commercial |
$10.04
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: Priority Health HMO/PPO |
$10.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.20
|
| 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 ABD REINFOR DBL
|
Facility
|
OP
|
$16.32
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300144
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$14.69 |
| Rate for Payer: Aetna Commercial |
$13.87
|
| Rate for Payer: Aetna Medicare |
$4.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.10
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: BCBS MAPPO |
$4.08
|
| Rate for Payer: BCBS Trust/PPO |
$13.42
|
| Rate for Payer: BCN Commercial |
$12.69
|
| Rate for Payer: BCN Medicare Advantage |
$4.08
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.08
|
| Rate for Payer: Healthscope Commercial |
$14.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.87
|
| Rate for Payer: Nomi Health Commercial |
$13.38
|
| Rate for Payer: PACE Senior Care Partners |
$3.88
|
| Rate for Payer: PACE SWMI |
$4.08
|
| Rate for Payer: PHP Commercial |
$13.87
|
| Rate for Payer: PHP Medicare Advantage |
$4.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.61
|
| Rate for Payer: Priority Health HMO/PPO |
$14.20
|
| Rate for Payer: Priority Health Medicare |
$4.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.93
|
| Rate for Payer: Railroad Medicare Medicare |
$4.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.36
|
| Rate for Payer: UHC Core |
$13.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.08
|
| Rate for Payer: UHC Exchange |
$4.08
|
| Rate for Payer: UHC Medicare Advantage |
$4.08
|
| Rate for Payer: VA VA |
$4.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.24
|
|
|
HC COMP BURN GARM ABD REINFOR DBL
|
Facility
|
IP
|
$16.32
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300144
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$14.69 |
| Rate for Payer: Aetna Commercial |
$13.87
|
| Rate for Payer: BCBS Trust/PPO |
$13.32
|
| Rate for Payer: BCN Commercial |
$12.61
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$14.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.87
|
| Rate for Payer: Nomi Health Commercial |
$13.38
|
| Rate for Payer: PHP Commercial |
$13.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.61
|
| Rate for Payer: Priority Health HMO/PPO |
$14.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.36
|
| Rate for Payer: UHC Core |
$13.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.24
|
|
|
HC COMP BURN GARM ANKLET
|
Facility
|
OP
|
$63.24
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300145
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: Aetna Medicare |
$16.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.76
|
| Rate for Payer: BCBS Complete |
$25.30
|
| Rate for Payer: BCBS MAPPO |
$15.81
|
| Rate for Payer: BCBS Trust/PPO |
$51.99
|
| Rate for Payer: BCN Commercial |
$49.17
|
| Rate for Payer: BCN Medicare Advantage |
$15.81
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.81
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: PACE Senior Care Partners |
$15.02
|
| Rate for Payer: PACE SWMI |
$15.81
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: PHP Medicare Advantage |
$15.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health HMO/PPO |
$55.02
|
| Rate for Payer: Priority Health Medicare |
$15.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.37
|
| Rate for Payer: Railroad Medicare Medicare |
$15.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.65
|
| Rate for Payer: UHC Core |
$52.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.81
|
| Rate for Payer: UHC Exchange |
$15.81
|
| Rate for Payer: UHC Medicare Advantage |
$15.81
|
| Rate for Payer: VA VA |
$15.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.43
|
|
|
HC COMP BURN GARM ANKLET
|
Facility
|
IP
|
$63.24
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300145
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: BCBS Trust/PPO |
$51.62
|
| Rate for Payer: BCN Commercial |
$48.87
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health HMO/PPO |
$55.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.65
|
| Rate for Payer: UHC Core |
$52.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.43
|
|
|
HC COMP BURN GARM BDY BRF SLVD LE
|
Facility
|
OP
|
$338.64
|
|
|
Service Code
|
HCPCS A6510
|
| Hospital Charge Code |
98300146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.43 |
| Max. Negotiated Rate |
$304.78 |
| Rate for Payer: Aetna Commercial |
$287.84
|
| Rate for Payer: Aetna Medicare |
$88.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.83
|
| Rate for Payer: BCBS Complete |
$135.46
|
| Rate for Payer: BCBS MAPPO |
$84.66
|
| Rate for Payer: BCBS Trust/PPO |
$278.40
|
| Rate for Payer: BCN Commercial |
$263.29
|
| Rate for Payer: BCN Medicare Advantage |
$84.66
|
| Rate for Payer: Cash Price |
$270.91
|
| Rate for Payer: Cofinity Commercial |
$291.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.66
|
| Rate for Payer: Healthscope Commercial |
$304.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.84
|
| Rate for Payer: Nomi Health Commercial |
$277.68
|
| Rate for Payer: PACE Senior Care Partners |
