|
HC COMP BURN GARM FACE MASK
|
Facility
|
IP
|
$136.68
|
|
|
Service Code
|
HCPCS A6503
|
| Hospital Charge Code |
98300159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$88.84 |
| Max. Negotiated Rate |
$123.01 |
| Rate for Payer: Aetna Commercial |
$116.18
|
| Rate for Payer: BCBS Trust/PPO |
$111.57
|
| Rate for Payer: BCN Commercial |
$105.63
|
| Rate for Payer: Cash Price |
$109.34
|
| Rate for Payer: Cofinity Commercial |
$117.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.34
|
| Rate for Payer: Healthscope Commercial |
$123.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.18
|
| Rate for Payer: Nomi Health Commercial |
$112.08
|
| Rate for Payer: PHP Commercial |
$116.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.84
|
| Rate for Payer: Priority Health HMO/PPO |
$118.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.28
|
| Rate for Payer: UHC Core |
$114.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.51
|
|
|
HC COMP BURN GARM FOOT GAUNTLET
|
Facility
|
IP
|
$34.68
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300160
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$29.48
|
| Rate for Payer: BCBS Trust/PPO |
$28.31
|
| Rate for Payer: BCN Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$29.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.74
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.48
|
| Rate for Payer: Nomi Health Commercial |
$28.44
|
| Rate for Payer: PHP Commercial |
$29.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.54
|
| Rate for Payer: Priority Health HMO/PPO |
$30.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.52
|
| Rate for Payer: UHC Core |
$28.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.01
|
|
|
HC COMP BURN GARM FOOT GAUNTLET
|
Facility
|
OP
|
$34.68
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300160
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$29.48
|
| Rate for Payer: Aetna Medicare |
$9.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.84
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS MAPPO |
$8.67
|
| Rate for Payer: BCBS Trust/PPO |
$28.51
|
| Rate for Payer: BCN Commercial |
$26.96
|
| Rate for Payer: BCN Medicare Advantage |
$8.67
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$29.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.67
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.48
|
| Rate for Payer: Nomi Health Commercial |
$28.44
|
| Rate for Payer: PACE Senior Care Partners |
$8.24
|
| Rate for Payer: PACE SWMI |
$8.67
|
| Rate for Payer: PHP Commercial |
$29.48
|
| Rate for Payer: PHP Medicare Advantage |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.54
|
| Rate for Payer: Priority Health HMO/PPO |
$30.17
|
| Rate for Payer: Priority Health Medicare |
$8.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.24
|
| Rate for Payer: Railroad Medicare Medicare |
$8.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.52
|
| Rate for Payer: UHC Core |
$28.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.67
|
| Rate for Payer: UHC Exchange |
$8.67
|
| Rate for Payer: UHC Medicare Advantage |
$8.67
|
| Rate for Payer: VA VA |
$8.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.01
|
|
|
HC COMP BURN GARM FOOT GLOVE
|
Facility
|
OP
|
$112.20
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: Aetna Medicare |
$29.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.06
|
| Rate for Payer: BCBS Complete |
$44.88
|
| Rate for Payer: BCBS MAPPO |
$28.05
|
| Rate for Payer: BCBS Trust/PPO |
$92.24
|
| Rate for Payer: BCN Commercial |
$87.24
|
| Rate for Payer: BCN Medicare Advantage |
$28.05
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$96.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.05
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: Nomi Health Commercial |
$92.00
|
| Rate for Payer: PACE Senior Care Partners |
$26.65
|
| Rate for Payer: PACE SWMI |
$28.05
|
| Rate for Payer: PHP Commercial |
$95.37
|
| Rate for Payer: PHP Medicare Advantage |
$28.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.93
|
| Rate for Payer: Priority Health HMO/PPO |
$97.61
|
| Rate for Payer: Priority Health Medicare |
$28.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.17
|
| Rate for Payer: Railroad Medicare Medicare |
$28.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.74
|
| Rate for Payer: UHC Core |
$93.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.05
|
| Rate for Payer: UHC Exchange |
$28.05
|
| Rate for Payer: UHC Medicare Advantage |
$28.05
|
| Rate for Payer: VA VA |
$28.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.15
|
|
|
HC COMP BURN GARM FOOT GLOVE
|
Facility
|
IP
|
$112.20
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$72.93 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: BCBS Trust/PPO |
$91.59
|
| Rate for Payer: BCN Commercial |
$86.71
