|
HC COMP BURN GARM HOOK&LOOP TAB S
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Aetna American Axle |
$5.20
|
| Rate for Payer: Aetna Commercial |
$6.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.20
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS Trust/PPO |
$496.69
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$6.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.40
|
| Rate for Payer: Healthscope Commercial |
$7.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.80
|
| Rate for Payer: PHP Commercial |
$6.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
| Rate for Payer: Priority Health SBD |
$5.04
|
| Rate for Payer: UMR Bronson Commercial |
$2.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.00
|
|
|
HC COMP BURN GARM HOOK&LOOP TAB S
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Aetna American Axle |
$5.20
|
| Rate for Payer: Aetna Commercial |
$6.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.20
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$6.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.40
|
| Rate for Payer: Healthscope Commercial |
$7.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.80
|
| Rate for Payer: PHP Commercial |
$6.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
| Rate for Payer: Priority Health SBD |
$5.04
|
| Rate for Payer: UMR Bronson Commercial |
$3.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.00
|
|
|
HC COMP BURN GARM LEG&CHAP TO WAI
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300036
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.96 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Aetna American Axle |
$135.20
|
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.20
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: BCBS Trust/PPO |
$496.69
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.80
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health SBD |
$131.04
|
| Rate for Payer: UMR Bronson Commercial |
$76.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.00
|
|
|
HC COMP BURN GARM LEG&CHAP TO WAI
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300036
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$91.52 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna American Axle |
$135.20
|
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.20
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.80
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health SBD |
$131.04
|
| Rate for Payer: UMR Bronson Commercial |
$91.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.00
|
|
|
HC COMP BURN GARM LEG & PANTY
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$97.68 |
| Max. Negotiated Rate |
$199.80 |
| Rate for Payer: Aetna American Axle |
$144.30
|
| Rate for Payer: Aetna Commercial |
$188.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.30
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cofinity Commercial |
$155.40
|
| Rate for Payer: Cofinity Commercial |
$190.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.60
|
| Rate for Payer: Healthscope Commercial |
$199.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.70
|
| Rate for Payer: PHP Commercial |
$188.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.40
|
| Rate for Payer: Priority Health SBD |
$139.86
|
| Rate for Payer: UMR Bronson Commercial |
$97.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.50
|
|
|
HC COMP BURN GARM LEG & PANTY
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.14 |
| Max. Negotiated Rate |
$342.54 |
| Rate for Payer: Aetna American Axle |
$144.30
|
| Rate for Payer: Aetna Commercial |
$188.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.30
|
| Rate for Payer: BCBS Complete |
$88.80
|
| Rate for Payer: BCBS Trust/PPO |
$342.54
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cofinity Commercial |
$190.92
|
| Rate for Payer: Cofinity Commercial |
$155.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.60
|
| Rate for Payer: Healthscope Commercial |
$199.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.70
|
| Rate for Payer: PHP Commercial |
$188.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.40
|
| Rate for Payer: Priority Health SBD |
$139.86
|
| Rate for Payer: UMR Bronson Commercial |
$82.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.50
|
|
|
HC COMP BURN GARM LINING,POCKET,F
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300037
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Aetna American Axle |
$7.80
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.80
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS Trust/PPO |
$496.69
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.20
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
| Rate for Payer: Priority Health SBD |
$7.56
|
| Rate for Payer: UMR Bronson Commercial |
$4.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
HC COMP BURN GARM LINING,POCKET,F
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300037
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna American Axle |
$7.80
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.20
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
| Rate for Payer: Priority Health SBD |
$7.56
|
| Rate for Payer: UMR Bronson Commercial |
$5.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
HC COMP BURN GARM MITTEN TO WRIST
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300038
|
|
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 MITTEN TO WRIST
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300038
|
|
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 POCKET & PAD CO
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300039
|
|
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 |
$9.80
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| 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
|
|
|
HC COMP BURN GARM POCKET & PAD CO
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300039
|
|
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 REINFORCEMENTS
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna American Axle |
$7.80
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.20
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
| Rate for Payer: Priority Health SBD |
$7.56
|
| Rate for Payer: UMR Bronson Commercial |
$5.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
HC COMP BURN GARM REINFORCEMENTS
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Aetna American Axle |
