|
HC COMP BURN GARM BODY BRF SLEEVE
|
Facility
|
IP
|
$245.53
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$108.03 |
| Max. Negotiated Rate |
$220.98 |
| Rate for Payer: Aetna American Axle |
$159.59
|
| Rate for Payer: Aetna Commercial |
$208.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.59
|
| Rate for Payer: Cash Price |
$196.42
|
| Rate for Payer: Cofinity Advantage |
$171.87
|
| Rate for Payer: Cofinity Commercial |
$211.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.42
|
| Rate for Payer: Healthscope Commercial |
$220.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.15
|
| Rate for Payer: PHP Commercial |
$208.70
|
| Rate for Payer: Priority Health SBD |
$154.68
|
| Rate for Payer: UMR Bronson Commercial |
$108.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.15
|
|
|
HC COMP BURN GARM BRF 2 LEGS ABV
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.67 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna American Axle |
$101.44
|
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Advantage |
$109.24
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health SBD |
$98.32
|
| Rate for Payer: UMR Bronson Commercial |
$68.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.05
|
|
|
HC COMP BURN GARM BRF 2 LEGS ABV
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$414.25 |
| Rate for Payer: Aetna American Axle |
$101.44
|
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna Medicare |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: BCBS Complete |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$414.25
|
| Rate for Payer: BCN Commercial |
$414.25
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Advantage |
$109.24
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health SBD |
$98.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.44
|
| Rate for Payer: UHC Core |
$81.31
|
| Rate for Payer: UHC Exchange |
$61.33
|
| Rate for Payer: UMR Bronson Commercial |
$57.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.05
|
|
|
HC COMP BURN GARM BRF&CHAP,LG-MID
|
Facility
|
OP
|
$137.33
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.81 |
| Max. Negotiated Rate |
$414.25 |
| Rate for Payer: Aetna American Axle |
$89.26
|
| Rate for Payer: Aetna Commercial |
$116.73
|
| Rate for Payer: Aetna Medicare |
$68.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.26
|
| Rate for Payer: BCBS Complete |
$54.93
|
| Rate for Payer: BCBS Trust/PPO |
$414.25
|
| Rate for Payer: BCN Commercial |
$414.25
|
| Rate for Payer: Cash Price |
$109.86
|
| Rate for Payer: Cash Price |
$109.86
|
| Rate for Payer: Cofinity Advantage |
$96.13
|
| Rate for Payer: Cofinity Commercial |
$118.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.86
|
| Rate for Payer: Healthscope Commercial |
$123.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.00
|
| Rate for Payer: PHP Commercial |
$116.73
|
| Rate for Payer: Priority Health SBD |
$86.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.26
|
| Rate for Payer: UHC Core |
$71.55
|
| Rate for Payer: UHC Exchange |
$53.97
|
| Rate for Payer: UMR Bronson Commercial |
$50.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.00
|
|
|
HC COMP BURN GARM BRF&CHAP,LG-MID
|
Facility
|
IP
|
$137.33
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$60.43 |
| Max. Negotiated Rate |
$123.60 |
| Rate for Payer: Aetna American Axle |
$89.26
|
| Rate for Payer: Aetna Commercial |
$116.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.26
|
| Rate for Payer: Cash Price |
$109.86
|
| Rate for Payer: Cofinity Advantage |
$96.13
|
| Rate for Payer: Cofinity Commercial |
$118.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.86
|
| Rate for Payer: Healthscope Commercial |
$123.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.00
|
| Rate for Payer: PHP Commercial |
$116.73
|
| Rate for Payer: Priority Health SBD |
$86.52
|
| Rate for Payer: UMR Bronson Commercial |
$60.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.00
|
|
|
HC COMP BURN GARM BRIEF
|
Facility
|
OP
|
$137.33
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.81 |
| Max. Negotiated Rate |
$285.69 |
| Rate for Payer: Aetna American Axle |
$89.26
|
| Rate for Payer: Aetna Commercial |
$116.73
|
| Rate for Payer: Aetna Medicare |
$68.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.26
|
| Rate for Payer: BCBS Complete |
$54.93
|
| Rate for Payer: BCBS Trust/PPO |
$285.69
|
| Rate for Payer: BCN Commercial |
$285.69
|
| Rate for Payer: Cash Price |
$109.86
|
| Rate for Payer: Cash Price |
$109.86
|
| Rate for Payer: Cofinity Advantage |
$96.13
|
| Rate for Payer: Cofinity Commercial |
$118.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.86
|
| Rate for Payer: Healthscope Commercial |
$123.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.00
|
| Rate for Payer: PHP Commercial |
$116.73
|
| Rate for Payer: Priority Health SBD |
$86.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.26
|
| Rate for Payer: UHC Core |
$71.55
|
| Rate for Payer: UHC Exchange |
$53.97
|
| Rate for Payer: UMR Bronson Commercial |
