|
HC COMP BURN GARM BELLY BAND
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$26.52
|
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$20.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: BCBS Complete |
$16.32
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: UMR Bronson Commercial |
$15.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC COMP BURN GARM BELLY BAND
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna American Axle |
$26.52
|
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: UMR Bronson Commercial |
$17.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC COMP BURN GARM BODY BRF SLEEVE
|
Facility
|
IP
|
$240.72
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$105.92 |
| Max. Negotiated Rate |
$216.65 |
| Rate for Payer: Aetna American Axle |
$156.47
|
| Rate for Payer: Aetna Commercial |
$204.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.47
|
| Rate for Payer: Cash Price |
$192.58
|
| Rate for Payer: Cofinity Commercial |
$168.50
|
| Rate for Payer: Cofinity Commercial |
$207.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.58
|
| Rate for Payer: Healthscope Commercial |
$216.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.61
|
| Rate for Payer: PHP Commercial |
$204.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.47
|
| Rate for Payer: Priority Health SBD |
$151.65
|
| Rate for Payer: UMR Bronson Commercial |
$105.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.54
|
|
|
HC COMP BURN GARM BODY BRF SLEEVE
|
Facility
|
OP
|
$240.72
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.07 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$156.47
|
| Rate for Payer: Aetna Commercial |
$204.61
|
| Rate for Payer: Aetna Medicare |
$120.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.47
|
| Rate for Payer: BCBS Complete |
$96.29
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$192.58
|
| Rate for Payer: Cash Price |
$192.58
|
| Rate for Payer: Cofinity Commercial |
$168.50
|
| Rate for Payer: Cofinity Commercial |
$207.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.58
|
| Rate for Payer: Healthscope Commercial |
$216.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.61
|
| Rate for Payer: PHP Commercial |
$204.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.47
|
| Rate for Payer: Priority Health SBD |
$151.65
|
| Rate for Payer: UMR Bronson Commercial |
$89.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.54
|
|
|
HC COMP BURN GARM BRF 2 LEGS ABV
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$67.32 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna American Axle |
$99.45
|
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health SBD |
$96.39
|
| Rate for Payer: UMR Bronson Commercial |
$67.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC COMP BURN GARM BRF 2 LEGS ABV
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.61 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$99.45
|
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health SBD |
$96.39
|
| Rate for Payer: UMR Bronson Commercial |
$56.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC COMP BURN GARM BRF&CHAP,LG-MID
|
Facility
|
IP
|
$134.64
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.24 |
| Max. Negotiated Rate |
$121.18 |
| Rate for Payer: Aetna American Axle |
$87.52
|
| Rate for Payer: Aetna Commercial |
$114.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.52
|
| Rate for Payer: Cash Price |
$107.71
|
| Rate for Payer: Cofinity Commercial |
$115.79
|
| Rate for Payer: Cofinity Commercial |
$94.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.71
|
| Rate for Payer: Healthscope Commercial |
$121.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.44
|
| Rate for Payer: PHP Commercial |
$114.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.52
|
| Rate for Payer: Priority Health SBD |
$84.82
|
| Rate for Payer: UMR Bronson Commercial |
$59.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.98
|
|
|
HC COMP BURN GARM BRF&CHAP,LG-MID
|
Facility
|
OP
|
$134.64
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.82 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$87.52
|
| Rate for Payer: Aetna Commercial |
$114.44
|
| Rate for Payer: Aetna Medicare |
$67.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.52
|
| Rate for Payer: BCBS Complete |
$53.86
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$107.71
|
| Rate for Payer: Cash Price |
$107.71
|
| Rate for Payer: Cofinity Commercial |
$115.79
|
| Rate for Payer: Cofinity Commercial |
$94.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.71
|
| Rate for Payer: Healthscope Commercial |
$121.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.44
|
| Rate for Payer: PHP Commercial |
$114.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.52
|
| Rate for Payer: Priority Health SBD |
$84.82
|
| Rate for Payer: UMR Bronson Commercial |
$49.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.98
|
|
|
HC COMP BURN GARM BRIEF
|
Facility
|
OP
|
$134.64
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.82 |
| Max. Negotiated Rate |
$285.81 |
| Rate for Payer: Aetna American Axle |
$87.52
|
| Rate for Payer: Aetna Commercial |
$114.44
|
| Rate for Payer: Aetna Medicare |
$67.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.52
|
| Rate for Payer: BCBS Complete |
$53.86
