|
HC COMP BURN GARM SUIT SLVD TWO LEGS
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
HCPCS A6501
|
| Hospital Charge Code |
98300060
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$178.34 |
| Max. Negotiated Rate |
$1,213.18 |
| Rate for Payer: Aetna American Axle |
$313.30
|
| Rate for Payer: Aetna Commercial |
$409.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.30
|
| Rate for Payer: BCBS Complete |
$192.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,213.18
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cofinity Commercial |
$414.52
|
| Rate for Payer: Cofinity Commercial |
$337.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.60
|
| Rate for Payer: Healthscope Commercial |
$433.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$409.70
|
| Rate for Payer: PHP Commercial |
$409.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.40
|
| Rate for Payer: Priority Health SBD |
$303.66
|
| Rate for Payer: UMR Bronson Commercial |
$178.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.50
|
|
|
HC COMP BURN GARM SUIT SLVD TWO LEGS
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
HCPCS A6501
|
| Hospital Charge Code |
98300060
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$212.08 |
| Max. Negotiated Rate |
$433.80 |
| Rate for Payer: Aetna American Axle |
$313.30
|
| Rate for Payer: Aetna Commercial |
$409.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.30
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cofinity Commercial |
$337.40
|
| Rate for Payer: Cofinity Commercial |
$414.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.60
|
| Rate for Payer: Healthscope Commercial |
$433.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$409.70
|
| Rate for Payer: PHP Commercial |
$409.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.40
|
| Rate for Payer: Priority Health SBD |
$303.66
|
| Rate for Payer: UMR Bronson Commercial |
$212.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.50
|
|
|
HC COMP BURN GARM SUIT SLVLS ABV
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300061
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.18 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Aetna American Axle |
$204.10
|
| Rate for Payer: Aetna Commercial |
$266.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.10
|
| Rate for Payer: BCBS Complete |
$125.60
|
| Rate for Payer: BCBS Trust/PPO |
$496.69
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Cofinity Commercial |
$219.80
|
| Rate for Payer: Cofinity Commercial |
$270.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.20
|
| Rate for Payer: Healthscope Commercial |
$282.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$266.90
|
| Rate for Payer: PHP Commercial |
$266.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.80
|
| Rate for Payer: Priority Health SBD |
$197.82
|
| Rate for Payer: UMR Bronson Commercial |
$116.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.50
|
|
|
HC COMP BURN GARM SUIT SLVLS ABV
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300061
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$138.16 |
| Max. Negotiated Rate |
$282.60 |
| Rate for Payer: Aetna American Axle |
$204.10
|
| Rate for Payer: Aetna Commercial |
$266.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.10
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Cofinity Commercial |
$219.80
|
| Rate for Payer: Cofinity Commercial |
$270.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.20
|
| Rate for Payer: Healthscope Commercial |
$282.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$266.90
|
| Rate for Payer: PHP Commercial |
$266.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.80
|
| Rate for Payer: Priority Health SBD |
$197.82
|
| Rate for Payer: UMR Bronson Commercial |
$138.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.50
|
|
|
HC COMP BURN GARM SUIT SLVLS-TWO LEGS
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300062
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$161.92 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna American Axle |
$239.20
|
| Rate for Payer: Aetna Commercial |
$312.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.20
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cofinity Commercial |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$316.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.40
|
| Rate for Payer: Healthscope Commercial |
$331.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$257.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.80
|
| Rate for Payer: PHP Commercial |
$312.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.60
|
| Rate for Payer: Priority Health SBD |
$231.84
|
| Rate for Payer: UMR Bronson Commercial |
$161.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.00
|
|
|
HC COMP BURN GARM SUIT SLVLS-TWO LEGS
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300062
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$136.16 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Aetna American Axle |
$239.20
|
| Rate for Payer: Aetna Commercial |
$312.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.20
|
| Rate for Payer: BCBS Complete |
$147.20
|
| Rate for Payer: BCBS Trust/PPO |
$496.69
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cofinity Commercial |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$316.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.40
|
| Rate for Payer: Healthscope Commercial |
$331.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$257.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.80
|
| Rate for Payer: PHP Commercial |
$312.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.60
|
| Rate for Payer: Priority Health SBD |
$231.84
|
| Rate for Payer: UMR Bronson Commercial |
$136.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.00
|
|
|
HC COMP BURN GARM SUSPENDERS ATTA
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300063
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna American Axle |
$29.25
|
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.25
