|
HC COMP BURN GARM LEG&CHAP TO WAI
|
Facility
|
IP
|
$216.40
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300036
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$162.30 |
| Max. Negotiated Rate |
$216.40 |
| Rate for Payer: Aetna Commercial |
$194.76
|
| Rate for Payer: ASR ASR |
$209.91
|
| Rate for Payer: BCBS Trust/PPO |
$177.71
|
| Rate for Payer: BCN Commercial |
$177.71
|
| Rate for Payer: Cash Price |
$173.12
|
| Rate for Payer: Cofinity Commercial |
$203.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.12
|
| Rate for Payer: Healthscope Commercial |
$209.91
|
| Rate for Payer: Healthscope Whirlpool |
$216.40
|
| Rate for Payer: Mclaren Commercial |
$194.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.94
|
| Rate for Payer: Nomi Health Commercial |
$177.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.43
|
|
|
HC COMP BURN GARM LEG&CHAP TO WAI
|
Facility
|
OP
|
$216.40
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300036
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.07 |
| Max. Negotiated Rate |
$216.40 |
| Rate for Payer: Aetna Commercial |
$194.76
|
| Rate for Payer: Aetna Medicare |
$80.07
|
| Rate for Payer: ASR ASR |
$209.91
|
| Rate for Payer: BCBS Complete |
$86.56
|
| Rate for Payer: BCBS Trust/PPO |
$178.42
|
| Rate for Payer: BCN Commercial |
$178.42
|
| Rate for Payer: Cash Price |
$173.12
|
| Rate for Payer: Cofinity Commercial |
$203.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.12
|
| Rate for Payer: Healthscope Commercial |
$209.91
|
| Rate for Payer: Healthscope Whirlpool |
$216.40
|
| Rate for Payer: Mclaren Commercial |
$194.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.94
|
| Rate for Payer: Nomi Health Commercial |
$177.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$189.61
|
| Rate for Payer: Priority Health Narrow Network |
$151.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.43
|
|
|
HC COMP BURN GARM LEG & PANTY
|
Facility
|
OP
|
$230.97
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$85.46 |
| Max. Negotiated Rate |
$230.97 |
| Rate for Payer: Aetna Commercial |
$207.87
|
| Rate for Payer: Aetna Medicare |
$85.46
|
| Rate for Payer: ASR ASR |
$224.04
|
| Rate for Payer: BCBS Complete |
$92.39
|
| Rate for Payer: BCBS Trust/PPO |
$190.43
|
| Rate for Payer: BCN Commercial |
$190.43
|
| Rate for Payer: Cash Price |
$184.78
|
| Rate for Payer: Cofinity Commercial |
$217.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.78
|
| Rate for Payer: Healthscope Commercial |
$224.04
|
| Rate for Payer: Healthscope Whirlpool |
$230.97
|
| Rate for Payer: Mclaren Commercial |
$207.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.32
|
| Rate for Payer: Nomi Health Commercial |
$189.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$202.38
|
| Rate for Payer: Priority Health Narrow Network |
$161.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.25
|
|
|
HC COMP BURN GARM LEG & PANTY
|
Facility
|
IP
|
$230.97
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$173.23 |
| Max. Negotiated Rate |
$230.97 |
| Rate for Payer: Aetna Commercial |
$207.87
|
| Rate for Payer: ASR ASR |
$224.04
|
| Rate for Payer: BCBS Trust/PPO |
$189.67
|
| Rate for Payer: BCN Commercial |
$189.67
|
| Rate for Payer: Cash Price |
$184.78
|
| Rate for Payer: Cofinity Commercial |
$217.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.78
|
| Rate for Payer: Healthscope Commercial |
$224.04
|
| Rate for Payer: Healthscope Whirlpool |
$230.97
|
| Rate for Payer: Mclaren Commercial |
$207.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.32
|
| Rate for Payer: Nomi Health Commercial |
$189.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.25
|
|
|
HC COMP BURN GARM LINING,POCKET,F
|
Facility
|
IP
|
$12.48
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300037
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: ASR ASR |
$12.11
|
| Rate for Payer: BCBS Trust/PPO |
$10.25
|
| Rate for Payer: BCN Commercial |
$10.25
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$11.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$12.11
|
| Rate for Payer: Healthscope Whirlpool |
$12.48
|
| Rate for Payer: Mclaren Commercial |
$11.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.98
|
|
|
HC COMP BURN GARM LINING,POCKET,F
|
Facility
|
OP
|
$12.48
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300037
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Medicare |
$4.62
|
| Rate for Payer: ASR ASR |
$12.11
|
| Rate for Payer: BCBS Complete |
$4.99
|
| Rate for Payer: BCBS Trust/PPO |
$10.29
|
| Rate for Payer: BCN Commercial |
$10.29
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$11.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$12.11
|
| Rate for Payer: Healthscope Whirlpool |
$12.48
|
| Rate for Payer: Mclaren Commercial |
$11.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10.93
|
| Rate for Payer: Priority Health Narrow Network |
$8.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.98
|
|
|
HC COMP BURN GARM MITTEN TO WRIST
|
Facility
|
OP
|
$70.75
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300038
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.18 |
