|
HC COMP BURN GARM STMP CLS STRCH
|
Facility
|
OP
|
$12.48
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
98300053
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$11.23 |
| Rate for Payer: Aetna Commercial |
$10.61
|
| Rate for Payer: Aetna Medicare |
$3.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.90
|
| Rate for Payer: BCBS Complete |
$4.99
|
| Rate for Payer: BCBS MAPPO |
$3.12
|
| Rate for Payer: BCBS Trust/PPO |
$10.26
|
| Rate for Payer: BCN Commercial |
$9.70
|
| Rate for Payer: BCN Medicare Advantage |
$3.12
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$10.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.12
|
| Rate for Payer: Healthscope Commercial |
$11.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: PACE Senior Care Partners |
$2.96
|
| Rate for Payer: PACE SWMI |
$3.12
|
| Rate for Payer: PHP Commercial |
$10.61
|
| Rate for Payer: PHP Medicare Advantage |
$3.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: Priority Health HMO/PPO |
$10.86
|
| Rate for Payer: Priority Health Medicare |
$3.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.36
|
| Rate for Payer: Railroad Medicare Medicare |
$3.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.98
|
| Rate for Payer: UHC Core |
$10.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.12
|
| Rate for Payer: UHC Exchange |
$3.12
|
| Rate for Payer: UHC Medicare Advantage |
$3.12
|
| Rate for Payer: VA VA |
$3.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.36
|
|
|
HC COMP BURN GARM STMP CLS STRCH
|
Facility
|
IP
|
$12.48
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
98300053
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$11.23 |
| Rate for Payer: Aetna Commercial |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$10.19
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$10.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$11.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: PHP Commercial |
$10.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: Priority Health HMO/PPO |
$10.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.98
|
| Rate for Payer: UHC Core |
$10.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.36
|
|
|
HC COMP BURN GARM STOCKING TO KNE
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
HCPCS A6507
|
| Hospital Charge Code |
98300054
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.96 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna Medicare |
$18.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.31
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: BCBS MAPPO |
$17.85
|
| Rate for Payer: BCBS Trust/PPO |
$58.70
|
| Rate for Payer: BCN Commercial |
$55.51
|
| Rate for Payer: BCN Medicare Advantage |
$17.85
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| Rate for Payer: PACE Senior Care Partners |
$16.96
|
| Rate for Payer: PACE SWMI |
$17.85
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: PHP Medicare Advantage |
$17.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO |
$62.12
|
| Rate for Payer: Priority Health Medicare |
$18.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.84
|
| Rate for Payer: Railroad Medicare Medicare |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.83
|
| Rate for Payer: UHC Core |
$59.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.85
|
| Rate for Payer: UHC Exchange |
$17.85
|
| Rate for Payer: UHC Medicare Advantage |
$17.85
|
| Rate for Payer: VA VA |
$17.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC COMP BURN GARM STOCKING TO KNE
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
HCPCS A6507
|
| Hospital Charge Code |
98300054
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: BCBS Trust/PPO |
$58.28
|
| Rate for Payer: BCN Commercial |
$55.18
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO |
$62.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.83
|
| Rate for Payer: UHC Core |
$59.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC COMP BURN GARM STOCKING TO THI
|
Facility
|
OP
|
$93.84
|
|
|
Service Code
|
HCPCS A6508
|
| Hospital Charge Code |
98300055
|
|
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 STOCKING TO THI
|
Facility
|
IP
|
$93.84
|
|
|
Service Code
|
HCPCS A6508
|
| Hospital Charge Code |
98300055
|
|
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 STOCK-KNEE/NO F
|
Facility
|
OP
|
$63.24
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300056
|
|
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 STOCK-KNEE/NO F
