|
HC COMP BURN GARM LEG&CHAP TO WAI
|
Facility
|
OP
|
$212.16
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300036
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.50 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$137.90
|
| Rate for Payer: Aetna Commercial |
$180.34
|
| Rate for Payer: Aetna Medicare |
$106.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.90
|
| Rate for Payer: BCBS Complete |
$84.86
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$169.73
|
| Rate for Payer: Cash Price |
$169.73
|
| Rate for Payer: Cofinity Commercial |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$182.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.73
|
| Rate for Payer: Healthscope Commercial |
$190.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: PHP Commercial |
$180.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.90
|
| Rate for Payer: Priority Health SBD |
$133.66
|
| Rate for Payer: UMR Bronson Commercial |
$78.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.12
|
|
|
HC COMP BURN GARM LEG&CHAP TO WAI
|
Facility
|
IP
|
$212.16
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300036
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$93.35 |
| Max. Negotiated Rate |
$190.94 |
| Rate for Payer: Aetna American Axle |
$137.90
|
| Rate for Payer: Aetna Commercial |
$180.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.90
|
| Rate for Payer: Cash Price |
$169.73
|
| Rate for Payer: Cofinity Commercial |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$182.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.73
|
| Rate for Payer: Healthscope Commercial |
$190.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: PHP Commercial |
$180.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.90
|
| Rate for Payer: Priority Health SBD |
$133.66
|
| Rate for Payer: UMR Bronson Commercial |
$93.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.12
|
|
|
HC COMP BURN GARM LEG & PANTY
|
Facility
|
IP
|
$226.44
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.63 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna American Axle |
$147.19
|
| Rate for Payer: Aetna Commercial |
$192.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.19
|
| Rate for Payer: Cash Price |
$181.15
|
| Rate for Payer: Cofinity Commercial |
$158.51
|
| Rate for Payer: Cofinity Commercial |
$194.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$158.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.15
|
| Rate for Payer: Healthscope Commercial |
$203.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.47
|
| Rate for Payer: PHP Commercial |
$192.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.19
|
| Rate for Payer: Priority Health SBD |
$142.66
|
| Rate for Payer: UMR Bronson Commercial |
$99.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.83
|
|
|
HC COMP BURN GARM LEG & PANTY
|
Facility
|
OP
|
$226.44
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$83.78 |
| Max. Negotiated Rate |
$285.81 |
| Rate for Payer: Aetna American Axle |
$147.19
|
| Rate for Payer: Aetna Commercial |
$192.47
|
| Rate for Payer: Aetna Medicare |
$113.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.19
|
| Rate for Payer: BCBS Complete |
$90.58
|
| Rate for Payer: BCBS Trust/PPO |
$285.81
|
| Rate for Payer: BCN Commercial |
$285.81
|
| Rate for Payer: Cash Price |
$181.15
|
| Rate for Payer: Cash Price |
$181.15
|
| Rate for Payer: Cofinity Commercial |
$158.51
|
| Rate for Payer: Cofinity Commercial |
$194.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$158.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.15
|
| Rate for Payer: Healthscope Commercial |
$203.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.47
|
| Rate for Payer: PHP Commercial |
$192.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.19
|
| Rate for Payer: Priority Health SBD |
$142.66
|
| Rate for Payer: UMR Bronson Commercial |
$83.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.83
|
|
|
HC COMP BURN GARM LINING,POCKET,F
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300037
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$7.96
|
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna Medicare |
$6.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: BCBS Complete |
$4.90
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: Priority Health SBD |
$7.71
|
| Rate for Payer: UMR Bronson Commercial |
$4.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
HC COMP BURN GARM LINING,POCKET,F
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300037
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna American Axle |
$7.96
|
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: Priority Health SBD |
$7.71
|
| Rate for Payer: UMR Bronson Commercial |
$5.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
HC COMP BURN GARM MITTEN TO WRIST
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300038
|
|
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 MITTEN TO WRIST
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300038
|
|
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 POCKET & PAD CO
|
Facility
|
OP
|
$14.28
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300039
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$9.28
|
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna Medicare |
$7.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.28
|
| Rate for Payer: BCBS Complete |
$5.71
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$10.00
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.14
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.28
|
| Rate for Payer: Priority Health SBD |
$9.00
|
| Rate for Payer: UMR Bronson Commercial |
$5.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.71
|
|
|
HC COMP BURN GARM POCKET & PAD CO
|
Facility
|
IP
|
$14.28
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300039
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna American Axle |
$9.28
|
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.28
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$10.00
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.14
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.28
|
| Rate for Payer: Priority Health SBD |
$9.00
|
| Rate for Payer: UMR Bronson Commercial |
$6.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.71
|
|
|
HC COMP BURN GARM REINFORCEMENTS
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna American Axle |
$7.96
|
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: Priority Health SBD |
$7.71
|
| Rate for Payer: UMR Bronson Commercial |
$5.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
HC COMP BURN GARM REINFORCEMENTS
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$7.96
|
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna Medicare |
$6.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: BCBS Complete |
$4.90
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: Priority Health SBD |
$7.71
|
| Rate for Payer: UMR Bronson Commercial |
$4.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
HC COMP BURN GARM REINF SET HK&LO
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna American Axle |
$6.63
|
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.63
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.67
