|
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
|
|
|
HC COMP BURN GARM FACE MASK
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
HCPCS A6503
|
| Hospital Charge Code |
98300159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$58.96 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna American Axle |
$87.10
|
| Rate for Payer: Aetna Commercial |
$113.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.10
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cofinity Commercial |
$115.24
|
| Rate for Payer: Cofinity Commercial |
$93.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.20
|
| Rate for Payer: Healthscope Commercial |
$120.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.90
|
| Rate for Payer: PHP Commercial |
$113.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.80
|
| Rate for Payer: Priority Health SBD |
$84.42
|
| Rate for Payer: UMR Bronson Commercial |
$58.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.50
|
|
|
HC COMP BURN GARM FACE MASK
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
HCPCS A6503
|
| Hospital Charge Code |
98300159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.58 |
| Max. Negotiated Rate |
$319.71 |
| Rate for Payer: Aetna American Axle |
$87.10
|
| Rate for Payer: Aetna Commercial |
$113.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.10
|
| Rate for Payer: BCBS Complete |
$53.60
|
| Rate for Payer: BCBS Trust/PPO |
$319.71
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cofinity Commercial |
$115.24
|
| Rate for Payer: Cofinity Commercial |
$93.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.20
|
| Rate for Payer: Healthscope Commercial |
$120.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.90
|
| Rate for Payer: PHP Commercial |
$113.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.80
|
| Rate for Payer: Priority Health SBD |
$84.42
|
| Rate for Payer: UMR Bronson Commercial |
$49.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.50
|
|
|
HC COMP BURN GARM FOOT GAUNTLET
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300160
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Aetna American Axle |
$22.10
|
| Rate for Payer: Aetna Commercial |
$28.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.10
|
| Rate for Payer: BCBS Complete |
$13.60
|
| Rate for Payer: BCBS Trust/PPO |
$496.69
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$29.24
|
| Rate for Payer: Cofinity Commercial |
$23.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.20
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.90
|
| Rate for Payer: PHP Commercial |
$28.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.80
|
| Rate for Payer: Priority Health SBD |
$21.42
|
| Rate for Payer: UMR Bronson Commercial |
$12.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.50
|
|
|
HC COMP BURN GARM FOOT GAUNTLET
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300160
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna American Axle |
$22.10
|
| Rate for Payer: Aetna Commercial |
$28.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.10
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$23.80
|
| Rate for Payer: Cofinity Commercial |
$29.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.20
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.90
|
| Rate for Payer: PHP Commercial |
$28.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.80
|
| Rate for Payer: Priority Health SBD |
$21.42
|
| Rate for Payer: UMR Bronson Commercial |
$14.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.50
|
|
|
HC COMP BURN GARM FOOT GLOVE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna American Axle |
$71.50
|
| Rate for Payer: Aetna Commercial |
$93.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.50
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$94.60
|
| Rate for Payer: Cofinity Commercial |
$77.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.00
|
| Rate for Payer: Healthscope Commercial |
$99.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.50
|
| Rate for Payer: PHP Commercial |
$93.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: Priority Health SBD |
$69.30
|
| Rate for Payer: UMR Bronson Commercial |
$48.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.50
|
|
|
HC COMP BURN GARM FOOT GLOVE
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Aetna American Axle |
$71.50
|
| Rate for Payer: Aetna Commercial |
$93.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.50
|
| Rate for Payer: BCBS Complete |
$44.00
|
| Rate for Payer: BCBS Trust/PPO |
$496.69
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$77.00
|
| Rate for Payer: Cofinity Commercial |
$94.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.00
|
| Rate for Payer: Healthscope Commercial |
$99.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.50
|
| Rate for Payer: PHP Commercial |
$93.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: Priority Health SBD |
$69.30
|
| Rate for Payer: UMR Bronson Commercial |
$40.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.50
|
|
|
HC COMP BURN GARM FOOT MITTEN
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna American Axle |
$58.50
|
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.50
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$63.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health SBD |
$56.70
|
| Rate for Payer: UMR Bronson Commercial |
$39.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.50
|
|
|
HC COMP BURN GARM FOOT MITTEN
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Aetna American Axle |
$58.50
|
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.50
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS Trust/PPO |
$496.69
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Cofinity Commercial |
$63.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health SBD |
$56.70
|
| Rate for Payer: UMR Bronson Commercial |
$33.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.50
|
|
|
HC COMP BURN GARM FULLY LINED GAR
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna American Axle |
$0.65
|
| Rate for Payer: Aetna Commercial |
$0.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.65
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.70
|
| Rate for Payer: Cofinity Commercial |
$0.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.80
|
| Rate for Payer: Healthscope Commercial |
$0.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.85
|
| Rate for Payer: PHP Commercial |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: Priority Health SBD |
$0.63
|
| Rate for Payer: UMR Bronson Commercial |
$0.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.75
|
|
|
HC COMP BURN GARM FULLY LINED GAR
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Aetna American Axle |
$0.65
|
| Rate for Payer: Aetna Commercial |
$0.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.65
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS Trust/PPO |
$496.69
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.70
|
| Rate for Payer: Cofinity Commercial |
$0.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.80
|
| Rate for Payer: Healthscope Commercial |
$0.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.85
|
| Rate for Payer: PHP Commercial |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: Priority Health SBD |
$0.63
|
| Rate for Payer: UMR Bronson Commercial |
$0.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.75
|
|
|
HC COMP BURN GARM GAUNTLET TO AXI
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.04 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Aetna American Axle |
$59.80
|
| Rate for Payer: Aetna Commercial |
$78.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.80
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: BCBS Trust/PPO |
$496.69
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$79.12
|
| Rate for Payer: Cofinity Commercial |
$64.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.60
|
| Rate for Payer: Healthscope Commercial |
$82.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.20
|
