|
HC COMP BURN GARM ABD REINFOR DBL
|
Facility
|
IP
|
$16.32
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300144
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$16.32 |
| Rate for Payer: Aetna Commercial |
$14.69
|
| Rate for Payer: ASR ASR |
$15.83
|
| Rate for Payer: ASR Commercial |
$15.83
|
| Rate for Payer: BCBS Trust/PPO |
$13.30
|
| Rate for Payer: BCN Commercial |
$12.65
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$16.32
|
| Rate for Payer: Healthscope Whirlpool |
$15.83
|
| Rate for Payer: Mclaren Commercial |
$14.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.87
|
| Rate for Payer: Nomi Health Commercial |
$13.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.36
|
|
|
HC COMP BURN GARM ABD REINFOR DBL
|
Facility
|
OP
|
$16.32
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300144
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$16.32 |
| Rate for Payer: Aetna Commercial |
$14.69
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: ASR ASR |
$15.83
|
| Rate for Payer: ASR Commercial |
$15.83
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: BCBS Trust/PPO |
$13.36
|
| Rate for Payer: BCN Commercial |
$12.65
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$16.32
|
| Rate for Payer: Healthscope Whirlpool |
$15.83
|
| Rate for Payer: Mclaren Commercial |
$14.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.87
|
| Rate for Payer: Nomi Health Commercial |
$13.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.30
|
| Rate for Payer: Priority Health Narrow Network |
$11.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.36
|
|
|
HC COMP BURN GARM ANKLET
|
Facility
|
OP
|
$63.24
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300145
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$63.24 |
| Rate for Payer: Aetna Commercial |
$56.92
|
| Rate for Payer: Aetna Medicare |
$31.62
|
| Rate for Payer: ASR ASR |
$61.34
|
| Rate for Payer: ASR Commercial |
$61.34
|
| Rate for Payer: BCBS Complete |
$25.30
|
| Rate for Payer: BCBS Trust/PPO |
$51.79
|
| Rate for Payer: BCN Commercial |
$49.03
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$59.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$63.24
|
| Rate for Payer: Healthscope Whirlpool |
$61.34
|
| Rate for Payer: Mclaren Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.41
|
| Rate for Payer: Priority Health Narrow Network |
$44.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.65
|
|
|
HC COMP BURN GARM ANKLET
|
Facility
|
IP
|
$63.24
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300145
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$63.24 |
| Rate for Payer: Aetna Commercial |
$56.92
|
| Rate for Payer: ASR ASR |
$61.34
|
| Rate for Payer: ASR Commercial |
$61.34
|
| Rate for Payer: BCBS Trust/PPO |
$51.53
|
| Rate for Payer: BCN Commercial |
$49.03
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$59.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$63.24
|
| Rate for Payer: Healthscope Whirlpool |
$61.34
|
| Rate for Payer: Mclaren Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.65
|
|
|
HC COMP BURN GARM BDY BRF SLVD LE
|
Facility
|
IP
|
$338.64
|
|
|
Service Code
|
HCPCS A6510
|
| Hospital Charge Code |
98300146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$220.12 |
| Max. Negotiated Rate |
$338.64 |
| Rate for Payer: Aetna Commercial |
$304.78
|
| Rate for Payer: ASR ASR |
$328.48
|
| Rate for Payer: ASR Commercial |
$328.48
|
| Rate for Payer: BCBS Trust/PPO |
$275.96
|
| Rate for Payer: BCN Commercial |
$262.55
|
| Rate for Payer: Cash Price |
$270.91
|
| Rate for Payer: Cofinity Commercial |
$318.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.91
|
| Rate for Payer: Healthscope Commercial |
$338.64
|
| Rate for Payer: Healthscope Whirlpool |
$328.48
|
| Rate for Payer: Mclaren Commercial |
$304.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.84
|
| Rate for Payer: Nomi Health Commercial |
$277.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.00
|
|
|
HC COMP BURN GARM BDY BRF SLVD LE
|
Facility
|
OP
|
$338.64
|
|
|
Service Code
|
HCPCS A6510
|
| Hospital Charge Code |
98300146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$135.46 |
| Max. Negotiated Rate |
$338.64 |
| Rate for Payer: Aetna Commercial |
$304.78
|
| Rate for Payer: Aetna Medicare |
$169.32
|
| Rate for Payer: ASR ASR |
$328.48
|
| Rate for Payer: ASR Commercial |
$328.48
|
| Rate for Payer: BCBS Complete |
$135.46
|
| Rate for Payer: BCBS Trust/PPO |
$277.31
|
| Rate for Payer: BCN Commercial |
$262.55
|
| Rate for Payer: Cash Price |