|
Facility
|
IP
|
$63.24
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300056
|
|
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 STRETCH INSERT
|
Facility
|
IP
|
$12.48
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
98300057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$11.23 |
| Rate for Payer: Aetna Commercial |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$10.19
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$10.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$11.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: PHP Commercial |
$10.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: Priority Health HMO/PPO |
$10.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.98
|
| Rate for Payer: UHC Core |
$10.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.36
|
|
|
HC COMP BURN GARM STRETCH INSERT
|
Facility
|
OP
|
$12.48
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
98300057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$11.23 |
| Rate for Payer: Aetna Commercial |
$10.61
|
| Rate for Payer: Aetna Medicare |
$3.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.90
|
| Rate for Payer: BCBS Complete |
$4.99
|
| Rate for Payer: BCBS MAPPO |
$3.12
|
| Rate for Payer: BCBS Trust/PPO |
$10.26
|
| Rate for Payer: BCN Commercial |
$9.70
|
| Rate for Payer: BCN Medicare Advantage |
$3.12
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$10.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.12
|
| Rate for Payer: Healthscope Commercial |
$11.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: PACE Senior Care Partners |
$2.96
|
| Rate for Payer: PACE SWMI |
$3.12
|
| Rate for Payer: PHP Commercial |
$10.61
|
| Rate for Payer: PHP Medicare Advantage |
$3.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: Priority Health HMO/PPO |
$10.86
|
| Rate for Payer: Priority Health Medicare |
$3.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.36
|
| Rate for Payer: Railroad Medicare Medicare |
$3.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.98
|
| Rate for Payer: UHC Core |
$10.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.12
|
| Rate for Payer: UHC Exchange |
$3.12
|
| Rate for Payer: UHC Medicare Advantage |
$3.12
|
| Rate for Payer: VA VA |
$3.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.36
|
|
|
HC COMP BURN GARM SUEDE/LEATHER G
|
Facility
|
OP
|
$45.90
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300058
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Medicare |
$11.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.34
|
| Rate for Payer: BCBS Complete |
$18.36
|
| Rate for Payer: BCBS MAPPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$37.73
|
| Rate for Payer: BCN Commercial |
$35.69
|
| Rate for Payer: BCN Medicare Advantage |
$11.47
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Nomi Health Commercial |
$37.64
|
| Rate for Payer: PACE Senior Care Partners |
$10.90
|
| Rate for Payer: PACE SWMI |
$11.47
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: PHP Medicare Advantage |
$11.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: Priority Health HMO/PPO |
$39.93
|
| Rate for Payer: Priority Health Medicare |
$11.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.75
|
| Rate for Payer: Railroad Medicare Medicare |
$11.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.39
|
| Rate for Payer: UHC Core |
$38.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.47
|
| Rate for Payer: UHC Exchange |
$11.47
|
| Rate for Payer: UHC Medicare Advantage |
$11.47
|
| Rate for Payer: VA VA |
$11.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
HC COMP BURN GARM SUEDE/LEATHER G
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300058
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.84 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: BCBS Trust/PPO |
$37.47
|
| Rate for Payer: BCN Commercial |
$35.47
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Nomi Health Commercial |
$37.64
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: Priority Health HMO/PPO |
$39.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.39
|
| Rate for Payer: UHC Core |
$38.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
HC COMP BURN GARM SUIT SLVD ABV K
|
Facility
|
IP
|
$387.60
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300059
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$251.94 |
| Max. Negotiated Rate |
$348.84 |
| Rate for Payer: Aetna Commercial |
$329.46
|