| Rate for Payer: PHP Commercial |
$78.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.40
|
| Rate for Payer: Priority Health SBD |
$57.96
|
| Rate for Payer: UMR Bronson Commercial |
$34.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.00
|
|
|
HC COMP BURN GARM GAUNTLET TO AXI
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.48 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna American Axle |
$59.80
|
| Rate for Payer: Aetna Commercial |
$78.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.80
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$64.40
|
| Rate for Payer: Cofinity Commercial |
$79.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.60
|
| Rate for Payer: Healthscope Commercial |
$82.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.20
|
| Rate for Payer: PHP Commercial |
$78.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.40
|
| Rate for Payer: Priority Health SBD |
$57.96
|
| Rate for Payer: UMR Bronson Commercial |
$40.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.00
|
|
|
HC COMP BURN GARM GAUNTLET TO WRI
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300028
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Aetna American Axle |
$22.75
|
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.75
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS Trust/PPO |
$496.69
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.75
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health SBD |
$22.05
|
| Rate for Payer: UMR Bronson Commercial |
$12.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
HC COMP BURN GARM GAUNTLET TO WRI
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300028
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna American Axle |
$22.75
|
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.75
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.75
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health SBD |
$22.05
|
| Rate for Payer: UMR Bronson Commercial |
$15.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
HC COMP BURN GARM GLOVE-ELBOW
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS A6505
|
| Hospital Charge Code |
98300030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$456.72 |
| Rate for Payer: Aetna American Axle |
$104.00
|
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$456.72
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
| Rate for Payer: UMR Bronson Commercial |
$59.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC COMP BURN GARM GLOVE-ELBOW
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS A6505
|
| Hospital Charge Code |
98300030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna American Axle |
$104.00
|
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
| Rate for Payer: UMR Bronson Commercial |
$70.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC COMP BURN GARM GLOVE TO AXILLA
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS A6506
|
| Hospital Charge Code |
98300029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$485.27 |
| Rate for Payer: Aetna American Axle |
$114.40
|
| Rate for Payer: Aetna Commercial |
$149.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.40
|
| Rate for Payer: BCBS Complete |
$70.40
|
| Rate for Payer: BCBS Trust/PPO |
$485.27
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Commercial |
$123.20
|
| Rate for Payer: Cofinity Commercial |
$151.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.80
|
| Rate for Payer: Healthscope Commercial |
$158.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.60
|
| Rate for Payer: PHP Commercial |
$149.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.20
|
| Rate for Payer: Priority Health SBD |
$110.88
|
| Rate for Payer: UMR Bronson Commercial |
$65.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.00
|
|
|
HC COMP BURN GARM GLOVE TO AXILLA
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS A6506
|
| Hospital Charge Code |
98300029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$77.44 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna American Axle |
$114.40
|
| Rate for Payer: Aetna Commercial |
$149.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.40
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Commercial |
$123.20
|
| Rate for Payer: Cofinity Commercial |
$151.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.80
|
| Rate for Payer: Healthscope Commercial |
$158.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.60
|
| Rate for Payer: PHP Commercial |
$149.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.20
|
| Rate for Payer: Priority Health SBD |
$110.88
|
| Rate for Payer: UMR Bronson Commercial |
$77.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.00
|
|
|
HC COMP BURN GARM GLOVE-WRIST
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS A6504
|
| Hospital Charge Code |
98300031
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna American Axle |
$71.50
|
| Rate for Payer: Aetna Commercial |
$93.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.50
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$77.00
|
| Rate for Payer: Cofinity Commercial |
$94.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.00
|
| Rate for Payer: Healthscope Commercial |
$99.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.50
|
| Rate for Payer: PHP Commercial |
$93.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: Priority Health SBD |
$69.30
|
| Rate for Payer: UMR Bronson Commercial |
$48.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.50
|
|
|
HC COMP BURN GARM GLOVE-WRIST
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS A6504
|
| Hospital Charge Code |
98300031
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$272.20 |
| Rate for Payer: Aetna American Axle |
$71.50
|
| Rate for Payer: Aetna Commercial |
$93.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.50
|
| Rate for Payer: BCBS Complete |
$44.00
|
| Rate for Payer: BCBS Trust/PPO |
$272.20
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$94.60
|
| Rate for Payer: Cofinity Commercial |
$77.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.00
|
| Rate for Payer: Healthscope Commercial |
$99.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.50
|
| Rate for Payer: PHP Commercial |
$93.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: Priority Health SBD |
$69.30
|
| Rate for Payer: UMR Bronson Commercial |
$40.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.50
|
|
|
HC COMP BURN GARM HEAD BAND
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300032
|
|
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 HEAD BAND
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300032
|
|
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 HOOK&LOOP SNAP
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna American Axle |
$9.10
|
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.10
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| Rate for Payer: Cofinity Commercial |
$9.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Healthscope Commercial |
$12.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.90
|
| Rate for Payer: PHP Commercial |
$11.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.80
|
| Rate for Payer: Priority Health SBD |
$8.82
|
| Rate for Payer: UMR Bronson Commercial |
$6.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.50
|
|
|
HC COMP BURN GARM HOOK&LOOP SNAP
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Aetna American Axle |
$9.10
|
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.10
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$496.69
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| Rate for Payer: Cofinity Commercial |
$9.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Healthscope Commercial |
$12.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.90
|
| Rate for Payer: PHP Commercial |
$11.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.80
|
| Rate for Payer: Priority Health SBD |
$8.82
|
| Rate for Payer: UMR Bronson Commercial |
$5.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.50
|
|