$50.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.00
|
|
|
HC COMP BURN GARM BRIEF
|
Facility
|
IP
|
$137.33
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$60.43 |
| Max. Negotiated Rate |
$123.60 |
| Rate for Payer: Aetna American Axle |
$89.26
|
| Rate for Payer: Aetna Commercial |
$116.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.26
|
| Rate for Payer: Cash Price |
$109.86
|
| Rate for Payer: Cofinity Advantage |
$96.13
|
| Rate for Payer: Cofinity Commercial |
$118.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.86
|
| Rate for Payer: Healthscope Commercial |
$123.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.00
|
| Rate for Payer: PHP Commercial |
$116.73
|
| Rate for Payer: Priority Health SBD |
$86.52
|
| Rate for Payer: UMR Bronson Commercial |
$60.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.00
|
|
|
HC COMP BURN GARM CHIN STRAP REGU
|
Facility
|
OP
|
$81.15
|
|
|
Service Code
|
HCPCS A6502
|
| Hospital Charge Code |
98300152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$171.42 |
| Rate for Payer: Aetna American Axle |
$52.75
|
| Rate for Payer: Aetna Commercial |
$68.98
|
| Rate for Payer: Aetna Medicare |
$40.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.75
|
| Rate for Payer: BCBS Complete |
$32.46
|
| Rate for Payer: BCBS Trust/PPO |
$171.42
|
| Rate for Payer: BCN Commercial |
$171.42
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Advantage |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$69.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.92
|
| Rate for Payer: Healthscope Commercial |
$73.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.86
|
| Rate for Payer: PHP Commercial |
$68.98
|
| Rate for Payer: Priority Health SBD |
$51.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.75
|
| Rate for Payer: UHC Core |
$42.28
|
| Rate for Payer: UHC Exchange |
$31.89
|
| Rate for Payer: UMR Bronson Commercial |
$30.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.86
|
|
|
HC COMP BURN GARM CHIN STRAP REGU
|
Facility
|
IP
|
$81.15
|
|
|
Service Code
|
HCPCS A6502
|
| Hospital Charge Code |
98300152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.71 |
| Max. Negotiated Rate |
$73.03 |
| Rate for Payer: Aetna American Axle |
$52.75
|
| Rate for Payer: Aetna Commercial |
$68.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.75
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Advantage |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$69.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.92
|
| Rate for Payer: Healthscope Commercial |
$73.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.86
|
| Rate for Payer: PHP Commercial |
$68.98
|
| Rate for Payer: Priority Health SBD |
$51.12
|
| Rate for Payer: UMR Bronson Commercial |
$35.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.86
|
|
|
HC COMP BURN GARM CHIN STRP W LIP
|
Facility
|
OP
|
$81.15
|
|
|
Service Code
|
HCPCS A6502
|
| Hospital Charge Code |
98300153
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$171.42 |
| Rate for Payer: Aetna American Axle |
$52.75
|
| Rate for Payer: Aetna Commercial |
$68.98
|
| Rate for Payer: Aetna Medicare |
$40.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.75
|
| Rate for Payer: BCBS Complete |
$32.46
|
| Rate for Payer: BCBS Trust/PPO |
$171.42
|
| Rate for Payer: BCN Commercial |
$171.42
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Advantage |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$69.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.92
|
| Rate for Payer: Healthscope Commercial |
$73.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.86
|
| Rate for Payer: PHP Commercial |
$68.98
|
| Rate for Payer: Priority Health SBD |
$51.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.75
|
| Rate for Payer: UHC Core |
$42.28
|
| Rate for Payer: UHC Exchange |
$31.89
|
| Rate for Payer: UMR Bronson Commercial |
$30.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.86
|
|
|
HC COMP BURN GARM CHIN STRP W LIP
|
Facility
|
IP
|
$81.15
|
|
|
Service Code
|
HCPCS A6502
|
| Hospital Charge Code |
98300153
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.71 |
| Max. Negotiated Rate |
$73.03 |
| Rate for Payer: Aetna American Axle |
$52.75
|
| Rate for Payer: Aetna Commercial |
$68.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.75
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Advantage |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$69.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.92
|
| Rate for Payer: Healthscope Commercial |
$73.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.86
|
| Rate for Payer: PHP Commercial |
$68.98
|
| Rate for Payer: Priority Health SBD |
$51.12
|
| Rate for Payer: UMR Bronson Commercial |
$35.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.86
|
|
|
HC COMP BURN GARM COLLAR FOAM
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300154
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.31 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna American Axle |
$27.05
|
