|
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
|
|
|
HC COMP BURN GARM ELECTIVE ALTERA
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: Aetna Medicare |
$10.20
|
| Rate for Payer: ASR ASR |
$19.79
|
| Rate for Payer: ASR Commercial |
$19.79
|
| Rate for Payer: BCBS Complete |
$8.16
|
| Rate for Payer: BCBS Trust/PPO |
$16.71
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.34
|
| Rate for Payer: Nomi Health Commercial |
$16.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.87
|
| Rate for Payer: Priority Health Narrow Network |
$14.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
|
|
HC COMP BURN GARM ELECTIVE ALTERA
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: ASR ASR |
$19.79
|
| Rate for Payer: ASR Commercial |
$19.79
|
| Rate for Payer: BCBS Trust/PPO |
$16.62
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.34
|
| Rate for Payer: Nomi Health Commercial |
$16.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
|
|
HC COMP BURN GARM EXPANSION PANEL
|
Facility
|
IP
|
$28.56
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.56 |
| Max. Negotiated Rate |
$28.56 |
| Rate for Payer: Aetna Commercial |
$25.70
|
| Rate for Payer: ASR ASR |
$27.70
|
| Rate for Payer: ASR Commercial |
$27.70
|
| Rate for Payer: BCBS Trust/PPO |
$23.27
|
| Rate for Payer: BCN Commercial |
$22.14
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$26.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.85
|
| Rate for Payer: Healthscope Commercial |
$28.56
|
| Rate for Payer: Healthscope Whirlpool |
$27.70
|
| Rate for Payer: Mclaren Commercial |
$25.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.28
|
| Rate for Payer: Nomi Health Commercial |
$23.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.13
|
|
|
HC COMP BURN GARM EXPANSION PANEL
|
Facility
|
OP
|
$28.56
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.42 |
| Max. Negotiated Rate |
$28.56 |
| Rate for Payer: Aetna Commercial |
$25.70
|
| Rate for Payer: Aetna Medicare |
$14.28
|
| Rate for Payer: ASR ASR |
$27.70
|
| Rate for Payer: ASR Commercial |
$27.70
|
| Rate for Payer: BCBS Complete |
$11.42
|
| Rate for Payer: BCBS Trust/PPO |
$23.39
|
| Rate for Payer: BCN Commercial |
$22.14
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$26.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.85
|
| Rate for Payer: Healthscope Commercial |
$28.56
|
| Rate for Payer: Healthscope Whirlpool |
$27.70
|
| Rate for Payer: Mclaren Commercial |
$25.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.28
|
| Rate for Payer: Nomi Health Commercial |
$23.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.02
|
| Rate for Payer: Priority Health Narrow Network |
$20.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.13
|
|
|
HC COMP BURN GARM FACE MASK
|
Facility
|
OP
|
$136.68
|
|
|
Service Code
|
HCPCS A6503
|
| Hospital Charge Code |
98300159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.67 |
| Max. Negotiated Rate |
$136.68 |
| Rate for Payer: Aetna Commercial |
$123.01
|
| Rate for Payer: Aetna Medicare |
$68.34
|
| Rate for Payer: ASR ASR |
$132.58
|
| Rate for Payer: ASR Commercial |
$132.58
|
| Rate for Payer: BCBS Complete |
$54.67
|
| Rate for Payer: BCBS Trust/PPO |
$111.93
|
| Rate for Payer: BCN Commercial |
$105.97
|
| Rate for Payer: Cash Price |
$109.34
|
| Rate for Payer: Cofinity Commercial |
$128.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.34
|
| Rate for Payer: Healthscope Commercial |
$136.68
|
| Rate for Payer: Healthscope Whirlpool |
$132.58
|
| Rate for Payer: Mclaren Commercial |
$123.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.18
|
| Rate for Payer: Nomi Health Commercial |
$112.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.76
|
| Rate for Payer: Priority Health Narrow Network |
$95.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.28
|
|
|
HC COMP BURN GARM FACE MASK
|
Facility
|
IP
|
$136.68
|
|
|
Service Code
|
HCPCS A6503
|
| Hospital Charge Code |
98300159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$88.84 |
| Max. Negotiated Rate |
$136.68 |
| Rate for Payer: Aetna Commercial |
$123.01
|
| Rate for Payer: ASR ASR |
$132.58
|
| Rate for Payer: ASR Commercial |
$132.58
|
| Rate for Payer: BCBS Trust/PPO |
$111.38
|
| Rate for Payer: BCN Commercial |
$105.97
|
| Rate for Payer: Cash Price |
$109.34
|
| Rate for Payer: Cofinity Commercial |
$128.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.34
|
| Rate for Payer: Healthscope Commercial |
$136.68
|
| Rate for Payer: Healthscope Whirlpool |
$132.58
|
| Rate for Payer: Mclaren Commercial |
$123.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.18
|
| Rate for Payer: Nomi Health Commercial |
$112.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.28
|
|
|
HC COMP BURN GARM FOOT GAUNTLET
|
Facility
|
IP
|
$34.68
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300160
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$34.68 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: ASR ASR |
$33.64
|
| Rate for Payer: ASR Commercial |
$33.64
|
| Rate for Payer: BCBS Trust/PPO |
$28.26
|
| Rate for Payer: BCN Commercial |
$26.89
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$32.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.74
|
| Rate for Payer: Healthscope Commercial |
$34.68
|
| Rate for Payer: Healthscope Whirlpool |
$33.64
|
| Rate for Payer: Mclaren Commercial |
$31.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.48
|
| Rate for Payer: Nomi Health Commercial |
$28.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.52
|
|
|
HC COMP BURN GARM FOOT GAUNTLET
|
Facility
|
OP
|
$34.68
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300160
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$34.68 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna Medicare |
$17.34
|
| Rate for Payer: ASR ASR |
$33.64
|
| Rate for Payer: ASR Commercial |
$33.64
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS Trust/PPO |