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.63
|
| Rate for Payer: Priority Health SBD |
$6.43
|
| Rate for Payer: UMR Bronson Commercial |
$4.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.65
|
|
|
HC COMP BURN GARM REINF SET HK&LO
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$6.63
|
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: Aetna Medicare |
$5.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.63
|
| Rate for Payer: BCBS Complete |
$4.08
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.67
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.63
|
| Rate for Payer: Priority Health SBD |
$6.43
|
| Rate for Payer: UMR Bronson Commercial |
$3.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.65
|
|
|
HC COMP BURN GARM SHOULD FLAP REG
|
Facility
|
OP
|
$34.68
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.83 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$22.54
|
| Rate for Payer: Aetna Commercial |
$29.48
|
| Rate for Payer: Aetna Medicare |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.54
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$24.28
|
| Rate for Payer: Cofinity Commercial |
$29.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.74
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.48
|
| Rate for Payer: PHP Commercial |
$29.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.54
|
| Rate for Payer: Priority Health SBD |
$21.85
|
| Rate for Payer: UMR Bronson Commercial |
$12.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.01
|
|
|
HC COMP BURN GARM SHOULD FLAP REG
|
Facility
|
IP
|
$34.68
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.26 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna American Axle |
$22.54
|
| Rate for Payer: Aetna Commercial |
$29.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.54
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$24.28
|
| Rate for Payer: Cofinity Commercial |
$29.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.74
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.48
|
| Rate for Payer: PHP Commercial |
$29.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.54
|
| Rate for Payer: Priority Health SBD |
$21.85
|
| Rate for Payer: UMR Bronson Commercial |
$15.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.01
|
|
|
HC COMP BURN GARM SILON-TEX P/D-G
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna American Axle |
$39.78
|
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: UMR Bronson Commercial |
$26.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC COMP BURN GARM SILON-TEX P/D-G
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.64 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$39.78
|
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$30.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: BCBS Complete |
$24.48
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: UMR Bronson Commercial |
$22.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC COMP BURN GARM SILON-TEX UP TO
|
Facility
|
OP
|
$36.72
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.59 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$23.87
|
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna Medicare |
$18.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.87
|
| Rate for Payer: BCBS Complete |
$14.69
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.21
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.87
|
| Rate for Payer: Priority Health SBD |
$23.13
|
| Rate for Payer: UMR Bronson Commercial |
$13.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.54
|
|
|
HC COMP BURN GARM SILON-TEX UP TO
|
Facility
|
IP
|
$36.72
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.16 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna American Axle |
$23.87
|
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.87
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.21
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.87
|
| Rate for Payer: Priority Health SBD |
$23.13
|
| Rate for Payer: UMR Bronson Commercial |
$16.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.54
|
|
|
HC COMP BURN GARM SILON-TEX WHOL
|
Facility
|
OP
|
$85.68
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300046
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$55.69
|
| Rate for Payer: Aetna Commercial |
$72.83
|
| Rate for Payer: Aetna Medicare |
$42.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.69
|
| Rate for Payer: BCBS Complete |
$34.27
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cofinity Commercial |
$59.98
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Healthscope Commercial |
$77.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.83
|
| Rate for Payer: PHP Commercial |
$72.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: Priority Health SBD |
$53.98
|
| Rate for Payer: UMR Bronson Commercial |
$31.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.26
|
|
|
HC COMP BURN GARM SILON-TEX WHOL
|
Facility
|
IP
|
$85.68
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300046
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$77.11 |
| Rate for Payer: Aetna American Axle |
$55.69
|
| Rate for Payer: Aetna Commercial |
$72.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.69
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cofinity Commercial |
$59.98
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Healthscope Commercial |
$77.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.83
|
| Rate for Payer: PHP Commercial |
$72.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: Priority Health SBD |
$53.98
|
| Rate for Payer: UMR Bronson Commercial |
$37.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.26
|
|
|
HC COMP BURN GARM SLEEVE WRIST/AX
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300047
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$46.41
|
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna Medicare |
$35.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| 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: Cofinity Medicare Advantage |
$49.98
|
| 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 Commercial |
$60.69
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health SBD |
$44.98
|
| Rate for Payer: UMR Bronson Commercial |
$26.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC COMP BURN GARM SLEEVE WRIST/AX
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300047
|
|
Hospital Revenue Code
|
270
|
| 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: Cofinity Medicare Advantage |
$49.98
|
| 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 Commercial |
$60.69
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| 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 COMP BURN GARM SLV WRST-ELB/EL
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300048
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.64 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$39.78
|
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$30.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: BCBS Complete |
$24.48
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: UMR Bronson Commercial |
$22.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