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Advantage |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: UMR Bronson Commercial |
$18.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.21
|
|
|
HC COMP BURN GARM COLLAR FOAM
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300154
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$414.25 |
| Rate for Payer: Aetna American Axle |
$27.05
|
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$20.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: BCBS Complete |
$16.65
|
| Rate for Payer: BCBS Trust/PPO |
$414.25
|
| Rate for Payer: BCN Commercial |
$414.25
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Advantage |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.05
|
| Rate for Payer: UHC Core |
$21.68
|
| Rate for Payer: UHC Exchange |
$16.36
|
| Rate for Payer: UMR Bronson Commercial |
$15.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.21
|
|
|
HC COMP BURN GARM COLLAR PILLOW
|
Facility
|
IP
|
$70.75
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300155
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna American Axle |
$45.99
|
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Advantage |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: Priority Health SBD |
$44.57
|
| Rate for Payer: UMR Bronson Commercial |
$31.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.06
|
|
|
HC COMP BURN GARM COLLAR PILLOW
|
Facility
|
OP
|
$70.75
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300155
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.18 |
| Max. Negotiated Rate |
$414.25 |
| Rate for Payer: Aetna American Axle |
$45.99
|
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna Medicare |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: BCBS Complete |
$28.30
|
| Rate for Payer: BCBS Trust/PPO |
$414.25
|
| Rate for Payer: BCN Commercial |
$414.25
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Advantage |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: Priority Health SBD |
$44.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.99
|
| Rate for Payer: UHC Core |
$36.86
|
| Rate for Payer: UHC Exchange |
$27.80
|
| Rate for Payer: UMR Bronson Commercial |
$26.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.06
|
|
|
HC COMP BURN GARM COLLAR TRACH
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300156
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.31 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna American Axle |
$27.05
|
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Advantage |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: UMR Bronson Commercial |
$18.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.21
|
|
|
HC COMP BURN GARM COLLAR TRACH
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300156
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$414.25 |
| Rate for Payer: Aetna American Axle |
$27.05
|
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$20.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: BCBS Complete |
$16.65
|
| Rate for Payer: BCBS Trust/PPO |
$414.25
|
| Rate for Payer: BCN Commercial |
$414.25
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Advantage |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.05
|
| Rate for Payer: UHC Core |
$21.68
|
| Rate for Payer: UHC Exchange |
$16.36
|
| Rate for Payer: UMR Bronson Commercial |
$15.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.21
|
|
|
HC COMP BURN GARM ELECTIVE ALTERA
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna American Axle |
$13.53
|
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Advantage |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.61
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: UMR Bronson Commercial |
$9.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC COMP BURN GARM ELECTIVE ALTERA
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$414.25 |
| Rate for Payer: Aetna American Axle |
$13.53
|
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS Trust/PPO |
$414.25
|
| Rate for Payer: BCN Commercial |
$414.25
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Advantage |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.61
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.53
|
| Rate for Payer: UHC Core |
$10.84
|
| Rate for Payer: UHC Exchange |
$8.18
|
| Rate for Payer: UMR Bronson Commercial |
$7.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC COMP BURN GARM EXPANSION PANEL
|
Facility
|
OP
|
$29.13
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$414.25 |
| Rate for Payer: Aetna American Axle |
$18.93
|
| Rate for Payer: Aetna Commercial |
$24.76
|
| Rate for Payer: Aetna Medicare |
$14.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.93
|
| Rate for Payer: BCBS Complete |
$11.65
|
| Rate for Payer: BCBS Trust/PPO |
$414.25
|
| Rate for Payer: BCN Commercial |
$414.25
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Advantage |
$20.39
|
| Rate for Payer: Cofinity Commercial |