| Rate for Payer: BCBS Trust/PPO |
$316.40
|
| Rate for Payer: BCN Commercial |
$299.54
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cofinity Commercial |
$333.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Healthscope Commercial |
$348.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.46
|
| Rate for Payer: Nomi Health Commercial |
$317.83
|
| Rate for Payer: PHP Commercial |
$329.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.94
|
| Rate for Payer: Priority Health HMO/PPO |
$337.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.09
|
| Rate for Payer: UHC Core |
$323.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.70
|
|
|
HC COMP BURN GARM SUIT SLVD ABV K
|
Facility
|
OP
|
$387.60
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300059
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$92.06 |
| Max. Negotiated Rate |
$348.84 |
| Rate for Payer: Aetna Commercial |
$329.46
|
| Rate for Payer: Aetna Medicare |
$100.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.12
|
| Rate for Payer: BCBS Complete |
$155.04
|
| Rate for Payer: BCBS MAPPO |
$96.90
|
| Rate for Payer: BCBS Trust/PPO |
$318.65
|
| Rate for Payer: BCN Commercial |
$301.36
|
| Rate for Payer: BCN Medicare Advantage |
$96.90
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cofinity Commercial |
$333.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.90
|
| Rate for Payer: Healthscope Commercial |
$348.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.46
|
| Rate for Payer: Nomi Health Commercial |
$317.83
|
| Rate for Payer: PACE Senior Care Partners |
$92.06
|
| Rate for Payer: PACE SWMI |
$96.90
|
| Rate for Payer: PHP Commercial |
$329.46
|
| Rate for Payer: PHP Medicare Advantage |
$96.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.94
|
| Rate for Payer: Priority Health HMO/PPO |
$337.21
|
| Rate for Payer: Priority Health Medicare |
$97.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.69
|
| Rate for Payer: Railroad Medicare Medicare |
$96.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.09
|
| Rate for Payer: UHC Core |
$323.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.90
|
| Rate for Payer: UHC Exchange |
$96.90
|
| Rate for Payer: UHC Medicare Advantage |
$96.90
|
| Rate for Payer: VA VA |
$96.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.70
|
|
|
HC COMP BURN GARM SUIT SLVD TWO LEGS
|
Facility
|
IP
|
$491.64
|
|
|
Service Code
|
HCPCS A6501
|
| Hospital Charge Code |
98300060
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$319.57 |
| Max. Negotiated Rate |
$442.48 |
| Rate for Payer: Aetna Commercial |
$417.89
|
| Rate for Payer: BCBS Trust/PPO |
$401.33
|
| Rate for Payer: BCN Commercial |
$379.94
|
| Rate for Payer: Cash Price |
$393.31
|
| Rate for Payer: Cofinity Commercial |
$422.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.31
|
| Rate for Payer: Healthscope Commercial |
$442.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$368.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.89
|
| Rate for Payer: Nomi Health Commercial |
$403.14
|
| Rate for Payer: PHP Commercial |
$417.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.57
|
| Rate for Payer: Priority Health HMO/PPO |
$427.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$329.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.64
|
| Rate for Payer: UHC Core |
$410.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$368.73
|
|
|
HC COMP BURN GARM SUIT SLVD TWO LEGS
|
Facility
|
OP
|
$491.64
|
|
|
Service Code
|
HCPCS A6501
|
| Hospital Charge Code |
98300060
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.76 |
| Max. Negotiated Rate |
$442.48 |
| Rate for Payer: Aetna Commercial |
$417.89
|
| Rate for Payer: Aetna Medicare |
$127.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$153.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$153.64
|
| Rate for Payer: BCBS Complete |
$196.66
|
| Rate for Payer: BCBS MAPPO |
$122.91
|
| Rate for Payer: BCBS Trust/PPO |
$404.18
|
| Rate for Payer: BCN Commercial |
$382.25
|
| Rate for Payer: BCN Medicare Advantage |
$122.91
|
| Rate for Payer: Cash Price |
$393.31
|
| Rate for Payer: Cofinity Commercial |
$422.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.91
|
| Rate for Payer: Healthscope Commercial |
$442.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$368.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.89
|
| Rate for Payer: Nomi Health Commercial |
$403.14
|
| Rate for Payer: PACE Senior Care Partners |
$116.76