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health SBD |
$28.35
|
| Rate for Payer: UMR Bronson Commercial |
$19.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
HC COMP BURN GARM SUSPENDERS ATTA
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300063
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$641.00 |
| Rate for Payer: Aetna American Axle |
$29.25
|
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.25
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS Trust/PPO |
$641.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health SBD |
$28.35
|
| Rate for Payer: UMR Bronson Commercial |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
HC COMP BURN GARM SUSPENDERS REMO
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300064
|
|
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 SUSPENDERS REMO
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300064
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$641.00 |
| 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 |
$641.00
|
| 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 TWO LEGS PREGNA
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300065
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Aetna American Axle |
$162.50
|
| Rate for Payer: Aetna Commercial |
$212.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.50
|
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: BCBS Trust/PPO |
$496.69
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$175.00
|
| Rate for Payer: Cofinity Commercial |
$215.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.00
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.50
|
| Rate for Payer: PHP Commercial |
$212.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health SBD |
$157.50
|
| Rate for Payer: UMR Bronson Commercial |
$92.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.50
|
|
|
HC COMP BURN GARM TWO LEGS PREGNA
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300065
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna American Axle |
$162.50
|
| Rate for Payer: Aetna Commercial |
$212.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.50
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$175.00
|
| Rate for Payer: Cofinity Commercial |
$215.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.00
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.50
|
| Rate for Payer: PHP Commercial |
$212.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health SBD |
$157.50
|
| Rate for Payer: UMR Bronson Commercial |
$110.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.50
|
|
|
HC COMP BURN GARM VEST SLEEVED
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS A6509
|
| Hospital Charge Code |
98300066
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna American Axle |
$162.50
|
| Rate for Payer: Aetna Commercial |
$212.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.50
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$175.00
|
| Rate for Payer: Cofinity Commercial |
$215.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.00
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.50
|
| Rate for Payer: PHP Commercial |
$212.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health SBD |
$157.50
|
| Rate for Payer: UMR Bronson Commercial |
$110.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.50
|
|
|
HC COMP BURN GARM VEST SLEEVED
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS A6509
|
| Hospital Charge Code |
98300066
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$513.82 |
| Rate for Payer: Aetna American Axle |
$162.50
|
| Rate for Payer: Aetna Commercial |
$212.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.50
|
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: BCBS Trust/PPO |
$513.82
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$175.00
|
| Rate for Payer: Cofinity Commercial |
$215.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.00
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.50
|
| Rate for Payer: PHP Commercial |
$212.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health SBD |
$157.50
|
| Rate for Payer: UMR Bronson Commercial |
$92.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.50
|
|
|
HC COMP BURN GARM VEST SLEEVELESS
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS A6509
|
| Hospital Charge Code |
98300067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.84 |
| Max. Negotiated Rate |
$513.82 |
| 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 |
$513.82
|
| 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 VEST SLEEVELESS
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS A6509
|
| Hospital Charge Code |
98300067
|
|
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 ZIPPER
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300068
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$641.00 |
| Rate for Payer: Aetna American Axle |
$29.25
|
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.25
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS Trust/PPO |
$641.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health SBD |
$28.35
|
| Rate for Payer: UMR Bronson Commercial |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
HC COMP BURN GARM ZIPPER
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300068
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna American Axle |
$29.25
|
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.25
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health SBD |
$28.35
|
| Rate for Payer: UMR Bronson Commercial |
$19.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
HC COMPLEMENT C 3
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200150
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna American Axle |
$73.45
|
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: BCBS Complete |
$6.89
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$10.79
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Cofinity Commercial |
$79.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.75
|
| Rate for Payer: Mclaren Medicaid |
$6.56
|
| Rate for Payer: Mclaren Medicare |