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$96.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: Nomi Health Commercial |
$92.00
|
| Rate for Payer: PHP Commercial |
$95.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.93
|
| Rate for Payer: Priority Health HMO/PPO |
$97.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.74
|
| Rate for Payer: UHC Core |
$93.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.15
|
|
|
HC COMP BURN GARM FOOT MITTEN
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$23.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.69
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS MAPPO |
$22.95
|
| Rate for Payer: BCBS Trust/PPO |
$75.47
|
| Rate for Payer: BCN Commercial |
$71.37
|
| Rate for Payer: BCN Medicare Advantage |
$22.95
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.95
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: PACE Senior Care Partners |
$21.80
|
| Rate for Payer: PACE SWMI |
$22.95
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Medicare Advantage |
$22.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Medicare |
$23.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.51
|
| Rate for Payer: Railroad Medicare Medicare |
$22.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.95
|
| Rate for Payer: UHC Exchange |
$22.95
|
| Rate for Payer: UHC Medicare Advantage |
$22.95
|
| Rate for Payer: VA VA |
$22.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
HC COMP BURN GARM FOOT MITTEN
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.67 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$74.94
|
| Rate for Payer: BCN Commercial |
$70.94
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
HC COMP BURN GARM FULLY LINED GAR
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: BCBS Trust/PPO |
$0.83
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$0.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.87
|
| Rate for Payer: Nomi Health Commercial |
$0.84
|
| Rate for Payer: PHP Commercial |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.66
|
| Rate for Payer: Priority Health HMO/PPO |
$0.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.90
|
| Rate for Payer: UHC Core |
$0.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.77
|
|
|
HC COMP BURN GARM FULLY LINED GAR
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: Aetna Medicare |
$0.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.32
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS MAPPO |
$0.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.84
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: BCN Medicare Advantage |
$0.26
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.26
|
| Rate for Payer: Healthscope Commercial |
$0.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.87
|
| Rate for Payer: Nomi Health Commercial |
$0.84
|
| Rate for Payer: PACE Senior Care Partners |
$0.24
|
| Rate for Payer: PACE SWMI |
$0.26
|
| Rate for Payer: PHP Commercial |
$0.87
|
| Rate for Payer: PHP Medicare Advantage |
$0.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.66
|
| Rate for Payer: Priority Health HMO/PPO |
$0.89
|
| Rate for Payer: Priority Health Medicare |
$0.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.68
|
| Rate for Payer: Railroad Medicare Medicare |
$0.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.90
|
| Rate for Payer: UHC Core |
$0.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.26
|
| Rate for Payer: UHC Exchange |
$0.26
|
| Rate for Payer: UHC Medicare Advantage |
$0.26
|
| Rate for Payer: VA VA |
$0.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.77
|
|
|
HC COMP BURN GARM GAUNTLET TO AXI
|
Facility
|
OP
|
$93.84
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.29 |
| Max. Negotiated Rate |
$84.46 |
| Rate for Payer: Aetna Commercial |
$79.76
|
| Rate for Payer: Aetna Medicare |
$24.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.32
|
| Rate for Payer: BCBS Complete |
$37.54
|
| Rate for Payer: BCBS MAPPO |
$23.46
|
| Rate for Payer: BCBS Trust/PPO |
$77.15
|
| Rate for Payer: BCN Commercial |
$72.96
|
| Rate for Payer: BCN Medicare Advantage |
$23.46
|
| Rate for Payer: Cash Price |
$75.07
|
| Rate for Payer: Cofinity Commercial |
$80.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.46
|
| Rate for Payer: Healthscope Commercial |
$84.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.76
|
| Rate for Payer: Nomi Health Commercial |
$76.95
|
| Rate for Payer: PACE Senior Care Partners |
$22.29
|
| Rate for Payer: PACE SWMI |
$23.46
|
| Rate for Payer: PHP Commercial |
$79.76
|
| Rate for Payer: PHP Medicare Advantage |
$23.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.00
|
| Rate for Payer: Priority Health HMO/PPO |
$81.64
|
| Rate for Payer: Priority Health Medicare |
$23.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.87
|
| Rate for Payer: Railroad Medicare Medicare |
$23.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.58