|
| Rate for Payer: PACE SWMI |
$122.91
|
| Rate for Payer: PHP Commercial |
$417.89
|
| Rate for Payer: PHP Medicare Advantage |
$122.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.57
|
| Rate for Payer: Priority Health HMO/PPO |
$427.73
|
| Rate for Payer: Priority Health Medicare |
$124.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$329.40
|
| Rate for Payer: Railroad Medicare Medicare |
$122.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.64
|
| Rate for Payer: UHC Core |
$410.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.91
|
| Rate for Payer: UHC Exchange |
$122.91
|
| Rate for Payer: UHC Medicare Advantage |
$122.91
|
| Rate for Payer: VA VA |
$122.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$368.73
|
|
|
HC COMP BURN GARM SUIT SLVLS ABV
|
Facility
|
OP
|
$320.28
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300061
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.07 |
| Max. Negotiated Rate |
$288.25 |
| Rate for Payer: Aetna Commercial |
$272.24
|
| Rate for Payer: Aetna Medicare |
$83.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.09
|
| Rate for Payer: BCBS Complete |
$128.11
|
| Rate for Payer: BCBS MAPPO |
$80.07
|
| Rate for Payer: BCBS Trust/PPO |
$263.30
|
| Rate for Payer: BCN Commercial |
$249.02
|
| Rate for Payer: BCN Medicare Advantage |
$80.07
|
| Rate for Payer: Cash Price |
$256.22
|
| Rate for Payer: Cofinity Commercial |
$275.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.07
|
| Rate for Payer: Healthscope Commercial |
$288.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.24
|
| Rate for Payer: Nomi Health Commercial |
$262.63
|
| Rate for Payer: PACE Senior Care Partners |
$76.07
|
| Rate for Payer: PACE SWMI |
$80.07
|
| Rate for Payer: PHP Commercial |
$272.24
|
| Rate for Payer: PHP Medicare Advantage |
$80.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.18
|
| Rate for Payer: Priority Health HMO/PPO |
$278.64
|
| Rate for Payer: Priority Health Medicare |
$80.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.59
|
| Rate for Payer: Railroad Medicare Medicare |
$80.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.85
|
| Rate for Payer: UHC Core |
$267.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.07
|
| Rate for Payer: UHC Exchange |
$80.07
|
| Rate for Payer: UHC Medicare Advantage |
$80.07
|
| Rate for Payer: VA VA |
$80.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.21
|
|
|
HC COMP BURN GARM SUIT SLVLS ABV
|
Facility
|
IP
|
$320.28
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300061
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$208.18 |
| Max. Negotiated Rate |
$288.25 |
| Rate for Payer: Aetna Commercial |
$272.24
|
| Rate for Payer: BCBS Trust/PPO |
$261.44
|
| Rate for Payer: BCN Commercial |
$247.51
|
| Rate for Payer: Cash Price |
$256.22
|
| Rate for Payer: Cofinity Commercial |
$275.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.22
|
| Rate for Payer: Healthscope Commercial |
$288.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.24
|
| Rate for Payer: Nomi Health Commercial |
$262.63
|
| Rate for Payer: PHP Commercial |
$272.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.18
|
| Rate for Payer: Priority Health HMO/PPO |
$278.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.85
|
| Rate for Payer: UHC Core |
$267.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.21
|
|
|
HC COMP BURN GARM SUIT SLVLS-TWO LEGS
|
Facility
|
OP
|
$375.36
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300062
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.15 |
| Max. Negotiated Rate |
$337.82 |
| Rate for Payer: Aetna Commercial |
$319.06
|
| Rate for Payer: Aetna Medicare |
$97.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.30
|
| Rate for Payer: BCBS Complete |
$150.14
|
| Rate for Payer: BCBS MAPPO |
$93.84
|
| Rate for Payer: BCBS Trust/PPO |
$308.58
|
| Rate for Payer: BCN Commercial |
$291.84
|
| Rate for Payer: BCN Medicare Advantage |
$93.84
|
| Rate for Payer: Cash Price |
$300.29
|
| Rate for Payer: Cofinity Commercial |
$322.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$337.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.06
|
| Rate for Payer: Nomi Health Commercial |
$307.80
|
| Rate for Payer: PACE Senior Care Partners |
$89.15
|
| Rate for Payer: PACE SWMI |
$93.84
|
| Rate for Payer: PHP Commercial |
$319.06
|
| Rate for Payer: PHP Medicare Advantage |
$93.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.98
|
