|
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 |
$104.56 |
| Max. Negotiated Rate |
$139.41 |
| Rate for Payer: Aetna Commercial |
$125.47
|
| Rate for Payer: ASR ASR |
$135.23
|
| Rate for Payer: BCBS Trust/PPO |
$114.48
|
| Rate for Payer: BCN Commercial |
$114.48
|
| Rate for Payer: Cash Price |
$111.53
|
| Rate for Payer: Cofinity Commercial |
$131.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.53
|
| Rate for Payer: Healthscope Commercial |
$135.23
|
| Rate for Payer: Healthscope Whirlpool |
$139.41
|
| Rate for Payer: Mclaren Commercial |
$125.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.50
|
| Rate for Payer: Nomi Health Commercial |
$114.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.68
|
|
|
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 |
$26.53 |
| Max. Negotiated Rate |
$35.37 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: ASR ASR |
$34.31
|
| Rate for Payer: BCBS Trust/PPO |
$29.05
|
| Rate for Payer: BCN Commercial |
$29.05
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Healthscope Commercial |
$34.31
|
| Rate for Payer: Healthscope Whirlpool |
$35.37
|
| Rate for Payer: Mclaren Commercial |
$31.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: Nomi Health Commercial |
$29.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.13
|
|
|
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 |
$35.37 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna Medicare |
$13.09
|
| Rate for Payer: ASR ASR |
$34.31
|
| Rate for Payer: BCBS Complete |
$14.15
|
| Rate for Payer: BCBS Trust/PPO |
$29.16
|
| Rate for Payer: BCN Commercial |
$29.16
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Healthscope Commercial |
$34.31
|
| Rate for Payer: Healthscope Whirlpool |
$35.37
|
| Rate for Payer: Mclaren Commercial |
$31.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: Nomi Health Commercial |
$29.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30.99
|
| Rate for Payer: Priority Health Narrow Network |
$24.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.13
|
|
|
HC COMP BURN GARM FOOT GLOVE
|
Facility
|
OP
|
$114.44
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.34 |
| Max. Negotiated Rate |
$114.44 |
| Rate for Payer: Aetna Commercial |
$103.00
|
| Rate for Payer: Aetna Medicare |
$42.34
|
| Rate for Payer: ASR ASR |
$111.01
|
| Rate for Payer: BCBS Complete |
$45.78
|
| Rate for Payer: BCBS Trust/PPO |
$94.36
|
| Rate for Payer: BCN Commercial |
$94.36
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cofinity Commercial |
$107.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.55
|
| Rate for Payer: Healthscope Commercial |
$111.01
|
| Rate for Payer: Healthscope Whirlpool |
$114.44
|
| Rate for Payer: Mclaren Commercial |
$103.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.27
|
| Rate for Payer: Nomi Health Commercial |
$93.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$100.27
|
| Rate for Payer: Priority Health Narrow Network |
$80.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.71
|
|
|
HC COMP BURN GARM FOOT GLOVE
|
Facility
|
IP
|
$114.44
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$85.83 |
| Max. Negotiated Rate |
$114.44 |
| Rate for Payer: Aetna Commercial |
$103.00
|
| Rate for Payer: ASR ASR |
$111.01
|
| Rate for Payer: BCBS Trust/PPO |
$93.98
|
| Rate for Payer: BCN Commercial |
$93.98
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cofinity Commercial |
$107.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.55
|
| Rate for Payer: Healthscope Commercial |
$111.01
|
| Rate for Payer: Healthscope Whirlpool |
$114.44
|
| Rate for Payer: Mclaren Commercial |
$103.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.27
|
| Rate for Payer: Nomi Health Commercial |
$93.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.71
|
|
|
HC COMP BURN GARM FOOT MITTEN
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| Rate for Payer: Aetna Medicare |
$34.65
|
| Rate for Payer: ASR ASR |
$90.83
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: BCBS Trust/PPO |
$77.21
|
| Rate for Payer: BCN Commercial |
$77.21
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$88.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$90.83
|
| Rate for Payer: Healthscope Whirlpool |
$93.64
|
| Rate for Payer: Mclaren Commercial |
$84.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$82.05
|
| Rate for Payer: Priority Health Narrow Network |
$65.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.40
|
|
|
HC COMP BURN GARM FOOT MITTEN
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.23 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| Rate for Payer: ASR ASR |
$90.83
|
| Rate for Payer: BCBS Trust/PPO |
$76.90
|
| Rate for Payer: BCN Commercial |
$76.90