|
| Rate for Payer: UHC Core |
$78.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.46
|
| Rate for Payer: UHC Exchange |
$23.46
|
| Rate for Payer: UHC Medicare Advantage |
$23.46
|
| Rate for Payer: VA VA |
$23.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.38
|
|
|
HC COMP BURN GARM GAUNTLET TO AXI
|
Facility
|
IP
|
$93.84
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$84.46 |
| Rate for Payer: Aetna Commercial |
$79.76
|
| Rate for Payer: BCBS Trust/PPO |
$76.60
|
| Rate for Payer: BCN Commercial |
$72.52
|
| Rate for Payer: Cash Price |
$75.07
|
| Rate for Payer: Cofinity Commercial |
$80.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.07
|
| Rate for Payer: Healthscope Commercial |
$84.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.76
|
| Rate for Payer: Nomi Health Commercial |
$76.95
|
| Rate for Payer: PHP Commercial |
$79.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.00
|
| Rate for Payer: Priority Health HMO/PPO |
$81.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.58
|
| Rate for Payer: UHC Core |
$78.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.38
|
|
|
HC COMP BURN GARM GAUNTLET TO WRI
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300028
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: BCBS Trust/PPO |
$29.14
|
| Rate for Payer: BCN Commercial |
$27.59
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: Nomi Health Commercial |
$29.27
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.20
|
| Rate for Payer: Priority Health HMO/PPO |
$31.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.42
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.78
|
|
|
HC COMP BURN GARM GAUNTLET TO WRI
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300028
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$9.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.16
|
| Rate for Payer: BCBS Complete |
$14.28
|
| Rate for Payer: BCBS MAPPO |
$8.92
|
| Rate for Payer: BCBS Trust/PPO |
$29.35
|
| Rate for Payer: BCN Commercial |
$27.76
|
| Rate for Payer: BCN Medicare Advantage |
$8.92
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.92
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: Nomi Health Commercial |
$29.27
|
| Rate for Payer: PACE Senior Care Partners |
$8.48
|
| Rate for Payer: PACE SWMI |
$8.92
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Medicare Advantage |
$8.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.20
|
| Rate for Payer: Priority Health HMO/PPO |
$31.06
|
| Rate for Payer: Priority Health Medicare |
$9.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.92
|
| Rate for Payer: Railroad Medicare Medicare |
$8.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.42
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.92
|
| Rate for Payer: UHC Exchange |
$8.92
|
| Rate for Payer: UHC Medicare Advantage |
$8.92
|
| Rate for Payer: VA VA |
$8.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.78
|
|
|
HC COMP BURN GARM GLOVE-ELBOW
|
Facility
|
OP
|
$163.20
|
|
|
Service Code
|
HCPCS A6505
|
| Hospital Charge Code |
98300030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.76 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$138.72
|
| Rate for Payer: Aetna Medicare |
$42.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.00
|
| Rate for Payer: BCBS Complete |
$65.28
|
| Rate for Payer: BCBS MAPPO |
$40.80
|
| Rate for Payer: BCBS Trust/PPO |
$134.17
|
| Rate for Payer: BCN Commercial |
$126.89
|
| Rate for Payer: BCN Medicare Advantage |
$40.80
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cofinity Commercial |
$140.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$146.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.72
|
| Rate for Payer: Nomi Health Commercial |
$133.82
|
| Rate for Payer: PACE Senior Care Partners |
$38.76
|
| Rate for Payer: PACE SWMI |
$40.80
|
| Rate for Payer: PHP Commercial |
$138.72
|
| Rate for Payer: PHP Medicare Advantage |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.08
|
| Rate for Payer: Priority Health HMO/PPO |
$141.98
|
| Rate for Payer: Priority Health Medicare |
$41.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.34
|
| Rate for Payer: Railroad Medicare Medicare |
$40.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.62
|
| Rate for Payer: UHC Core |
$136.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.80
|
| Rate for Payer: UHC Exchange |
$40.80
|
| Rate for Payer: UHC Medicare Advantage |
$40.80
|
| Rate for Payer: VA VA |
$40.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.40
|
|
|
HC COMP BURN GARM GLOVE-ELBOW
|
Facility
|
IP
|
$163.20
|
|
|
Service Code
|
HCPCS A6505
|
| Hospital Charge Code |
98300030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$138.72
|
| Rate for Payer: BCBS Trust/PPO |
$133.22
|
| Rate for Payer: BCN Commercial |
$126.12
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cofinity Commercial |