| Rate for Payer: Priority Health HMO/PPO |
$326.56
|
| Rate for Payer: Priority Health Medicare |
$94.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.49
|
| Rate for Payer: Railroad Medicare Medicare |
$93.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.32
|
| Rate for Payer: UHC Core |
$313.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.84
|
| Rate for Payer: UHC Exchange |
$93.84
|
| Rate for Payer: UHC Medicare Advantage |
$93.84
|
| Rate for Payer: VA VA |
$93.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.52
|
|
|
HC COMP BURN GARM SUIT SLVLS-TWO LEGS
|
Facility
|
IP
|
$375.36
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300062
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$243.98 |
| Max. Negotiated Rate |
$337.82 |
| Rate for Payer: Aetna Commercial |
$319.06
|
| Rate for Payer: BCBS Trust/PPO |
$306.41
|
| Rate for Payer: BCN Commercial |
$290.08
|
| Rate for Payer: Cash Price |
$300.29
|
| Rate for Payer: Cofinity Commercial |
$322.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.29
|
| Rate for Payer: Healthscope Commercial |
$337.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.06
|
| Rate for Payer: Nomi Health Commercial |
$307.80
|
| Rate for Payer: PHP Commercial |
$319.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.98
|
| Rate for Payer: Priority Health HMO/PPO |
$326.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.32
|
| Rate for Payer: UHC Core |
$313.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.52
|
|
|
HC COMP BURN GARM SUSPENDERS ATTA
|
Facility
|
OP
|
$45.90
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300063
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Medicare |
$11.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.34
|
| Rate for Payer: BCBS Complete |
$18.36
|
| Rate for Payer: BCBS MAPPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$37.73
|
| Rate for Payer: BCN Commercial |
$35.69
|
| Rate for Payer: BCN Medicare Advantage |
$11.47
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Nomi Health Commercial |
$37.64
|
| Rate for Payer: PACE Senior Care Partners |
$10.90
|
| Rate for Payer: PACE SWMI |
$11.47
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: PHP Medicare Advantage |
$11.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: Priority Health HMO/PPO |
$39.93
|
| Rate for Payer: Priority Health Medicare |
$11.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.75
|
| Rate for Payer: Railroad Medicare Medicare |
$11.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.39
|
| Rate for Payer: UHC Core |
$38.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.47
|
| Rate for Payer: UHC Exchange |
$11.47
|
| Rate for Payer: UHC Medicare Advantage |
$11.47
|
| Rate for Payer: VA VA |
$11.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
HC COMP BURN GARM SUSPENDERS ATTA
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300063
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.84 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: BCBS Trust/PPO |
$37.47
|
| Rate for Payer: BCN Commercial |
$35.47
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Nomi Health Commercial |
$37.64
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: Priority Health HMO/PPO |
$39.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.39
|
| Rate for Payer: UHC Core |
$38.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
HC COMP BURN GARM SUSPENDERS REMO
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300064
|
|
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 SUSPENDERS REMO
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300064
|
|
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 TWO LEGS PREGNA
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300065
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$165.75 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna Commercial |
$216.75
|
| Rate for Payer: BCBS Trust/PPO |
$208.16
|
| Rate for Payer: BCN Commercial |
$197.06
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$219.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Healthscope Commercial |
$229.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.75
|
| Rate for Payer: Nomi Health Commercial |
$209.10
|
| Rate for Payer: PHP Commercial |
$216.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health HMO/PPO |
$221.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.40
|
| Rate for Payer: UHC Core |
$212.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.25
|
|