| Max. Negotiated Rate |
$70.75 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: Aetna Medicare |
$26.18
|
| Rate for Payer: ASR ASR |
$68.63
|
| Rate for Payer: BCBS Complete |
$28.30
|
| Rate for Payer: BCBS Trust/PPO |
$58.33
|
| Rate for Payer: BCN Commercial |
$58.33
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$68.63
|
| Rate for Payer: Healthscope Whirlpool |
$70.75
|
| Rate for Payer: Mclaren Commercial |
$63.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$58.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$61.99
|
| Rate for Payer: Priority Health Narrow Network |
$49.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.26
|
|
|
HC COMP BURN GARM MITTEN TO WRIST
|
Facility
|
IP
|
$70.75
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300038
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.06 |
| Max. Negotiated Rate |
$70.75 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: ASR ASR |
$68.63
|
| Rate for Payer: BCBS Trust/PPO |
$58.10
|
| Rate for Payer: BCN Commercial |
$58.10
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$68.63
|
| Rate for Payer: Healthscope Whirlpool |
$70.75
|
| Rate for Payer: Mclaren Commercial |
$63.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$58.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.26
|
|
|
HC COMP BURN GARM POCKET & PAD CO
|
Facility
|
IP
|
$14.57
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300039
|
|
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 POCKET & PAD CO
|
Facility
|
OP
|
$14.57
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300039
|
|
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 REINFORCEMENTS
|
Facility
|
IP
|
$12.48
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: ASR ASR |
$12.11
|
| Rate for Payer: BCBS Trust/PPO |
$10.25
|
| Rate for Payer: BCN Commercial |
$10.25
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$11.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$12.11
|
| Rate for Payer: Healthscope Whirlpool |
$12.48
|
| Rate for Payer: Mclaren Commercial |
$11.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.98
|
|
|
HC COMP BURN GARM REINFORCEMENTS
|
Facility
|
OP
|
$12.48
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Medicare |
$4.62
|
| Rate for Payer: ASR ASR |
$12.11
|
| Rate for Payer: BCBS Complete |
$4.99
|
| Rate for Payer: BCBS Trust/PPO |
$10.29
|
| Rate for Payer: BCN Commercial |
$10.29
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$11.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$12.11
|
| Rate for Payer: Healthscope Whirlpool |
$12.48
|
| Rate for Payer: Mclaren Commercial |
$11.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10.93
|
| Rate for Payer: Priority Health Narrow Network |
$8.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.98
|
|
|
HC COMP BURN GARM REINF SET HK&LO
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Medicare |
$3.85
|
| Rate for Payer: ASR ASR |
$10.09
|
| Rate for Payer: BCBS Complete |
$4.16
|
| Rate for Payer: BCBS Trust/PPO |
$8.57
|
| Rate for Payer: BCN Commercial |
$8.57
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$9.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$10.09
|
| Rate for Payer: Healthscope Whirlpool |
$10.40
|
| Rate for Payer: Mclaren Commercial |
$9.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.11
|
| Rate for Payer: Priority Health Narrow Network |
$7.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.15
|
|
|
HC COMP BURN GARM REINF SET HK&LO
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: ASR ASR |
$10.09
|
| Rate for Payer: BCBS Trust/PPO |
$8.54
|
| Rate for Payer: BCN Commercial |
$8.54
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$9.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$10.09
|
| Rate for Payer: Healthscope Whirlpool |
$10.40
|
| Rate for Payer: Mclaren Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.15
|
|
|
HC COMP BURN GARM SHOULD FLAP REG
|
Facility
|
OP
|
$35.37
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300042
|
|
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 SHOULD FLAP REG
|
Facility
|
IP
|
$35.37
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300042
|
|
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 SILON-TEX P/D-G
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: Aetna Medicare |
$23.10
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: BCBS Complete |
$24.97
|
| Rate for Payer: BCBS Trust/PPO |
$51.47
|
| Rate for Payer: BCN Commercial |
$51.47
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$60.55
|
| Rate for Payer: Healthscope Whirlpool |
$62.42
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.69
|
| Rate for Payer: Priority Health Narrow Network |
$43.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
|
|
HC COMP BURN GARM SILON-TEX P/D-G
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.81 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: BCBS Trust/PPO |
$51.26
|
| Rate for Payer: BCN Commercial |
$51.26
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$60.55
|
| Rate for Payer: Healthscope Whirlpool |
$62.42
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