$25.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$26.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.85
|
| Rate for Payer: PHP Commercial |
$24.76
|
| Rate for Payer: Priority Health SBD |
$18.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.93
|
| Rate for Payer: UHC Core |
$15.18
|
| Rate for Payer: UHC Exchange |
$11.45
|
| Rate for Payer: UMR Bronson Commercial |
$10.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.85
|
|
|
HC COMP BURN GARM EXPANSION PANEL
|
Facility
|
IP
|
$29.13
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$26.22 |
| Rate for Payer: Aetna American Axle |
$18.93
|
| Rate for Payer: Aetna Commercial |
$24.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.93
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Advantage |
$20.39
|
| Rate for Payer: Cofinity Commercial |
$25.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$26.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.85
|
| Rate for Payer: PHP Commercial |
$24.76
|
| Rate for Payer: Priority Health SBD |
$18.35
|
| Rate for Payer: UMR Bronson Commercial |
$12.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.85
|
|
|
HC COMP BURN GARM FACE MASK
|
Facility
|
OP
|
$139.41
|
|
|
Service Code
|
HCPCS A6503
|
| Hospital Charge Code |
98300159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.58 |
| Max. Negotiated Rate |
$266.65 |
| Rate for Payer: Aetna American Axle |
$90.62
|
| Rate for Payer: Aetna Commercial |
$118.50
|
| Rate for Payer: Aetna Medicare |
$69.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.62
|
| Rate for Payer: BCBS Complete |
$55.76
|
| Rate for Payer: BCBS Trust/PPO |
$266.65
|
| Rate for Payer: BCN Commercial |
$266.65
|
| Rate for Payer: Cash Price |
$111.53
|
| Rate for Payer: Cash Price |
$111.53
|
| Rate for Payer: Cofinity Advantage |
$97.59
|
| Rate for Payer: Cofinity Commercial |
$119.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.53
|
| Rate for Payer: Healthscope Commercial |
$125.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.56
|
| Rate for Payer: PHP Commercial |
$118.50
|
| Rate for Payer: Priority Health SBD |
$87.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.62
|
| Rate for Payer: UHC Core |
$72.63
|
| Rate for Payer: UHC Exchange |
$54.79
|
| Rate for Payer: UMR Bronson Commercial |
$51.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.56
|
|
|
HC COMP BURN GARM FACE MASK
|
Facility
|
IP
|
$139.41
|
|
|
Service Code
|
HCPCS A6503
|
| Hospital Charge Code |
98300159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.34 |
| Max. Negotiated Rate |
$125.47 |
| Rate for Payer: Aetna American Axle |
$90.62
|
| Rate for Payer: Aetna Commercial |
$118.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.62
|
| Rate for Payer: Cash Price |
$111.53
|
| Rate for Payer: Cofinity Advantage |
$97.59
|
| Rate for Payer: Cofinity Commercial |
$119.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.53
|
| Rate for Payer: Healthscope Commercial |
$125.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.56
|
| Rate for Payer: PHP Commercial |
$118.50
|
| Rate for Payer: Priority Health SBD |
$87.83
|
| Rate for Payer: UMR Bronson Commercial |
$61.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.56
|
|
|
HC COMP BURN GARM FOOT GAUNTLET
|
Facility
|
OP
|
$35.37
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300160
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$414.25 |
| Rate for Payer: Aetna American Axle |
$22.99
|
| Rate for Payer: Aetna Commercial |
$30.06
|
| Rate for Payer: Aetna Medicare |
$17.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.99
|
| Rate for Payer: BCBS Complete |
$14.15
|
| Rate for Payer: BCBS Trust/PPO |
$414.25
|
| Rate for Payer: BCN Commercial |
$414.25
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Advantage |
$24.76
|
| Rate for Payer: Cofinity Commercial |
$30.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Healthscope Commercial |
$31.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.53
|
| Rate for Payer: PHP Commercial |
$30.06
|
| Rate for Payer: Priority Health SBD |
$22.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.99
|
| Rate for Payer: UHC Core |
$18.43
|
| Rate for Payer: UHC Exchange |
$13.90
|
| Rate for Payer: UMR Bronson Commercial |
$13.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.53
|
|
|
HC COMP BURN GARM FOOT GAUNTLET
|
Facility
|
IP
|
$35.37
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300160
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$31.83 |
| Rate for Payer: Aetna American Axle |
$22.99
|
| Rate for Payer: Aetna Commercial |
$30.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.99
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Advantage |
$24.76
|
| Rate for Payer: Cofinity Commercial |
$30.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Healthscope Commercial |
$31.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.53
|
| Rate for Payer: PHP Commercial |
$30.06
|
| Rate for Payer: Priority Health SBD |
$22.28
|
| Rate for Payer: UMR Bronson Commercial |
$15.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.53
|
|