$12.00
|
| Rate for Payer: Meridian Medicaid |
$6.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.01
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health Narrow Network |
$10.41
|
| Rate for Payer: Priority Health SBD |
$71.19
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.40
|
| Rate for Payer: UHC Core |
$19.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.00
|
| Rate for Payer: UHC Exchange |
$12.00
|
| Rate for Payer: UHC Medicare Advantage |
$12.36
|
| Rate for Payer: UMR Bronson Commercial |
$41.81
|
| Rate for Payer: VA VA |
$12.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.75
|
|
|
HC COMPLEMENT C 3
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200150
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.72 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna American Axle |
$73.45
|
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.45
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$79.10
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health SBD |
$71.19
|
| Rate for Payer: UMR Bronson Commercial |
$49.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.75
|
|
|
HC COMPLEMENT C 4
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200151
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.72 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna American Axle |
$73.45
|
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.45
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$79.10
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health SBD |
$71.19
|
| Rate for Payer: UMR Bronson Commercial |
$49.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.75
|
|
|
HC COMPLEMENT C 4
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200151
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna American Axle |
$73.45
|
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: BCBS Complete |
$6.89
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$10.79
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$79.10
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.75
|
| Rate for Payer: Mclaren Medicaid |
$6.56
|
| Rate for Payer: Mclaren Medicare |
$12.00
|
| Rate for Payer: Meridian Medicaid |
$6.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.01
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health Narrow Network |
$10.41
|
| Rate for Payer: Priority Health SBD |
$71.19
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.40
|
| Rate for Payer: UHC Core |
$19.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.00
|
| Rate for Payer: UHC Exchange |
$12.00
|
| Rate for Payer: UHC Medicare Advantage |
$12.36
|
| Rate for Payer: UMR Bronson Commercial |
$41.81
|
| Rate for Payer: VA VA |
$12.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.75
|
|
|
HC COMPLEMENT C 5
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200152
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna American Axle |
$46.41
|
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: BCBS Complete |
$6.89
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$10.79
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| 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 |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Mclaren Medicaid |
$6.56
|
| Rate for Payer: Mclaren Medicare |
$12.00
|
| Rate for Payer: Meridian Medicaid |
$6.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.01
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health Narrow Network |
$10.41
|
| Rate for Payer: Priority Health SBD |
$44.98
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.40
|
| Rate for Payer: UHC Core |
$19.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.00
|
| Rate for Payer: UHC Exchange |
$12.00
|
| Rate for Payer: UHC Medicare Advantage |
$12.36
|
| Rate for Payer: UMR Bronson Commercial |
$26.42
|
| Rate for Payer: VA VA |
$12.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC COMPLEMENT C 5
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200152
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna American Axle |
$46.41
|
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$49.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health SBD |
$44.98
|
| Rate for Payer: UMR Bronson Commercial |
$31.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC COMPLEMENT CH50 TOTAL
|
Facility
|
OP
|
$38.76
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
30200154
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Aetna American Axle |
$25.19
|
| Rate for Payer: Aetna Commercial |
$32.95
|
| Rate for Payer: Aetna Medicare |
$21.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.40
|
| Rate for Payer: BCBS Complete |
$11.67
|
| Rate for Payer: BCBS MAPPO |
$20.32
|
| Rate for Payer: BCBS Trust/PPO |
$18.27
|
| Rate for Payer: BCN Medicare Advantage |
$20.32
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Cofinity Commercial |
$27.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.32
|
| Rate for Payer: Healthscope Commercial |
$34.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.07
|
| Rate for Payer: Mclaren Medicaid |
$11.12
|
| Rate for Payer: Mclaren Medicare |
$20.32
|
| Rate for Payer: Meridian Medicaid |
$11.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.95
|
| Rate for Payer: PACE Medicare |
$19.30
|
| Rate for Payer: PACE SWMI |
$20.32
|
| Rate for Payer: PHP Commercial |
$32.95
|
| Rate for Payer: PHP Medicare Advantage |
$20.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.88
|
| Rate for Payer: Priority Health Medicare |
$20.32
|
| Rate for Payer: Priority Health Narrow Network |
$22.30
|
| Rate for Payer: Priority Health SBD |
$24.42
|
| Rate for Payer: Railroad Medicare Medicare |
$20.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.38
|
| Rate for Payer: UHC Core |
$33.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.32
|
| Rate for Payer: UHC Exchange |
$20.32
|
| Rate for Payer: UHC Medicare Advantage |
$20.93
|
| Rate for Payer: UMR Bronson Commercial |
$14.34
|
| Rate for Payer: VA VA |
$20.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.07
|
|
