HC COMP BURN GARM BDY BRF SLVD LE
|
Facility
|
OP
|
$332.00
|
|
Service Code
|
HCPCS A6510
|
Hospital Charge Code |
98300146
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$122.84 |
Max. Negotiated Rate |
$628.00 |
Rate for Payer: Aetna American Axle |
$215.80
|
Rate for Payer: Aetna Commercial |
$282.20
|
Rate for Payer: Aetna New Business (MI Preferred) |
$215.80
|
Rate for Payer: BCBS Complete |
$132.80
|
Rate for Payer: BCBS Trust/PPO |
$628.00
|
Rate for Payer: Cash Price |
$265.60
|
Rate for Payer: Cash Price |
$265.60
|
Rate for Payer: Cofinity Commercial |
$232.40
|
Rate for Payer: Cofinity Commercial |
$285.52
|
Rate for Payer: Encore Health Key Benefits Commercial |
$265.60
|
Rate for Payer: Healthscope Commercial |
$298.80
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.40
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.20
|
Rate for Payer: PHP Commercial |
$282.20
|
Rate for Payer: Priority Health Cigna Priority Health |
$232.40
|
Rate for Payer: Priority Health SBD |
$209.16
|
Rate for Payer: UMR Bronson Commercial |
$122.84
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.00
|
|
HC COMP BURN GARM BDY BRF SLVD LE
|
Facility
|
IP
|
$332.00
|
|
Service Code
|
HCPCS A6510
|
Hospital Charge Code |
98300146
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$146.08 |
Max. Negotiated Rate |
$298.80 |
Rate for Payer: Aetna American Axle |
$215.80
|
Rate for Payer: Aetna Commercial |
$282.20
|
Rate for Payer: Aetna New Business (MI Preferred) |
$215.80
|
Rate for Payer: Cash Price |
$265.60
|
Rate for Payer: Cofinity Commercial |
$232.40
|
Rate for Payer: Cofinity Commercial |
$285.52
|
Rate for Payer: Encore Health Key Benefits Commercial |
$265.60
|
Rate for Payer: Healthscope Commercial |
$298.80
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.40
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.20
|
Rate for Payer: PHP Commercial |
$282.20
|
Rate for Payer: Priority Health Cigna Priority Health |
$232.40
|
Rate for Payer: Priority Health SBD |
$209.16
|
Rate for Payer: UMR Bronson Commercial |
$146.08
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.00
|
|
HC COMP BURN GARM BELLY BAND
|
Facility
|
IP
|
$40.00
|
|
Service Code
|
HCPCS A6512
|
Hospital Charge Code |
98300147
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$17.60 |
Max. Negotiated Rate |
$36.00 |
Rate for Payer: Aetna American Axle |
$26.00
|
Rate for Payer: Aetna Commercial |
$34.00
|
Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
Rate for Payer: Cash Price |
$32.00
|
Rate for Payer: Cofinity Commercial |
$28.00
|
Rate for Payer: Cofinity Commercial |
$34.40
|
Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
Rate for Payer: Healthscope Commercial |
$36.00
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.00
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
Rate for Payer: PHP Commercial |
$34.00
|
Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
Rate for Payer: Priority Health SBD |
$25.20
|
Rate for Payer: UMR Bronson Commercial |
$17.60
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
HC COMP BURN GARM BELLY BAND
|
Facility
|
OP
|
$40.00
|
|
Service Code
|
HCPCS A6512
|
Hospital Charge Code |
98300147
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$14.80 |
Max. Negotiated Rate |
$496.69 |
Rate for Payer: Aetna American Axle |
$26.00
|
Rate for Payer: Aetna Commercial |
$34.00
|
Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
Rate for Payer: BCBS Complete |
$16.00
|
Rate for Payer: BCBS Trust/PPO |
$496.69
|
Rate for Payer: Cash Price |
$32.00
|
Rate for Payer: Cash Price |
$32.00
|
Rate for Payer: Cofinity Commercial |
$28.00
|
Rate for Payer: Cofinity Commercial |
$34.40
|
Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
Rate for Payer: Healthscope Commercial |
$36.00
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.00
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
Rate for Payer: PHP Commercial |
$34.00
|
Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
Rate for Payer: Priority Health SBD |
$25.20
|
Rate for Payer: UMR Bronson Commercial |
$14.80
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
HC COMP BURN GARM BODY BRF SLEEVE
|
Facility
|
OP
|
$236.00
|
|
Service Code
|
HCPCS A6512
|
Hospital Charge Code |
98300148
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$87.32 |
Max. Negotiated Rate |
$496.69 |
Rate for Payer: Aetna American Axle |
$153.40
|
Rate for Payer: Aetna Commercial |
$200.60
|
Rate for Payer: Aetna New Business (MI Preferred) |
$153.40
|
Rate for Payer: BCBS Complete |
$94.40
|
Rate for Payer: BCBS Trust/PPO |
$496.69
|
Rate for Payer: Cash Price |
$188.80
|
Rate for Payer: Cash Price |
$188.80
|
Rate for Payer: Cofinity Commercial |
$165.20
|
Rate for Payer: Cofinity Commercial |
$202.96
|
Rate for Payer: Encore Health Key Benefits Commercial |
$188.80
|
Rate for Payer: Healthscope Commercial |
$212.40
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.20
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.60
|
Rate for Payer: PHP Commercial |
$200.60
|
Rate for Payer: Priority Health Cigna Priority Health |
$165.20
|
Rate for Payer: Priority Health SBD |
$148.68
|
Rate for Payer: UMR Bronson Commercial |
$87.32
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.00
|
|
HC COMP BURN GARM BODY BRF SLEEVE
|
Facility
|
IP
|
$236.00
|
|
Service Code
|
HCPCS A6512
|
Hospital Charge Code |
98300148
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$103.84 |
Max. Negotiated Rate |
$212.40 |
Rate for Payer: Aetna American Axle |
$153.40
|
Rate for Payer: Aetna Commercial |
$200.60
|
Rate for Payer: Aetna New Business (MI Preferred) |
$153.40
|
Rate for Payer: Cash Price |
$188.80
|
Rate for Payer: Cofinity Commercial |
$165.20
|
Rate for Payer: Cofinity Commercial |
$202.96
|
Rate for Payer: Encore Health Key Benefits Commercial |
$188.80
|
Rate for Payer: Healthscope Commercial |
$212.40
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.20
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.60
|
Rate for Payer: PHP Commercial |
$200.60
|
Rate for Payer: Priority Health Cigna Priority Health |
$165.20
|
Rate for Payer: Priority Health SBD |
$148.68
|
Rate for Payer: UMR Bronson Commercial |
$103.84
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.00
|
|
HC COMP BURN GARM BRF 2 LEGS ABV
|
Facility
|
OP
|
$150.00
|
|
Service Code
|
HCPCS A6512
|
Hospital Charge Code |
98300149
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$55.50 |
Max. Negotiated Rate |
$496.69 |
Rate for Payer: Aetna American Axle |
$97.50
|
Rate for Payer: Aetna Commercial |
$127.50
|
Rate for Payer: Aetna New Business (MI Preferred) |
$97.50
|
Rate for Payer: BCBS Complete |
$60.00
|
Rate for Payer: BCBS Trust/PPO |
$496.69
|
Rate for Payer: Cash Price |
$120.00
|
Rate for Payer: Cash Price |
$120.00
|
Rate for Payer: Cofinity Commercial |
$105.00
|
Rate for Payer: Cofinity Commercial |
$129.00
|
Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
Rate for Payer: Healthscope Commercial |
$135.00
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.00
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
Rate for Payer: PHP Commercial |
$127.50
|
Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
Rate for Payer: Priority Health SBD |
$94.50
|
Rate for Payer: UMR Bronson Commercial |
$55.50
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.50
|
|
HC COMP BURN GARM BRF 2 LEGS ABV