|
|
HC COMP BURN GARM SILON-TEX UP TO
|
Facility
|
IP
|
$37.45
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.09 |
| Max. Negotiated Rate |
$37.45 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: ASR ASR |
$36.33
|
| Rate for Payer: BCBS Trust/PPO |
$30.75
|
| Rate for Payer: BCN Commercial |
$30.75
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$35.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$36.33
|
| Rate for Payer: Healthscope Whirlpool |
$37.45
|
| Rate for Payer: Mclaren Commercial |
$33.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$30.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.96
|
|
|
HC COMP BURN GARM SILON-TEX UP TO
|
Facility
|
OP
|
$37.45
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$37.45 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Medicare |
$13.86
|
| Rate for Payer: ASR ASR |
$36.33
|
| Rate for Payer: BCBS Complete |
$14.98
|
| Rate for Payer: BCBS Trust/PPO |
$30.88
|
| Rate for Payer: BCN Commercial |
$30.88
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$35.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$36.33
|
| Rate for Payer: Healthscope Whirlpool |
$37.45
|
| Rate for Payer: Mclaren Commercial |
$33.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$30.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$32.81
|
| Rate for Payer: Priority Health Narrow Network |
$26.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.96
|
|
|
HC COMP BURN GARM SILON-TEX WHOL
|
Facility
|
IP
|
$87.39
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300046
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$65.54 |
| Max. Negotiated Rate |
$87.39 |
| Rate for Payer: Aetna Commercial |
$78.65
|
| Rate for Payer: ASR ASR |
$84.77
|
| Rate for Payer: BCBS Trust/PPO |
$71.76
|
| Rate for Payer: BCN Commercial |
$71.76
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cofinity Commercial |
$82.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.91
|
| Rate for Payer: Healthscope Commercial |
$84.77
|
| Rate for Payer: Healthscope Whirlpool |
$87.39
|
| Rate for Payer: Mclaren Commercial |
$78.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.28
|
| Rate for Payer: Nomi Health Commercial |
$71.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.90
|
|
|
HC COMP BURN GARM SILON-TEX WHOL
|
Facility
|
OP
|
$87.39
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300046
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.33 |
| Max. Negotiated Rate |
$87.39 |
| Rate for Payer: Aetna Commercial |
$78.65
|
| Rate for Payer: Aetna Medicare |
$32.33
|
| Rate for Payer: ASR ASR |
$84.77
|
| Rate for Payer: BCBS Complete |
$34.96
|
| Rate for Payer: BCBS Trust/PPO |
$72.05
|
| Rate for Payer: BCN Commercial |
$72.05
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cofinity Commercial |
$82.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.91
|
| Rate for Payer: Healthscope Commercial |
$84.77
|
| Rate for Payer: Healthscope Whirlpool |
$87.39
|
| Rate for Payer: Mclaren Commercial |
$78.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.28
|
| Rate for Payer: Nomi Health Commercial |
$71.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$76.57
|
| Rate for Payer: Priority Health Narrow Network |
$61.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.90
|
|
|
HC COMP BURN GARM SLEEVE WRIST/AX
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300047
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.62 |
| Max. Negotiated Rate |
$72.83 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: ASR ASR |
$70.65
|
| Rate for Payer: BCBS Trust/PPO |
$59.81
|
| Rate for Payer: BCN Commercial |
$59.81
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$68.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$70.65
|
| Rate for Payer: Healthscope Whirlpool |
$72.83
|
| Rate for Payer: Mclaren Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.09
|
|
|
HC COMP BURN GARM SLEEVE WRIST/AX
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300047
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$72.83 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Medicare |
$26.95
|
| Rate for Payer: ASR ASR |
$70.65
|
| Rate for Payer: BCBS Complete |
$29.13
|
| Rate for Payer: BCBS Trust/PPO |
$60.05
|
| Rate for Payer: BCN Commercial |
$60.05
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$68.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$70.65
|
| Rate for Payer: Healthscope Whirlpool |
$72.83
|
| Rate for Payer: Mclaren Commercial |
$65.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$63.81
|
| Rate for Payer: Priority Health Narrow Network |
$51.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.09
|
|
|
HC COMP BURN GARM SLV WRST-ELB/EL
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300048
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.81 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: BCBS Trust/PPO |
$51.26
|
| Rate for Payer: BCN Commercial |
$51.26
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$60.55
|
| Rate for Payer: Healthscope Whirlpool |
$62.42
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
|