|
| Rate for Payer: BCBS Trust/PPO |
$285.81
|
| Rate for Payer: BCN Commercial |
$285.81
|
| Rate for Payer: Cash Price |
$107.71
|
| Rate for Payer: Cash Price |
$107.71
|
| Rate for Payer: Cofinity Commercial |
$115.79
|
| Rate for Payer: Cofinity Commercial |
$94.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.71
|
| Rate for Payer: Healthscope Commercial |
$121.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.44
|
| Rate for Payer: PHP Commercial |
$114.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.52
|
| Rate for Payer: Priority Health SBD |
$84.82
|
| Rate for Payer: UMR Bronson Commercial |
$49.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.98
|
|
|
HC COMP BURN GARM BRIEF
|
Facility
|
IP
|
$134.64
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.24 |
| Max. Negotiated Rate |
$121.18 |
| Rate for Payer: Aetna American Axle |
$87.52
|
| Rate for Payer: Aetna Commercial |
$114.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.52
|
| Rate for Payer: Cash Price |
$107.71
|
| Rate for Payer: Cofinity Commercial |
$115.79
|
| Rate for Payer: Cofinity Commercial |
$94.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.71
|
| Rate for Payer: Healthscope Commercial |
$121.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.44
|
| Rate for Payer: PHP Commercial |
$114.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.52
|
| Rate for Payer: Priority Health SBD |
$84.82
|
| Rate for Payer: UMR Bronson Commercial |
$59.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.98
|
|
|
HC COMP BURN GARM CHIN STRAP REGU
|
Facility
|
IP
|
$79.56
|
|
|
Service Code
|
HCPCS A6502
|
| Hospital Charge Code |
98300152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$71.60 |
| Rate for Payer: Aetna American Axle |
$51.71
|
| Rate for Payer: Aetna Commercial |
$67.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.71
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$55.69
|
| Rate for Payer: Cofinity Commercial |
$68.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$71.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.63
|
| Rate for Payer: PHP Commercial |
$67.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: Priority Health SBD |
$50.12
|
| Rate for Payer: UMR Bronson Commercial |
$35.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.67
|
|
|
HC COMP BURN GARM CHIN STRAP REGU
|
Facility
|
OP
|
$79.56
|
|
|
Service Code
|
HCPCS A6502
|
| Hospital Charge Code |
98300152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.44 |
| Max. Negotiated Rate |
$171.49 |
| Rate for Payer: Aetna American Axle |
$51.71
|
| Rate for Payer: Aetna Commercial |
$67.63
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.71
|
| Rate for Payer: BCBS Complete |
$31.82
|
| Rate for Payer: BCBS Trust/PPO |
$171.49
|
| Rate for Payer: BCN Commercial |
$171.49
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$55.69
|
| Rate for Payer: Cofinity Commercial |
$68.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$71.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.63
|
| Rate for Payer: PHP Commercial |
$67.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: Priority Health SBD |
$50.12
|
| Rate for Payer: UMR Bronson Commercial |
$29.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.67
|
|
|
HC COMP BURN GARM CHIN STRP W LIP
|
Facility
|
OP
|
$79.56
|
|
|
Service Code
|
HCPCS A6502
|
| Hospital Charge Code |
98300153
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.44 |
| Max. Negotiated Rate |
$171.49 |
| Rate for Payer: Aetna American Axle |
$51.71
|
| Rate for Payer: Aetna Commercial |
$67.63
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.71
|
| Rate for Payer: BCBS Complete |
$31.82
|
| Rate for Payer: BCBS Trust/PPO |
$171.49
|
| Rate for Payer: BCN Commercial |
$171.49
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$55.69
|
| Rate for Payer: Cofinity Commercial |
$68.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$71.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.63
|
| Rate for Payer: PHP Commercial |
$67.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: Priority Health SBD |
$50.12
|
| Rate for Payer: UMR Bronson Commercial |
$29.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.67
|
|
|
HC COMP BURN GARM CHIN STRP W LIP
|
Facility
|
IP
|
$79.56
|
|
|
Service Code
|
HCPCS A6502
|
| Hospital Charge Code |
98300153
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$71.60 |
| Rate for Payer: Aetna American Axle |
$51.71
|
| Rate for Payer: Aetna Commercial |
$67.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.71
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$55.69
|
| Rate for Payer: Cofinity Commercial |
$68.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$71.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.63
|
| Rate for Payer: PHP Commercial |
$67.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: Priority Health SBD |
$50.12
|
| Rate for Payer: UMR Bronson Commercial |
$35.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.67
|
|
|
HC COMP BURN GARM COLLAR FOAM
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300154
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$26.52
|
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$20.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: BCBS Complete |
$16.32