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$88.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$90.83
|
| Rate for Payer: Healthscope Whirlpool |
$93.64
|
| Rate for Payer: Mclaren Commercial |
$84.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.40
|
|
|
HC COMP BURN GARM FULLY LINED GAR
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Medicare |
$0.38
|
| Rate for Payer: ASR ASR |
$1.01
|
| Rate for Payer: BCBS Complete |
$0.42
|
| Rate for Payer: BCBS Trust/PPO |
$0.86
|
| Rate for Payer: BCN Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cofinity Commercial |
$0.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$1.01
|
| Rate for Payer: Healthscope Whirlpool |
$1.04
|
| Rate for Payer: Mclaren Commercial |
$0.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.88
|
| Rate for Payer: Nomi Health Commercial |
$0.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.91
|
| Rate for Payer: Priority Health Narrow Network |
$0.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.92
|
|
|
HC COMP BURN GARM FULLY LINED GAR
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: ASR ASR |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cofinity Commercial |
$0.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$1.01
|
| Rate for Payer: Healthscope Whirlpool |
$1.04
|
| Rate for Payer: Mclaren Commercial |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.88
|
| Rate for Payer: Nomi Health Commercial |
$0.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.92
|
|
|
HC COMP BURN GARM GAUNTLET TO AXI
|
Facility
|
OP
|
$95.72
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.42 |
| Max. Negotiated Rate |
$95.72 |
| Rate for Payer: Aetna Commercial |
$86.15
|
| Rate for Payer: Aetna Medicare |
$35.42
|
| Rate for Payer: ASR ASR |
$92.85
|
| Rate for Payer: BCBS Complete |
$38.29
|
| Rate for Payer: BCBS Trust/PPO |
$78.92
|
| Rate for Payer: BCN Commercial |
$78.92
|
| Rate for Payer: Cash Price |
$76.58
|
| Rate for Payer: Cofinity Commercial |
$89.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.58
|
| Rate for Payer: Healthscope Commercial |
$92.85
|
| Rate for Payer: Healthscope Whirlpool |
$95.72
|
| Rate for Payer: Mclaren Commercial |
$86.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.36
|
| Rate for Payer: Nomi Health Commercial |
$78.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$83.87
|
| Rate for Payer: Priority Health Narrow Network |
$67.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.23
|
|
|
HC COMP BURN GARM GAUNTLET TO AXI
|
Facility
|
IP
|
$95.72
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$71.79 |
| Max. Negotiated Rate |
$95.72 |
| Rate for Payer: Aetna Commercial |
$86.15
|
| Rate for Payer: ASR ASR |
$92.85
|
| Rate for Payer: BCBS Trust/PPO |
$78.61
|
| Rate for Payer: BCN Commercial |
$78.61
|
| Rate for Payer: Cash Price |
$76.58
|
| Rate for Payer: Cofinity Commercial |
$89.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.58
|
| Rate for Payer: Healthscope Commercial |
$92.85
|
| Rate for Payer: Healthscope Whirlpool |
$95.72
|
| Rate for Payer: Mclaren Commercial |
$86.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.36
|
| Rate for Payer: Nomi Health Commercial |
$78.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.23
|
|
|
HC COMP BURN GARM GAUNTLET TO WRI
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300028
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$36.41 |
| Rate for Payer: Aetna Commercial |
$32.77
|
| Rate for Payer: Aetna Medicare |
$13.47
|
| Rate for Payer: ASR ASR |
$35.32
|
| Rate for Payer: BCBS Complete |
$14.56
|
| Rate for Payer: BCBS Trust/PPO |
$30.02
|
| Rate for Payer: BCN Commercial |
$30.02
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$35.32
|
| Rate for Payer: Healthscope Whirlpool |
$36.41
|
| Rate for Payer: Mclaren Commercial |
$32.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$31.90
|
| Rate for Payer: Priority Health Narrow Network |
$25.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.04
|
|
|
HC COMP BURN GARM GAUNTLET TO WRI
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300028
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.31 |
| Max. Negotiated Rate |
$36.41 |
| Rate for Payer: Aetna Commercial |
$32.77
|
| Rate for Payer: ASR ASR |
$35.32
|
| Rate for Payer: BCBS Trust/PPO |
$29.90
|
| Rate for Payer: BCN Commercial |
$29.90
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$35.32
|
| Rate for Payer: Healthscope Whirlpool |
$36.41
|
| Rate for Payer: Mclaren Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.04
|
|
|
HC COMP BURN GARM GLOVE-ELBOW
|
Facility
|
IP
|
$166.46
|
|
|
Service Code
|
HCPCS A6505
|
| Hospital Charge Code |
98300030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$124.84 |
| Max. Negotiated Rate |