|
Facility
|
IP
|
$150.00
|
|
Service Code
|
HCPCS A6512
|
Hospital Charge Code |
98300149
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$66.00 |
Max. Negotiated Rate |
$135.00 |
Rate for Payer: Aetna American Axle |
$97.50
|
Rate for Payer: Aetna Commercial |
$127.50
|
Rate for Payer: Aetna New Business (MI Preferred) |
$97.50
|
Rate for Payer: Cash Price |
$120.00
|
Rate for Payer: Cofinity Commercial |
$105.00
|
Rate for Payer: Cofinity Commercial |
$129.00
|
Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
Rate for Payer: Healthscope Commercial |
$135.00
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.00
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
Rate for Payer: PHP Commercial |
$127.50
|
Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
Rate for Payer: Priority Health SBD |
$94.50
|
Rate for Payer: UMR Bronson Commercial |
$66.00
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.50
|
|
HC COMP BURN GARM BRF&CHAP,LG-MID
|
Facility
|
OP
|
$132.00
|
|
Service Code
|
HCPCS A6512
|
Hospital Charge Code |
98300150
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$48.84 |
Max. Negotiated Rate |
$496.69 |
Rate for Payer: Aetna American Axle |
$85.80
|
Rate for Payer: Aetna Commercial |
$112.20
|
Rate for Payer: Aetna New Business (MI Preferred) |
$85.80
|
Rate for Payer: BCBS Complete |
$52.80
|
Rate for Payer: BCBS Trust/PPO |
$496.69
|
Rate for Payer: Cash Price |
$105.60
|
Rate for Payer: Cash Price |
$105.60
|
Rate for Payer: Cofinity Commercial |
$113.52
|
Rate for Payer: Cofinity Commercial |
$92.40
|
Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
Rate for Payer: Healthscope Commercial |
$118.80
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.40
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.20
|
Rate for Payer: PHP Commercial |
$112.20
|
Rate for Payer: Priority Health Cigna Priority Health |
$92.40
|
Rate for Payer: Priority Health SBD |
$83.16
|
Rate for Payer: UMR Bronson Commercial |
$48.84
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.00
|
|
HC COMP BURN GARM BRF&CHAP,LG-MID
|
Facility
|
IP
|
$132.00
|
|
Service Code
|
HCPCS A6512
|
Hospital Charge Code |
98300150
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$58.08 |
Max. Negotiated Rate |
$118.80 |
Rate for Payer: Aetna American Axle |
$85.80
|
Rate for Payer: Aetna Commercial |
$112.20
|
Rate for Payer: Aetna New Business (MI Preferred) |
$85.80
|
Rate for Payer: Cash Price |
$105.60
|
Rate for Payer: Cofinity Commercial |
$113.52
|
Rate for Payer: Cofinity Commercial |
$92.40
|
Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
Rate for Payer: Healthscope Commercial |
$118.80
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.40
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.20
|
Rate for Payer: PHP Commercial |
$112.20
|
Rate for Payer: Priority Health Cigna Priority Health |
$92.40
|
Rate for Payer: Priority Health SBD |
$83.16
|
Rate for Payer: UMR Bronson Commercial |
$58.08
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.00
|
|
HC COMP BURN GARM BRIEF
|
Facility
|
IP
|
$132.00
|
|
Service Code
|
HCPCS A6511
|
Hospital Charge Code |
98300151
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$58.08 |
Max. Negotiated Rate |
$118.80 |
Rate for Payer: Aetna American Axle |
$85.80
|
Rate for Payer: Aetna Commercial |
$112.20
|
Rate for Payer: Aetna New Business (MI Preferred) |
$85.80
|
Rate for Payer: Cash Price |
$105.60
|
Rate for Payer: Cofinity Commercial |
$113.52
|
Rate for Payer: Cofinity Commercial |
$92.40
|
Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
Rate for Payer: Healthscope Commercial |
$118.80
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.40