$270.91
|
| Rate for Payer: Cofinity Commercial |
$318.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.91
|
| Rate for Payer: Healthscope Commercial |
$338.64
|
| Rate for Payer: Healthscope Whirlpool |
$328.48
|
| Rate for Payer: Mclaren Commercial |
$304.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.84
|
| Rate for Payer: Nomi Health Commercial |
$277.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$296.72
|
| Rate for Payer: Priority Health Narrow Network |
$237.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.00
|
|
|
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 |
$16.32 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: Aetna Medicare |
$20.40
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: ASR Commercial |
$39.58
|
| Rate for Payer: BCBS Complete |
$16.32
|
| Rate for Payer: BCBS Trust/PPO |
$33.41
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: Nomi Health Commercial |
$33.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.75
|
| Rate for Payer: Priority Health Narrow Network |
$28.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
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 |
$26.52 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: ASR Commercial |
$39.58
|
| Rate for Payer: BCBS Trust/PPO |
$33.25
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: Nomi Health Commercial |
$33.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
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 |
$156.47 |
| Max. Negotiated Rate |
$240.72 |
| Rate for Payer: Aetna Commercial |
$216.65
|
| Rate for Payer: ASR ASR |
$233.50
|
| Rate for Payer: ASR Commercial |
$233.50
|
| Rate for Payer: BCBS Trust/PPO |
$196.16
|
| Rate for Payer: BCN Commercial |
$186.63
|
| Rate for Payer: Cash Price |
$192.58
|
| Rate for Payer: Cofinity Commercial |
$226.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.58
|
| Rate for Payer: Healthscope Commercial |
$240.72
|
| Rate for Payer: Healthscope Whirlpool |
$233.50
|
| Rate for Payer: Mclaren Commercial |
$216.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.61
|
| Rate for Payer: Nomi Health Commercial |
$197.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.83
|
|
|
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 |
$96.29 |
| Max. Negotiated Rate |
$240.72 |
| Rate for Payer: Aetna Commercial |
$216.65
|
| Rate for Payer: Aetna Medicare |
$120.36
|
| Rate for Payer: ASR ASR |
$233.50
|
| Rate for Payer: ASR Commercial |
$233.50
|
| Rate for Payer: BCBS Complete |
$96.29
|
| Rate for Payer: BCBS Trust/PPO |
$197.13
|
| Rate for Payer: BCN Commercial |
$186.63
|
| Rate for Payer: Cash Price |
$192.58
|
| Rate for Payer: Cofinity Commercial |
$226.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.58
|
| Rate for Payer: Healthscope Commercial |
$240.72
|
| Rate for Payer: Healthscope Whirlpool |
$233.50
|
| Rate for Payer: Mclaren Commercial |
$216.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.61
|
| Rate for Payer: Nomi Health Commercial |
$197.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.92
|
| Rate for Payer: Priority Health Narrow Network |
$168.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.83
|
|
|
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 |
$61.20 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: ASR ASR |
$148.41
|
| Rate for Payer: ASR Commercial |
$148.41
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$125.29
|
| Rate for Payer: BCN Commercial |
$118.62
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$143.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$153.00
|
| Rate for Payer: Healthscope Whirlpool |
$148.41
|
| Rate for Payer: Mclaren Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.06
|
| Rate for Payer: Priority Health Narrow Network |
$107.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.64
|
|
|
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 |
$99.45 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: ASR ASR |
$148.41
|
| Rate for Payer: ASR Commercial |
$148.41
|
| Rate for Payer: BCBS Trust/PPO |
$124.68
|
| Rate for Payer: BCN Commercial |
$118.62
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$143.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$153.00
|
| Rate for Payer: Healthscope Whirlpool |
$148.41
|
| Rate for Payer: Mclaren Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.64
|
|
|
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 |
$87.52 |
| Max. Negotiated Rate |
$134.64 |
| Rate for Payer: Aetna Commercial |
$121.18
|
| Rate for Payer: ASR ASR |