$7.80
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.80
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS Trust/PPO |
$496.69
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.20
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
| Rate for Payer: Priority Health SBD |
$7.56
|
| Rate for Payer: UMR Bronson Commercial |
$4.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
HC COMP BURN GARM REINF SET HK&LO
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna American Axle |
$6.50
|
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.50
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$7.00
|
| Rate for Payer: Cofinity Commercial |
$8.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.00
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.50
|
| Rate for Payer: PHP Commercial |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health SBD |
$6.30
|
| Rate for Payer: UMR Bronson Commercial |
$4.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.50
|
|
|
HC COMP BURN GARM REINF SET HK&LO
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Aetna American Axle |
$6.50
|
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.50
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS Trust/PPO |
$496.69
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$7.00
|
| Rate for Payer: Cofinity Commercial |
$8.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.00
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.50
|
| Rate for Payer: PHP Commercial |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health SBD |
$6.30
|
| Rate for Payer: UMR Bronson Commercial |
$3.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.50
|
|
|
HC COMP BURN GARM SHOULD FLAP REG
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300042
|
|
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 SHOULD FLAP REG
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300042
|
|
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 |
$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 |
$12.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.50
|
|
|
HC COMP BURN GARM SILON-TEX P/D-G
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Aetna American Axle |
$39.00
|
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.00
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS Trust/PPO |
$496.69
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Cofinity Commercial |
$42.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health SBD |
$37.80
|
| Rate for Payer: UMR Bronson Commercial |
$22.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC COMP BURN GARM SILON-TEX P/D-G
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna American Axle |
$39.00
|
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$42.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health SBD |
$37.80
|
| Rate for Payer: UMR Bronson Commercial |
$26.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC COMP BURN GARM SILON-TEX UP TO
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Aetna American Axle |
$23.40
|
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.40
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS Trust/PPO |
$496.69
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$25.20
|
| Rate for Payer: Cofinity Commercial |
$30.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.80
|
| Rate for Payer: Healthscope Commercial |
$32.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.60
|
| Rate for Payer: PHP Commercial |
$30.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.20
|
| Rate for Payer: Priority Health SBD |
$22.68
|
| Rate for Payer: UMR Bronson Commercial |
$13.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.00
|
|
|
HC COMP BURN GARM SILON-TEX UP TO
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna American Axle |
$23.40
|
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$25.20
|
| Rate for Payer: Cofinity Commercial |
$30.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.80
|
| Rate for Payer: Healthscope Commercial |
$32.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.60
|
| Rate for Payer: PHP Commercial |
$30.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.20
|
| Rate for Payer: Priority Health SBD |
$22.68
|
| Rate for Payer: UMR Bronson Commercial |
$15.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.00
|
|
|
HC COMP BURN GARM SILON-TEX WHOL
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300046
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna American Axle |
$54.60
|
| Rate for Payer: Aetna Commercial |
$71.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.60
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cofinity Commercial |
$58.80
|
| Rate for Payer: Cofinity Commercial |
$72.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.20
|
| Rate for Payer: Healthscope Commercial |
$75.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.40
|
| Rate for Payer: PHP Commercial |
$71.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.80
|
| Rate for Payer: Priority Health SBD |
$52.92
|
| Rate for Payer: UMR Bronson Commercial |
$36.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.00
|
|
|
HC COMP BURN GARM SILON-TEX WHOL
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300046
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Aetna American Axle |
$54.60
|
| Rate for Payer: Aetna Commercial |
$71.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.60
|
| Rate for Payer: BCBS Complete |
$33.60
|
| Rate for Payer: BCBS Trust/PPO |
$496.69
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cofinity Commercial |
$58.80
|
| Rate for Payer: Cofinity Commercial |
$72.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.20
|
| Rate for Payer: Healthscope Commercial |
$75.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.40
|
| Rate for Payer: PHP Commercial |
$71.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.80
|
| Rate for Payer: Priority Health SBD |
$52.92
|
| Rate for Payer: UMR Bronson Commercial |
$31.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.00
|
|
|
HC COMP BURN GARM SLEEVE WRIST/AX
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300047
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna American Axle |
$45.50
|
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health SBD |
$44.10
|
| Rate for Payer: UMR Bronson Commercial |
$30.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