$166.46 |
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: ASR ASR |
$161.47
|
| Rate for Payer: BCBS Trust/PPO |
$136.70
|
| Rate for Payer: BCN Commercial |
$136.70
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cofinity Commercial |
$156.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.17
|
| Rate for Payer: Healthscope Commercial |
$161.47
|
| Rate for Payer: Healthscope Whirlpool |
$166.46
|
| Rate for Payer: Mclaren Commercial |
$149.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.49
|
| Rate for Payer: Nomi Health Commercial |
$136.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.48
|
|
|
HC COMP BURN GARM GLOVE-ELBOW
|
Facility
|
OP
|
$166.46
|
|
|
Service Code
|
HCPCS A6505
|
| Hospital Charge Code |
98300030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.59 |
| Max. Negotiated Rate |
$166.46 |
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: Aetna Medicare |
$61.59
|
| Rate for Payer: ASR ASR |
$161.47
|
| Rate for Payer: BCBS Complete |
$66.58
|
| Rate for Payer: BCBS Trust/PPO |
$137.25
|
| Rate for Payer: BCN Commercial |
$137.25
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cofinity Commercial |
$156.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.17
|
| Rate for Payer: Healthscope Commercial |
$161.47
|
| Rate for Payer: Healthscope Whirlpool |
$166.46
|
| Rate for Payer: Mclaren Commercial |
$149.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.49
|
| Rate for Payer: Nomi Health Commercial |
$136.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$145.85
|
| Rate for Payer: Priority Health Narrow Network |
$116.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.48
|
|
|
HC COMP BURN GARM GLOVE TO AXILLA
|
Facility
|
OP
|
$183.11
|
|
|
Service Code
|
HCPCS A6506
|
| Hospital Charge Code |
98300029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$67.75 |
| Max. Negotiated Rate |
$183.11 |
| Rate for Payer: Aetna Commercial |
$164.80
|
| Rate for Payer: Aetna Medicare |
$67.75
|
| Rate for Payer: ASR ASR |
$177.62
|
| Rate for Payer: BCBS Complete |
$73.24
|
| Rate for Payer: BCBS Trust/PPO |
$150.97
|
| Rate for Payer: BCN Commercial |
$150.97
|
| Rate for Payer: Cash Price |
$146.49
|
| Rate for Payer: Cofinity Commercial |
$172.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.49
|
| Rate for Payer: Healthscope Commercial |
$177.62
|
| Rate for Payer: Healthscope Whirlpool |
$183.11
|
| Rate for Payer: Mclaren Commercial |
$164.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.64
|
| Rate for Payer: Nomi Health Commercial |
$150.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$160.44
|
| Rate for Payer: Priority Health Narrow Network |
$128.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.14
|
|
|
HC COMP BURN GARM GLOVE TO AXILLA
|
Facility
|
IP
|
$183.11
|
|
|
Service Code
|
HCPCS A6506
|
| Hospital Charge Code |
98300029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$137.33 |
| Max. Negotiated Rate |
$183.11 |
| Rate for Payer: Aetna Commercial |
$164.80
|
| Rate for Payer: ASR ASR |
$177.62
|
| Rate for Payer: BCBS Trust/PPO |
$150.37
|
| Rate for Payer: BCN Commercial |
$150.37
|
| Rate for Payer: Cash Price |
$146.49
|
| Rate for Payer: Cofinity Commercial |
$172.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.49
|
| Rate for Payer: Healthscope Commercial |
$177.62
|
| Rate for Payer: Healthscope Whirlpool |
$183.11
|
| Rate for Payer: Mclaren Commercial |
$164.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.64
|
| Rate for Payer: Nomi Health Commercial |
$150.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.14
|
|
|
HC COMP BURN GARM GLOVE-WRIST
|
Facility
|
IP
|
$114.44
|
|
|
Service Code
|
HCPCS A6504
|
| Hospital Charge Code |
98300031
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$85.83 |
| Max. Negotiated Rate |
$114.44 |
| Rate for Payer: Aetna Commercial |
$103.00
|
| Rate for Payer: ASR ASR |
$111.01
|
| Rate for Payer: BCBS Trust/PPO |
$93.98
|
| Rate for Payer: BCN Commercial |
$93.98
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cofinity Commercial |
$107.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.55
|
| Rate for Payer: Healthscope Commercial |
$111.01
|
| Rate for Payer: Healthscope Whirlpool |
$114.44
|
| Rate for Payer: Mclaren Commercial |
$103.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.27
|
| Rate for Payer: Nomi Health Commercial |
$93.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.71
|
|
|
HC COMP BURN GARM GLOVE-WRIST
|
Facility
|
OP
|
$114.44
|
|
|
Service Code
|
HCPCS A6504
|
| Hospital Charge Code |
98300031
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.34 |
| Max. Negotiated Rate |
$114.44 |
| Rate for Payer: Aetna Commercial |
$103.00
|
| Rate for Payer: Aetna Medicare |
$42.34
|
| Rate for Payer: ASR ASR |