$80.43
|
| Rate for Payer: PACE SWMI |
$84.66
|
| Rate for Payer: PHP Commercial |
$287.84
|
| Rate for Payer: PHP Medicare Advantage |
$84.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.12
|
| Rate for Payer: Priority Health HMO/PPO |
$294.62
|
| Rate for Payer: Priority Health Medicare |
$85.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.89
|
| Rate for Payer: Railroad Medicare Medicare |
$84.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.00
|
| Rate for Payer: UHC Core |
$282.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.66
|
| Rate for Payer: UHC Exchange |
$84.66
|
| Rate for Payer: UHC Medicare Advantage |
$84.66
|
| Rate for Payer: VA VA |
$84.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.98
|
|
|
HC COMP BURN GARM BDY BRF SLVD LE
|
Facility
|
IP
|
$338.64
|
|
|
Service Code
|
HCPCS A6510
|
| Hospital Charge Code |
98300146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$220.12 |
| Max. Negotiated Rate |
$304.78 |
| Rate for Payer: Aetna Commercial |
$287.84
|
| Rate for Payer: BCBS Trust/PPO |
$276.43
|
| Rate for Payer: BCN Commercial |
$261.70
|
| Rate for Payer: Cash Price |
$270.91
|
| Rate for Payer: Cofinity Commercial |
$291.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.91
|
| Rate for Payer: Healthscope Commercial |
$304.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.84
|
| Rate for Payer: Nomi Health Commercial |
$277.68
|
| Rate for Payer: PHP Commercial |
$287.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.12
|
| Rate for Payer: Priority Health HMO/PPO |
$294.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.00
|
| Rate for Payer: UHC Core |
$282.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.98
|
|
|
HC COMP BURN GARM BELLY BAND
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$10.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.75
|
| Rate for Payer: BCBS Complete |
$16.32
|
| Rate for Payer: BCBS MAPPO |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$33.54
|
| Rate for Payer: BCN Commercial |
$31.72
|
| Rate for Payer: BCN Medicare Advantage |
$10.20
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.20
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: Nomi Health Commercial |
$33.46
|
| Rate for Payer: PACE Senior Care Partners |
$9.69
|
| Rate for Payer: PACE SWMI |
$10.20
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health HMO/PPO |
$35.50
|
| Rate for Payer: Priority Health Medicare |
$10.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.34
|
| Rate for Payer: Railroad Medicare Medicare |
$10.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.90
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.20
|
| Rate for Payer: UHC Exchange |
$10.20
|
| Rate for Payer: UHC Medicare Advantage |
$10.20
|
| Rate for Payer: VA VA |
$10.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC COMP BURN GARM BELLY BAND
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: BCBS Trust/PPO |
$33.31
|
| Rate for Payer: BCN Commercial |
$31.53
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: Nomi Health Commercial |
$33.46
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health HMO/PPO |
$35.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.90
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC COMP BURN GARM BODY BRF SLEEVE
|
Facility
|
OP
|
$240.72
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.17 |
| Max. Negotiated Rate |
$216.65 |
| Rate for Payer: Aetna Commercial |
$204.61
|
| Rate for Payer: Aetna Medicare |
$62.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.22
|
| Rate for Payer: BCBS Complete |
$96.29
|
| Rate for Payer: BCBS MAPPO |
$60.18
|
| Rate for Payer: BCBS Trust/PPO |
$197.90
|
| Rate for Payer: BCN Commercial |
$187.16
|
| Rate for Payer: BCN Medicare Advantage |
$60.18
|
| Rate for Payer: Cash Price |
$192.58
|
| Rate for Payer: Cofinity Commercial |
$207.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.18
|
| Rate for Payer: Healthscope Commercial |
$216.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.61
|
| Rate for Payer: Nomi Health Commercial |
$197.39
|
| Rate for Payer: PACE Senior Care Partners |
$57.17
|
| Rate for Payer: PACE SWMI |
$60.18
|
| Rate for Payer: PHP Commercial |
$204.61
|
| Rate for Payer: PHP Medicare Advantage |
$60.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.47
|
| Rate for Payer: Priority Health HMO/PPO |
$209.43
|
| Rate for Payer: Priority Health Medicare |
$60.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.28
|
| Rate for Payer: Railroad Medicare Medicare |
$60.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.83
|
| Rate for Payer: UHC Core |
$201.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.18
|
| Rate for Payer: UHC Exchange |
$60.18
|
| Rate for Payer: UHC Medicare Advantage |
$60.18
|
| Rate for Payer: VA VA |
$60.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.54
|
|
|
HC COMP BURN GARM BODY BRF SLEEVE
|
Facility
|
IP
|
$240.72
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$156.47 |
| Max. Negotiated Rate |
$216.65 |
| Rate for Payer: Aetna Commercial |
$204.61
|
| Rate for Payer: BCBS Trust/PPO |
$196.50
|
| Rate for Payer: BCN Commercial |
$186.03
|
| Rate for Payer: Cash Price |