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.20
|
Rate for Payer: PHP Commercial |
$112.20
|
Rate for Payer: Priority Health Cigna Priority Health |
$92.40
|
Rate for Payer: Priority Health SBD |
$83.16
|
Rate for Payer: UMR Bronson Commercial |
$58.08
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.00
|
|
HC COMP BURN GARM BRIEF
|
Facility
|
OP
|
$132.00
|
|
Service Code
|
HCPCS A6511
|
Hospital Charge Code |
98300151
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$48.84 |
Max. Negotiated Rate |
$342.54 |
Rate for Payer: Aetna American Axle |
$85.80
|
Rate for Payer: Aetna Commercial |
$112.20
|
Rate for Payer: Aetna New Business (MI Preferred) |
$85.80
|
Rate for Payer: BCBS Complete |
$52.80
|
Rate for Payer: BCBS Trust/PPO |
$342.54
|
Rate for Payer: Cash Price |
$105.60
|
Rate for Payer: Cash Price |
$105.60
|
Rate for Payer: Cofinity Commercial |
$113.52
|
Rate for Payer: Cofinity Commercial |
$92.40
|
Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
Rate for Payer: Healthscope Commercial |
$118.80
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.40
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.20
|
Rate for Payer: PHP Commercial |
$112.20
|
Rate for Payer: Priority Health Cigna Priority Health |
$92.40
|
Rate for Payer: Priority Health SBD |
$83.16
|
Rate for Payer: UMR Bronson Commercial |
$48.84
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.00
|
|
HC COMP BURN GARM CHIN STRAP REGU
|
Facility
|
IP
|
$78.00
|
|
Service Code
|
HCPCS A6502
|
Hospital Charge Code |
98300152
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$34.32 |
Max. Negotiated Rate |
$70.20 |
Rate for Payer: Aetna American Axle |
$50.70
|
Rate for Payer: Aetna Commercial |
$66.30
|
Rate for Payer: Aetna New Business (MI Preferred) |
$50.70
|
Rate for Payer: Cash Price |
$62.40
|
Rate for Payer: Cofinity Commercial |
$54.60
|
Rate for Payer: Cofinity Commercial |
$67.08
|
Rate for Payer: Encore Health Key Benefits Commercial |
$62.40
|
Rate for Payer: Healthscope Commercial |
$70.20
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.60
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.30
|
Rate for Payer: PHP Commercial |
$66.30
|
Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
Rate for Payer: Priority Health SBD |
$49.14
|
Rate for Payer: UMR Bronson Commercial |
$34.32
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.50
|
|
HC COMP BURN GARM CHIN STRAP REGU
|
Facility
|
OP
|
$78.00
|
|
Service Code
|
HCPCS A6502
|
Hospital Charge Code |
98300152
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$28.86 |
Max. Negotiated Rate |
$205.53 |
Rate for Payer: Aetna American Axle |
$50.70
|
Rate for Payer: Aetna Commercial |
$66.30
|
Rate for Payer: Aetna New Business (MI Preferred) |
$50.70
|
Rate for Payer: BCBS Complete |
$31.20
|
Rate for Payer: BCBS Trust/PPO |
$205.53
|
Rate for Payer: Cash Price |
$62.40
|
Rate for Payer: Cash Price |
$62.40
|
Rate for Payer: Cofinity Commercial |
$54.60
|
Rate for Payer: Cofinity Commercial |
$67.08
|
Rate for Payer: Encore Health Key Benefits Commercial |
$62.40
|
Rate for Payer: Healthscope Commercial |
$70.20
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.60
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.30
|
Rate for Payer: PHP Commercial |
$66.30
|
Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
Rate for Payer: Priority Health SBD |
$49.14
|
Rate for Payer: UMR Bronson Commercial |
$28.86
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.50
|
|
HC COMP BURN GARM CHIN STRP W LIP
|
Facility
|
IP
|
$78.00
|
|
Service Code
|
HCPCS A6502
|
Hospital Charge Code |
98300153
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$34.32 |
Max. Negotiated Rate |