$111.01
|
| Rate for Payer: BCBS Complete |
$45.78
|
| Rate for Payer: BCBS Trust/PPO |
$94.36
|
| Rate for Payer: BCN Commercial |
$94.36
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cofinity Commercial |
$107.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.55
|
| Rate for Payer: Healthscope Commercial |
$111.01
|
| Rate for Payer: Healthscope Whirlpool |
$114.44
|
| Rate for Payer: Mclaren Commercial |
$103.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.27
|
| Rate for Payer: Nomi Health Commercial |
$93.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$100.27
|
| Rate for Payer: Priority Health Narrow Network |
$80.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.71
|
|
|
HC COMP BURN GARM HEAD BAND
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300032
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.21 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: BCBS Trust/PPO |
$34.18
|
| Rate for Payer: BCN Commercial |
$34.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$40.37
|
| Rate for Payer: Healthscope Whirlpool |
$41.62
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
|
|
HC COMP BURN GARM HEAD BAND
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300032
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: Aetna Medicare |
$15.40
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: BCBS Complete |
$16.65
|
| Rate for Payer: BCBS Trust/PPO |
$34.32
|
| Rate for Payer: BCN Commercial |
$34.32
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$40.37
|
| Rate for Payer: Healthscope Whirlpool |
$41.62
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$36.47
|
| Rate for Payer: Priority Health Narrow Network |
$29.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
|
|
HC COMP BURN GARM HOOK&LOOP SNAP
|
Facility
|
IP
|
$14.57
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$14.57 |
| Rate for Payer: Aetna Commercial |
$13.11
|
| Rate for Payer: ASR ASR |
$14.13
|
| Rate for Payer: BCBS Trust/PPO |
$11.96
|
| Rate for Payer: BCN Commercial |
$11.96
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$13.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$14.13
|
| Rate for Payer: Healthscope Whirlpool |
$14.57
|
| Rate for Payer: Mclaren Commercial |
$13.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Nomi Health Commercial |
$11.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.82
|
|
|
HC COMP BURN GARM HOOK&LOOP SNAP
|
Facility
|
OP
|
$14.57
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$14.57 |
| Rate for Payer: Aetna Commercial |
$13.11
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: ASR ASR |
$14.13
|
| Rate for Payer: BCBS Complete |
$5.83
|
| Rate for Payer: BCBS Trust/PPO |
$12.01
|
| Rate for Payer: BCN Commercial |
$12.01
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$13.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$14.13
|
| Rate for Payer: Healthscope Whirlpool |
$14.57
|
| Rate for Payer: Mclaren Commercial |
$13.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Nomi Health Commercial |
$11.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12.77
|
| Rate for Payer: Priority Health Narrow Network |
$10.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.82
|
|
|
HC COMP BURN GARM HOOK&LOOP TAB S
|
Facility
|
OP
|
$8.32
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$8.32 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Medicare |
$3.08
|
| Rate for Payer: ASR ASR |
$8.07
|
| Rate for Payer: BCBS Complete |
$3.33
|
| Rate for Payer: BCBS Trust/PPO |
$6.86
|
| Rate for Payer: BCN Commercial |
$6.86
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$7.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Healthscope Commercial |
$8.07
|
| Rate for Payer: Healthscope Whirlpool |
$8.32
|
| Rate for Payer: Mclaren Commercial |
$7.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.07
|
| Rate for Payer: Nomi Health Commercial |
$6.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.29
|
| Rate for Payer: Priority Health Narrow Network |
$5.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.32
|
|
|
HC COMP BURN GARM HOOK&LOOP TAB S
|
Facility
|
IP
|
$8.32
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$8.32 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: ASR ASR |
$8.07
|
| Rate for Payer: BCBS Trust/PPO |
$6.83
|
| Rate for Payer: BCN Commercial |
$6.83
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$7.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Healthscope Commercial |
$8.07
|
| Rate for Payer: Healthscope Whirlpool |
$8.32
|
| Rate for Payer: Mclaren Commercial |
$7.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.07
|
| Rate for Payer: Nomi Health Commercial |
$6.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.32
|
|