$192.58
|
| Rate for Payer: Cofinity Commercial |
$207.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.58
|
| Rate for Payer: Healthscope Commercial |
$216.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.61
|
| Rate for Payer: Nomi Health Commercial |
$197.39
|
| Rate for Payer: PHP Commercial |
$204.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.47
|
| Rate for Payer: Priority Health HMO/PPO |
$209.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.83
|
| Rate for Payer: UHC Core |
$201.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.54
|
|
|
HC COMP BURN GARM BRF 2 LEGS ABV
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.34 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.81
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$125.78
|
| Rate for Payer: BCN Commercial |
$118.96
|
| Rate for Payer: BCN Medicare Advantage |
$38.25
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: PACE Senior Care Partners |
$36.34
|
| Rate for Payer: PACE SWMI |
$38.25
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: PHP Medicare Advantage |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO |
$133.11
|
| Rate for Payer: Priority Health Medicare |
$38.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.51
|
| Rate for Payer: Railroad Medicare Medicare |
$38.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.25
|
| Rate for Payer: UHC Exchange |
$38.25
|
| Rate for Payer: UHC Medicare Advantage |
$38.25
|
| Rate for Payer: VA VA |
$38.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC COMP BURN GARM BRF 2 LEGS ABV
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: BCBS Trust/PPO |
$124.89
|
| Rate for Payer: BCN Commercial |
$118.24
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO |
$133.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC COMP BURN GARM BRF&CHAP,LG-MID
|
Facility
|
IP
|
$134.64
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$87.52 |
| Max. Negotiated Rate |
$121.18 |
| Rate for Payer: Aetna Commercial |
$114.44
|
| Rate for Payer: BCBS Trust/PPO |
$109.91
|
| Rate for Payer: BCN Commercial |
$104.05
|
| Rate for Payer: Cash Price |
$107.71
|
| Rate for Payer: Cofinity Commercial |
$115.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.71
|
| Rate for Payer: Healthscope Commercial |
$121.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.44
|
| Rate for Payer: Nomi Health Commercial |
$110.40
|
| Rate for Payer: PHP Commercial |
$114.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.52
|
| Rate for Payer: Priority Health HMO/PPO |
$117.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.48
|
| Rate for Payer: UHC Core |
$112.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.98
|
|
|
HC COMP BURN GARM BRF&CHAP,LG-MID
|
Facility
|
OP
|
$134.64
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.98 |
| Max. Negotiated Rate |
$121.18 |
| Rate for Payer: Aetna Commercial |
$114.44
|
| Rate for Payer: Aetna Medicare |
$35.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.08
|
| Rate for Payer: BCBS Complete |
$53.86
|
| Rate for Payer: BCBS MAPPO |
$33.66
|
| Rate for Payer: BCBS Trust/PPO |
$110.69
|
| Rate for Payer: BCN Commercial |
$104.68
|
| Rate for Payer: BCN Medicare Advantage |
$33.66
|
| Rate for Payer: Cash Price |
$107.71
|
| Rate for Payer: Cofinity Commercial |
$115.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.66
|
| Rate for Payer: Healthscope Commercial |
$121.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.44
|
| Rate for Payer: Nomi Health Commercial |
$110.40
|
| Rate for Payer: PACE Senior Care Partners |
$31.98
|
| Rate for Payer: PACE SWMI |
$33.66
|
| Rate for Payer: PHP Commercial |
$114.44
|
| Rate for Payer: PHP Medicare Advantage |
$33.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.52
|
| Rate for Payer: Priority Health HMO/PPO |
$117.14
|
| Rate for Payer: Priority Health Medicare |
$34.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.21
|
| Rate for Payer: Railroad Medicare Medicare |
$33.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.48
|
| Rate for Payer: UHC Core |
$112.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.66
|
| Rate for Payer: UHC Exchange |
$33.66
|
| Rate for Payer: UHC Medicare Advantage |
$33.66
|
| Rate for Payer: VA VA |
$33.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.98
|
|
|
HC COMP BURN GARM BRIEF
|
Facility
|
IP
|
$134.64
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$87.52 |
| Max. Negotiated Rate |
$121.18 |
| Rate for Payer: Aetna Commercial |
$114.44
|
| Rate for Payer: BCBS Trust/PPO |
$109.91
|
| Rate for Payer: BCN Commercial |
$104.05
|
| Rate for Payer: Cash Price |
$107.71
|
| Rate for Payer: Cofinity Commercial |
$115.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.71
|
| Rate for Payer: Healthscope Commercial |
$121.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.44
|
| Rate for Payer: Nomi Health Commercial |
$110.40
|
| Rate for Payer: PHP Commercial |
$114.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.52
|
| Rate for Payer: Priority Health HMO/PPO |
$117.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.48
|
| Rate for Payer: UHC Core |
$112.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.98
|
|