$70.20 |
Rate for Payer: Aetna American Axle |
$50.70
|
Rate for Payer: Aetna Commercial |
$66.30
|
Rate for Payer: Aetna New Business (MI Preferred) |
$50.70
|
Rate for Payer: Cash Price |
$62.40
|
Rate for Payer: Cofinity Commercial |
$54.60
|
Rate for Payer: Cofinity Commercial |
$67.08
|
Rate for Payer: Encore Health Key Benefits Commercial |
$62.40
|
Rate for Payer: Healthscope Commercial |
$70.20
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.60
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.30
|
Rate for Payer: PHP Commercial |
$66.30
|
Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
Rate for Payer: Priority Health SBD |
$49.14
|
Rate for Payer: UMR Bronson Commercial |
$34.32
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.50
|
|
HC COMP BURN GARM CHIN STRP W LIP
|
Facility
|
OP
|
$78.00
|
|
Service Code
|
HCPCS A6502
|
Hospital Charge Code |
98300153
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$28.86 |
Max. Negotiated Rate |
$205.53 |
Rate for Payer: Aetna American Axle |
$50.70
|
Rate for Payer: Aetna Commercial |
$66.30
|
Rate for Payer: Aetna New Business (MI Preferred) |
$50.70
|
Rate for Payer: BCBS Complete |
$31.20
|
Rate for Payer: BCBS Trust/PPO |
$205.53
|
Rate for Payer: Cash Price |
$62.40
|
Rate for Payer: Cash Price |
$62.40
|
Rate for Payer: Cofinity Commercial |
$54.60
|
Rate for Payer: Cofinity Commercial |
$67.08
|
Rate for Payer: Encore Health Key Benefits Commercial |
$62.40
|
Rate for Payer: Healthscope Commercial |
$70.20
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.60
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.30
|
Rate for Payer: PHP Commercial |
$66.30
|
Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
Rate for Payer: Priority Health SBD |
$49.14
|
Rate for Payer: UMR Bronson Commercial |
$28.86
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.50
|
|
HC COMP BURN GARM COLLAR FOAM
|
Facility
|
IP
|
$40.00
|
|
Service Code
|
HCPCS A6512
|
Hospital Charge Code |
98300154
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$17.60 |
Max. Negotiated Rate |
$36.00 |
Rate for Payer: Aetna American Axle |
$26.00
|
Rate for Payer: Aetna Commercial |
$34.00
|
Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
Rate for Payer: Cash Price |
$32.00
|
Rate for Payer: Cofinity Commercial |
$28.00
|
Rate for Payer: Cofinity Commercial |
$34.40
|
Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
Rate for Payer: Healthscope Commercial |
$36.00
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.00
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
Rate for Payer: PHP Commercial |
$34.00
|
Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
Rate for Payer: Priority Health SBD |
$25.20
|
Rate for Payer: UMR Bronson Commercial |
$17.60
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
HC COMP BURN GARM COLLAR FOAM
|
Facility
|
OP
|
$40.00
|
|
Service Code
|
HCPCS A6512
|
Hospital Charge Code |
98300154
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$14.80 |
Max. Negotiated Rate |
$496.69 |
Rate for Payer: Aetna American Axle |
$26.00
|
Rate for Payer: Aetna Commercial |
$34.00
|
Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
Rate for Payer: BCBS Complete |
$16.00
|
Rate for Payer: BCBS Trust/PPO |
$496.69
|
Rate for Payer: Cash Price |
$32.00
|
Rate for Payer: Cash Price |
$32.00
|
Rate for Payer: Cofinity Commercial |
$28.00
|
Rate for Payer: Cofinity Commercial |
$34.40
|
Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
Rate for Payer: Healthscope Commercial |
$36.00
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.00
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
Rate for Payer: PHP Commercial |
$34.00
|
Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
Rate for Payer: Priority Health SBD |
$25.20
|
Rate for Payer: UMR Bronson Commercial |
$14.80
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
HC COMP BURN GARM COLLAR PILLOW
|
Facility
|
IP
|
$68.00
|
|
Service Code
|
HCPCS A6512
|
Hospital Charge Code |
98300155
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$29.92 |
Max. Negotiated Rate |
$61.20 |
Rate for Payer: Aetna American Axle |
$44.20
|
Rate for Payer: Aetna Commercial |
$57.80
|
Rate for Payer: Aetna New Business (MI Preferred) |
$44.20
|
Rate for Payer: Cash Price |
$54.40
|
Rate for Payer: Cofinity Commercial |
$47.60
|
Rate for Payer: Cofinity Commercial |
$58.48
|
Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
Rate for Payer: Healthscope Commercial |
$61.20
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.60
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
Rate for Payer: PHP Commercial |
$57.80
|
Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
Rate for Payer: Priority Health SBD |
$42.84
|
Rate for Payer: UMR Bronson Commercial |
$29.92
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.00
|
|
HC COMP BURN GARM COLLAR PILLOW
|
Facility
|
OP
|
$68.00
|
|
Service Code
|
HCPCS A6512
|
Hospital Charge Code |
98300155
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$25.16 |
Max. Negotiated Rate |
$496.69 |
Rate for Payer: Aetna American Axle |
$44.20
|
Rate for Payer: Aetna Commercial |
$57.80
|
Rate for Payer: Aetna New Business (MI Preferred) |
$44.20
|
Rate for Payer: BCBS Complete |
$27.20
|
Rate for Payer: BCBS Trust/PPO |
$496.69
|
Rate for Payer: Cash Price |
$54.40
|
Rate for Payer: Cash Price |
$54.40
|
Rate for Payer: Cofinity Commercial |
$47.60
|
Rate for Payer: Cofinity Commercial |
$58.48
|
Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
Rate for Payer: Healthscope Commercial |
$61.20
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.60
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
Rate for Payer: PHP Commercial |
$57.80
|
Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
Rate for Payer: Priority Health SBD |
$42.84
|
Rate for Payer: UMR Bronson Commercial |
$25.16
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.00
|
|
HC COMP BURN GARM COLLAR TRACH
|
Facility
|
OP
|
$40.00
|
|
Service Code
|
HCPCS A6512
|
Hospital Charge Code |
98300156
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$14.80 |
Max. Negotiated Rate |
$496.69 |
Rate for Payer: Aetna American Axle |
$26.00
|
Rate for Payer: Aetna Commercial |
$34.00
|
Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
Rate for Payer: BCBS Complete |
$16.00
|
Rate for Payer: BCBS Trust/PPO |
$496.69
|
Rate for Payer: Cash Price |
$32.00
|
Rate for Payer: Cash Price |
$32.00
|
Rate for Payer: Cofinity Commercial |
$28.00
|
Rate for Payer: Cofinity Commercial |
$34.40
|
Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
Rate for Payer: Healthscope Commercial |
$36.00
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.00
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
Rate for Payer: PHP Commercial |
$34.00
|
Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
Rate for Payer: Priority Health SBD |
$25.20
|
Rate for Payer: UMR Bronson Commercial |
$14.80
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
HC COMP BURN GARM COLLAR TRACH
|
Facility
|
IP
|
$40.00
|
|
Service Code
|
HCPCS A6512
|
Hospital Charge Code |
98300156
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$17.60 |
Max. Negotiated Rate |
$36.00 |
Rate for Payer: Aetna American Axle |
$26.00
|
Rate for Payer: Aetna Commercial |
$34.00
|
Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
Rate for Payer: Cash Price |
$32.00
|