$140.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.56
|
| Rate for Payer: Healthscope Commercial |
$146.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.72
|
| Rate for Payer: Nomi Health Commercial |
$133.82
|
| Rate for Payer: PHP Commercial |
$138.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.08
|
| Rate for Payer: Priority Health HMO/PPO |
$141.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.62
|
| Rate for Payer: UHC Core |
$136.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.40
|
|
|
HC COMP BURN GARM GLOVE TO AXILLA
|
Facility
|
IP
|
$179.52
|
|
|
Service Code
|
HCPCS A6506
|
| Hospital Charge Code |
98300029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.69 |
| Max. Negotiated Rate |
$161.57 |
| Rate for Payer: Aetna Commercial |
$152.59
|
| Rate for Payer: BCBS Trust/PPO |
$146.54
|
| Rate for Payer: BCN Commercial |
$138.73
|
| Rate for Payer: Cash Price |
$143.62
|
| Rate for Payer: Cofinity Commercial |
$154.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.62
|
| Rate for Payer: Healthscope Commercial |
$161.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.59
|
| Rate for Payer: Nomi Health Commercial |
$147.21
|
| Rate for Payer: PHP Commercial |
$152.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.69
|
| Rate for Payer: Priority Health HMO/PPO |
$156.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.98
|
| Rate for Payer: UHC Core |
$149.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.64
|
|
|
HC COMP BURN GARM GLOVE TO AXILLA
|
Facility
|
OP
|
$179.52
|
|
|
Service Code
|
HCPCS A6506
|
| Hospital Charge Code |
98300029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.64 |
| Max. Negotiated Rate |
$161.57 |
| Rate for Payer: Aetna Commercial |
$152.59
|
| Rate for Payer: Aetna Medicare |
$46.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.10
|
| Rate for Payer: BCBS Complete |
$71.81
|
| Rate for Payer: BCBS MAPPO |
$44.88
|
| Rate for Payer: BCBS Trust/PPO |
$147.58
|
| Rate for Payer: BCN Commercial |
$139.58
|
| Rate for Payer: BCN Medicare Advantage |
$44.88
|
| Rate for Payer: Cash Price |
$143.62
|
| Rate for Payer: Cofinity Commercial |
$154.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.88
|
| Rate for Payer: Healthscope Commercial |
$161.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.59
|
| Rate for Payer: Nomi Health Commercial |
$147.21
|
| Rate for Payer: PACE Senior Care Partners |
$42.64
|
| Rate for Payer: PACE SWMI |
$44.88
|
| Rate for Payer: PHP Commercial |
$152.59
|
| Rate for Payer: PHP Medicare Advantage |
$44.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.69
|
| Rate for Payer: Priority Health HMO/PPO |
$156.18
|
| Rate for Payer: Priority Health Medicare |
$45.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.28
|
| Rate for Payer: Railroad Medicare Medicare |
$44.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.98
|
| Rate for Payer: UHC Core |
$149.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.88
|
| Rate for Payer: UHC Exchange |
$44.88
|
| Rate for Payer: UHC Medicare Advantage |
$44.88
|
| Rate for Payer: VA VA |
$44.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.64
|
|
|
HC COMP BURN GARM GLOVE-WRIST
|
Facility
|
IP
|
$112.20
|
|
|
Service Code
|
HCPCS A6504
|
| Hospital Charge Code |
98300031
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$72.93 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: BCBS Trust/PPO |
$91.59
|
| Rate for Payer: BCN Commercial |
$86.71
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$96.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: Nomi Health Commercial |
$92.00
|
| Rate for Payer: PHP Commercial |
$95.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.93
|
| Rate for Payer: Priority Health HMO/PPO |
$97.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.74
|
| Rate for Payer: UHC Core |
$93.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.15
|
|
|
HC COMP BURN GARM GLOVE-WRIST
|
Facility
|
OP
|
$112.20
|
|
|
Service Code
|
HCPCS A6504
|
| Hospital Charge Code |
98300031
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: Aetna Medicare |
$29.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.06
|
| Rate for Payer: BCBS Complete |
$44.88
|
| Rate for Payer: BCBS MAPPO |
$28.05
|
| Rate for Payer: BCBS Trust/PPO |
$92.24
|
| Rate for Payer: BCN Commercial |
$87.24
|
| Rate for Payer: BCN Medicare Advantage |
$28.05
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$96.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.05
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: Nomi Health Commercial |
$92.00
|
| Rate for Payer: PACE Senior Care Partners |
$26.65
|
| Rate for Payer: PACE SWMI |
$28.05
|
| Rate for Payer: PHP Commercial |
$95.37
|
| Rate for Payer: PHP Medicare Advantage |
$28.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.93
|
| Rate for Payer: Priority Health HMO/PPO |