$130.60
|
| Rate for Payer: ASR Commercial |
$130.60
|
| Rate for Payer: BCBS Trust/PPO |
$109.72
|
| Rate for Payer: BCN Commercial |
$104.39
|
| Rate for Payer: Cash Price |
$107.71
|
| Rate for Payer: Cofinity Commercial |
$126.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.71
|
| Rate for Payer: Healthscope Commercial |
$134.64
|
| Rate for Payer: Healthscope Whirlpool |
$130.60
|
| Rate for Payer: Mclaren Commercial |
$121.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.44
|
| Rate for Payer: Nomi Health Commercial |
$110.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.48
|
|
|
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 |
$53.86 |
| Max. Negotiated Rate |
$134.64 |
| Rate for Payer: Aetna Commercial |
$121.18
|
| Rate for Payer: Aetna Medicare |
$67.32
|
| Rate for Payer: ASR ASR |
$130.60
|
| Rate for Payer: ASR Commercial |
$130.60
|
| Rate for Payer: BCBS Complete |
$53.86
|
| Rate for Payer: BCBS Trust/PPO |
$110.26
|
| Rate for Payer: BCN Commercial |
$104.39
|
| Rate for Payer: Cash Price |
$107.71
|
| Rate for Payer: Cofinity Commercial |
$126.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.71
|
| Rate for Payer: Healthscope Commercial |
$134.64
|
| Rate for Payer: Healthscope Whirlpool |
$130.60
|
| Rate for Payer: Mclaren Commercial |
$121.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.44
|
| Rate for Payer: Nomi Health Commercial |
$110.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.97
|
| Rate for Payer: Priority Health Narrow Network |
$94.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.48
|
|
|
HC COMP BURN GARM BRIEF
|
Facility
|
IP
|
$134.64
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$87.52 |
| Max. Negotiated Rate |
$134.64 |
| Rate for Payer: Aetna Commercial |
$121.18
|
| Rate for Payer: ASR ASR |
$130.60
|
| Rate for Payer: ASR Commercial |
$130.60
|
| Rate for Payer: BCBS Trust/PPO |
$109.72
|
| Rate for Payer: BCN Commercial |
$104.39
|
| Rate for Payer: Cash Price |
$107.71
|
| Rate for Payer: Cofinity Commercial |
$126.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.71
|
| Rate for Payer: Healthscope Commercial |
$134.64
|
| Rate for Payer: Healthscope Whirlpool |
$130.60
|
| Rate for Payer: Mclaren Commercial |
$121.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.44
|
| Rate for Payer: Nomi Health Commercial |
$110.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.48
|
|
|
HC COMP BURN GARM BRIEF
|
Facility
|
OP
|
$134.64
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$134.64 |
| Rate for Payer: Aetna Commercial |
$121.18
|
| Rate for Payer: Aetna Medicare |
$67.32
|
| Rate for Payer: ASR ASR |
$130.60
|
| Rate for Payer: ASR Commercial |
$130.60
|
| Rate for Payer: BCBS Complete |
$53.86
|
| Rate for Payer: BCBS Trust/PPO |
$110.26
|
| Rate for Payer: BCN Commercial |
$104.39
|
| Rate for Payer: Cash Price |
$107.71
|
| Rate for Payer: Cofinity Commercial |
$126.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.71
|
| Rate for Payer: Healthscope Commercial |
$134.64
|
| Rate for Payer: Healthscope Whirlpool |
$130.60
|
| Rate for Payer: Mclaren Commercial |
$121.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.44
|
| Rate for Payer: Nomi Health Commercial |
$110.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.97
|
| Rate for Payer: Priority Health Narrow Network |
$94.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.48
|
|
|
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 |
$31.82 |
| Max. Negotiated Rate |
$79.56 |
| Rate for Payer: Aetna Commercial |
$71.60
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: ASR ASR |
$77.17
|
| Rate for Payer: ASR Commercial |
$77.17
|
| Rate for Payer: BCBS Complete |
$31.82
|
| Rate for Payer: BCBS Trust/PPO |
$65.15
|
| Rate for Payer: BCN Commercial |
$61.68
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$74.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$79.56
|
| Rate for Payer: Healthscope Whirlpool |
$77.17
|
| Rate for Payer: Mclaren Commercial |
$71.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.63
|
| Rate for Payer: Nomi Health Commercial |
$65.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.71
|
| Rate for Payer: Priority Health Narrow Network |
$55.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.01
|
|
|
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 |
$51.71 |
| Max. Negotiated Rate |
$79.56 |
| Rate for Payer: Aetna Commercial |
$71.60
|
| Rate for Payer: ASR ASR |
$77.17
|
| Rate for Payer: ASR Commercial |
$77.17
|
| Rate for Payer: BCBS Trust/PPO |