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: UMR Bronson Commercial |
$15.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC COMP BURN GARM COLLAR FOAM
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300154
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna American Axle |
$26.52
|
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: UMR Bronson Commercial |
$17.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC COMP BURN GARM COLLAR PILLOW
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300155
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.52 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna American Axle |
$45.08
|
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.08
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$48.55
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: Priority Health SBD |
$43.70
|
| Rate for Payer: UMR Bronson Commercial |
$30.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.02
|
|
|
HC COMP BURN GARM COLLAR PILLOW
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300155
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.66 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$45.08
|
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna Medicare |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.08
|
| Rate for Payer: BCBS Complete |
$27.74
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$48.55
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: Priority Health SBD |
$43.70
|
| Rate for Payer: UMR Bronson Commercial |
$25.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.02
|
|
|
HC COMP BURN GARM COLLAR TRACH
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300156
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna American Axle |
$26.52
|
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: UMR Bronson Commercial |
$17.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC COMP BURN GARM COLLAR TRACH
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300156
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$26.52
|
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$20.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: BCBS Complete |
$16.32
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: UMR Bronson Commercial |
$15.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC COMP BURN GARM ELECTIVE ALTERA
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna American Axle |
$13.26
|
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.26
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: UMR Bronson Commercial |
$8.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC COMP BURN GARM ELECTIVE ALTERA
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$13.26
|
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: BCBS Complete |
$8.16
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.26
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: UMR Bronson Commercial |
$7.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC COMP BURN GARM EXPANSION PANEL
|
Facility
|
IP
|
$28.56
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$25.70 |
| Rate for Payer: Aetna American Axle |
$18.56
|
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.56
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$19.99
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.85
|
| Rate for Payer: Healthscope Commercial |
$25.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.28
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.56
|
| Rate for Payer: Priority Health SBD |
$17.99
|
| Rate for Payer: UMR Bronson Commercial |
$12.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.42
|
|
|
HC COMP BURN GARM EXPANSION PANEL
|
Facility
|
OP
|
$28.56
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.57 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$18.56
|
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna Medicare |
$14.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.56
|
| Rate for Payer: BCBS Complete |
$11.42
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$19.99
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.85
|
| Rate for Payer: Healthscope Commercial |
$25.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.28
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.56
|
| Rate for Payer: Priority Health SBD |
$17.99
|
| Rate for Payer: UMR Bronson Commercial |
$10.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.42
|
|
|
HC COMP BURN GARM FACE MASK
|
Facility
|
IP
|
$136.68
|
|
|
Service Code
|
HCPCS A6503
|
| Hospital Charge Code |
98300159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$60.14 |
| Max. Negotiated Rate |
$123.01 |
| Rate for Payer: Aetna American Axle |
$88.84
|
| Rate for Payer: Aetna Commercial |
$116.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.84
|
| Rate for Payer: Cash Price |
$109.34
|
| Rate for Payer: Cofinity Commercial |
$117.54
|
| Rate for Payer: Cofinity Commercial |
$95.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.34
|
| Rate for Payer: Healthscope Commercial |
$123.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.18
|
| Rate for Payer: PHP Commercial |
$116.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.84
|
| Rate for Payer: Priority Health SBD |
$86.11
|
| Rate for Payer: UMR Bronson Commercial |
$60.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.51
|
|