$97.61
|
| Rate for Payer: Priority Health Medicare |
$28.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.17
|
| Rate for Payer: Railroad Medicare Medicare |
$28.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.74
|
| Rate for Payer: UHC Core |
$93.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.05
|
| Rate for Payer: UHC Exchange |
$28.05
|
| Rate for Payer: UHC Medicare Advantage |
$28.05
|
| Rate for Payer: VA VA |
$28.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.15
|
|
|
HC COMP BURN GARM HEAD BAND
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300032
|
|
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 HEAD BAND
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300032
|
|
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 HOOK&LOOP SNAP
|
Facility
|
IP
|
$14.28
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: BCBS Trust/PPO |
$11.66
|
| Rate for Payer: BCN Commercial |
$11.04
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.14
|
| Rate for Payer: Nomi Health Commercial |
$11.71
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.28
|
| Rate for Payer: Priority Health HMO/PPO |
$12.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.57
|
| Rate for Payer: UHC Core |
$11.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.71
|
|
|
HC COMP BURN GARM HOOK&LOOP SNAP
|
Facility
|
OP
|
$14.28
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna Medicare |
$3.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.46
|
| Rate for Payer: BCBS Complete |
$5.71
|
| Rate for Payer: BCBS MAPPO |
$3.57
|
| Rate for Payer: BCBS Trust/PPO |
$11.74
|
| Rate for Payer: BCN Commercial |
$11.10
|
| Rate for Payer: BCN Medicare Advantage |
$3.57
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.14
|
| Rate for Payer: Nomi Health Commercial |
$11.71
|
| Rate for Payer: PACE Senior Care Partners |
$3.39
|
| Rate for Payer: PACE SWMI |
$3.57
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: PHP Medicare Advantage |
$3.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.28
|
| Rate for Payer: Priority Health HMO/PPO |
$12.42
|
| Rate for Payer: Priority Health Medicare |
$3.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.57
|
| Rate for Payer: Railroad Medicare Medicare |
$3.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.57
|
| Rate for Payer: UHC Core |
$11.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.57
|
| Rate for Payer: UHC Exchange |
$3.57
|
| Rate for Payer: UHC Medicare Advantage |
$3.57
|
| Rate for Payer: VA VA |
$3.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.71
|
|
|
HC COMP BURN GARM HOOK&LOOP TAB S
|
Facility
|
IP
|
$8.16
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$7.34 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: BCBS Trust/PPO |
$6.66
|
| Rate for Payer: BCN Commercial |
$6.31
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cofinity Commercial |
$7.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.53
|
| Rate for Payer: Healthscope Commercial |
$7.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.94
|
| Rate for Payer: Nomi Health Commercial |
$6.69
|
| Rate for Payer: PHP Commercial |
$6.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.30
|
| Rate for Payer: Priority Health HMO/PPO |
$7.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.18
|
| Rate for Payer: UHC Core |
$6.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.12
|
|
|
HC COMP BURN GARM HOOK&LOOP TAB S
|
Facility
|
OP
|
$8.16
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$7.34 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Aetna Medicare |
$2.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.55
|
| Rate for Payer: BCBS Complete |
$3.26
|
| Rate for Payer: BCBS MAPPO |
$2.04
|
| Rate for Payer: BCBS Trust/PPO |
$6.71
|
| Rate for Payer: BCN Commercial |
$6.34
|
| Rate for Payer: BCN Medicare Advantage |
$2.04
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cofinity Commercial |
$7.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$7.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.94
|
| Rate for Payer: Nomi Health Commercial |
$6.69
|
| Rate for Payer: PACE Senior Care Partners |
$1.94
|
| Rate for Payer: PACE SWMI |
$2.04
|
| Rate for Payer: PHP Commercial |
$6.94
|
| Rate for Payer: PHP Medicare Advantage |
$2.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.30
|
| Rate for Payer: Priority Health HMO/PPO |
$7.10
|
| Rate for Payer: Priority Health Medicare |
$2.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.47
|
| Rate for Payer: Railroad Medicare Medicare |
$2.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.18
|
| Rate for Payer: UHC Core |
$6.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.04
|
| Rate for Payer: UHC Exchange |
$2.04
|
| Rate for Payer: UHC Medicare Advantage |
$2.04
|
| Rate for Payer: VA VA |
$2.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.12
|
|