Rate for Payer: Cofinity Commercial |
$28.00
|
Rate for Payer: Cofinity Commercial |
$34.40
|
Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
Rate for Payer: Healthscope Commercial |
$36.00
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.00
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
Rate for Payer: PHP Commercial |
$34.00
|
Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
Rate for Payer: Priority Health SBD |
$25.20
|
Rate for Payer: UMR Bronson Commercial |
$17.60
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
HC COMP BURN GARM ELECTIVE ALTERA
|
Facility
|
IP
|
$20.00
|
|
Service Code
|
HCPCS A6512
|
Hospital Charge Code |
98300157
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$8.80 |
Max. Negotiated Rate |
$18.00 |
Rate for Payer: Aetna American Axle |
$13.00
|
Rate for Payer: Aetna Commercial |
$17.00
|
Rate for Payer: Aetna New Business (MI Preferred) |
$13.00
|
Rate for Payer: Cash Price |
$16.00
|
Rate for Payer: Cofinity Commercial |
$17.20
|
Rate for Payer: Cofinity Commercial |
$14.00
|
Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
Rate for Payer: Healthscope Commercial |
$18.00
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.00
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.00
|
Rate for Payer: PHP Commercial |
$17.00
|
Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
Rate for Payer: Priority Health SBD |
$12.60
|
Rate for Payer: UMR Bronson Commercial |
$8.80
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
HC COMP BURN GARM ELECTIVE ALTERA
|
Facility
|
OP
|
$20.00
|
|
Service Code
|
HCPCS A6512
|
Hospital Charge Code |
98300157
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$7.40 |
Max. Negotiated Rate |
$496.69 |
Rate for Payer: Aetna American Axle |
$13.00
|
Rate for Payer: Aetna Commercial |
$17.00
|
Rate for Payer: Aetna New Business (MI Preferred) |
$13.00
|
Rate for Payer: BCBS Complete |
$8.00
|
Rate for Payer: BCBS Trust/PPO |
$496.69
|
Rate for Payer: Cash Price |
$16.00
|
Rate for Payer: Cash Price |
$16.00
|
Rate for Payer: Cofinity Commercial |
$14.00
|
Rate for Payer: Cofinity Commercial |
$17.20
|
Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
Rate for Payer: Healthscope Commercial |
$18.00
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.00
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.00
|
Rate for Payer: PHP Commercial |
$17.00
|
Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
Rate for Payer: Priority Health SBD |
$12.60
|
Rate for Payer: UMR Bronson Commercial |
$7.40
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
HC COMP BURN GARM EXPANSION PANEL
|
Facility
|
OP
|
$28.00
|
|
Service Code
|
HCPCS A6512
|
Hospital Charge Code |
98300158
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$10.36 |
Max. Negotiated Rate |
$496.69 |
Rate for Payer: Aetna American Axle |
$18.20
|
Rate for Payer: Aetna Commercial |
$23.80
|
Rate for Payer: Aetna New Business (MI Preferred) |
$18.20
|
Rate for Payer: BCBS Complete |
$11.20
|
Rate for Payer: BCBS Trust/PPO |
$496.69
|
Rate for Payer: Cash Price |
$22.40
|
Rate for Payer: Cash Price |
$22.40
|
Rate for Payer: Cofinity Commercial |
$24.08
|
Rate for Payer: Cofinity Commercial |
$19.60
|
Rate for Payer: Encore Health Key Benefits Commercial |
$22.40
|
Rate for Payer: Healthscope Commercial |
$25.20
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.60
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.80
|
Rate for Payer: PHP Commercial |
$23.80
|
Rate for Payer: Priority Health Cigna Priority Health |
$19.60
|
Rate for Payer: Priority Health SBD |
$17.64
|
Rate for Payer: UMR Bronson Commercial |
$10.36
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.00
|
|