$64.83
|
| Rate for Payer: BCN Commercial |
$61.68
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$74.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$79.56
|
| Rate for Payer: Healthscope Whirlpool |
$77.17
|
| Rate for Payer: Mclaren Commercial |
$71.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.63
|
| Rate for Payer: Nomi Health Commercial |
$65.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.01
|
|
|
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 |
$31.82 |
| Max. Negotiated Rate |
$79.56 |
| Rate for Payer: Aetna Commercial |
$71.60
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: ASR ASR |
$77.17
|
| Rate for Payer: ASR Commercial |
$77.17
|
| Rate for Payer: BCBS Complete |
$31.82
|
| Rate for Payer: BCBS Trust/PPO |
$65.15
|
| Rate for Payer: BCN Commercial |
$61.68
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$74.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$79.56
|
| Rate for Payer: Healthscope Whirlpool |
$77.17
|
| Rate for Payer: Mclaren Commercial |
$71.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.63
|
| Rate for Payer: Nomi Health Commercial |
$65.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.71
|
| Rate for Payer: Priority Health Narrow Network |
$55.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.01
|
|
|
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 |
$51.71 |
| Max. Negotiated Rate |
$79.56 |
| Rate for Payer: Aetna Commercial |
$71.60
|
| Rate for Payer: ASR ASR |
$77.17
|
| Rate for Payer: ASR Commercial |
$77.17
|
| Rate for Payer: BCBS Trust/PPO |
$64.83
|
| Rate for Payer: BCN Commercial |
$61.68
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$74.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$79.56
|
| Rate for Payer: Healthscope Whirlpool |
$77.17
|
| Rate for Payer: Mclaren Commercial |
$71.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.63
|
| Rate for Payer: Nomi Health Commercial |
$65.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.01
|
|
|
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 |
$16.32 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: Aetna Medicare |
$20.40
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: ASR Commercial |
$39.58
|
| Rate for Payer: BCBS Complete |
$16.32
|
| Rate for Payer: BCBS Trust/PPO |
$33.41
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: Nomi Health Commercial |
$33.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.75
|
| Rate for Payer: Priority Health Narrow Network |
$28.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
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 |
$26.52 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: ASR Commercial |
$39.58
|
| Rate for Payer: BCBS Trust/PPO |
$33.25
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: Nomi Health Commercial |
$33.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
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 |
$27.74 |
| Max. Negotiated Rate |
$69.36 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$34.68
|
| Rate for Payer: ASR ASR |
$67.28
|
| Rate for Payer: ASR Commercial |
$67.28
|
| Rate for Payer: BCBS Complete |
$27.74
|
| Rate for Payer: BCBS Trust/PPO |
$56.80
|
| Rate for Payer: BCN Commercial |
$53.77
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$69.36
|
| Rate for Payer: Healthscope Whirlpool |
$67.28
|
| Rate for Payer: Mclaren Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: Nomi Health Commercial |
$56.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.77
|
| Rate for Payer: Priority Health Narrow Network |
$48.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.04
|
|
|
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 |
$45.08 |
| Max. Negotiated Rate |
$69.36 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: ASR ASR |
$67.28
|
| Rate for Payer: ASR Commercial |
$67.28
|
| Rate for Payer: BCBS Trust/PPO |
$56.52
|
| Rate for Payer: BCN Commercial |
$53.77
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$69.36
|
| Rate for Payer: Healthscope Whirlpool |
$67.28
|
| Rate for Payer: Mclaren Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: Nomi Health Commercial |
$56.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.04
|
|
|
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 |
$26.52 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: ASR Commercial |
$39.58
|
| Rate for Payer: BCBS Trust/PPO |
$33.25
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: Nomi Health Commercial |
$33.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