$28.40
|
| Rate for Payer: BCN Commercial |
$26.89
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$32.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.74
|
| Rate for Payer: Healthscope Commercial |
$34.68
|
| Rate for Payer: Healthscope Whirlpool |
$33.64
|
| Rate for Payer: Mclaren Commercial |
$31.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.48
|
| Rate for Payer: Nomi Health Commercial |
$28.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.39
|
| Rate for Payer: Priority Health Narrow Network |
$24.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.52
|
|
|
HC COMP BURN GARM FOOT GLOVE
|
Facility
|
OP
|
$112.20
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.88 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Aetna Commercial |
$100.98
|
| Rate for Payer: Aetna Medicare |
$56.10
|
| Rate for Payer: ASR ASR |
$108.83
|
| Rate for Payer: ASR Commercial |
$108.83
|
| Rate for Payer: BCBS Complete |
$44.88
|
| Rate for Payer: BCBS Trust/PPO |
$91.88
|
| Rate for Payer: BCN Commercial |
$86.99
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$105.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Healthscope Commercial |
$112.20
|
| Rate for Payer: Healthscope Whirlpool |
$108.83
|
| Rate for Payer: Mclaren Commercial |
$100.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: Nomi Health Commercial |
$92.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.31
|
| Rate for Payer: Priority Health Narrow Network |
$78.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.74
|
|
|
HC COMP BURN GARM FOOT GLOVE
|
Facility
|
IP
|
$112.20
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$72.93 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Aetna Commercial |
$100.98
|
| Rate for Payer: ASR ASR |
$108.83
|
| Rate for Payer: ASR Commercial |
$108.83
|
| Rate for Payer: BCBS Trust/PPO |
$91.43
|
| Rate for Payer: BCN Commercial |
$86.99
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$105.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Healthscope Commercial |
$112.20
|
| Rate for Payer: Healthscope Whirlpool |
$108.83
|
| Rate for Payer: Mclaren Commercial |
$100.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: Nomi Health Commercial |
$92.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.74
|
|
|
HC COMP BURN GARM FOOT MITTEN
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.67 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: ASR Commercial |
$89.05
|
| Rate for Payer: BCBS Trust/PPO |
$74.81
|
| Rate for Payer: BCN Commercial |
$71.17
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
|
|
HC COMP BURN GARM FOOT MITTEN
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.72 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: ASR Commercial |
$89.05
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS Trust/PPO |
$75.18
|
| Rate for Payer: BCN Commercial |
$71.17
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.44
|
| Rate for Payer: Priority Health Narrow Network |
$64.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
|
|
HC COMP BURN GARM FULLY LINED GAR
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna Commercial |
$0.92
|
| Rate for Payer: ASR ASR |
$0.99
|
| Rate for Payer: ASR Commercial |
$0.99
|
| Rate for Payer: BCBS Trust/PPO |
$0.83
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$1.02
|
| Rate for Payer: Healthscope Whirlpool |
$0.99
|
| Rate for Payer: Mclaren Commercial |
$0.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.87
|
| Rate for Payer: Nomi Health Commercial |
$0.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.90
|
|
|
HC COMP BURN GARM FULLY LINED GAR
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna Commercial |
$0.92
|
| Rate for Payer: Aetna Medicare |
$0.51
|
| Rate for Payer: ASR ASR |
$0.99
|
| Rate for Payer: ASR Commercial |
$0.99
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS Trust/PPO |
$0.84
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$1.02
|
| Rate for Payer: Healthscope Whirlpool |
$0.99
|
| Rate for Payer: Mclaren Commercial |
$0.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.87
|
| Rate for Payer: Nomi Health Commercial |
$0.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.89
|
| Rate for Payer: Priority Health Narrow Network |
$0.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.90
|
|
|
HC COMP BURN GARM GAUNTLET TO AXI
|
Facility
|
IP
|
$93.84
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$84.46
|
| Rate for Payer: ASR ASR |
$91.02
|
| Rate for Payer: ASR Commercial |
$91.02
|
| Rate for Payer: BCBS Trust/PPO |
$76.47
|
| Rate for Payer: BCN Commercial |
$72.75
|
| Rate for Payer: Cash Price |
$75.07
|
| Rate for Payer: Cofinity Commercial |
$88.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.07
|
| Rate for Payer: Healthscope Commercial |
$93.84
|
| Rate for Payer: Healthscope Whirlpool |
$91.02
|
| Rate for Payer: Mclaren Commercial |
$84.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.76
|
| Rate for Payer: Nomi Health Commercial |
$76.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.58
|
|
|
HC COMP BURN GARM GAUNTLET TO AXI
|
Facility
|
OP
|
$93.84
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.54 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$84.46
|
| Rate for Payer: Aetna Medicare |
$46.92
|
| Rate for Payer: ASR ASR |
$91.02
|
| Rate for Payer: ASR Commercial |
$91.02
|
| Rate for Payer: BCBS Complete |
$37.54
|
| Rate for Payer: BCBS Trust/PPO |
$76.85
|
| Rate for Payer: BCN Commercial |
$72.75
|
| Rate for Payer: Cash Price |
$75.07
|
| Rate for Payer: Cofinity Commercial |
$88.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.07
|
| Rate for Payer: Healthscope Commercial |
$93.84
|
| Rate for Payer: Healthscope Whirlpool |
$91.02
|
| Rate for Payer: Mclaren Commercial |
$84.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.76
|
| Rate for Payer: Nomi Health Commercial |
$76.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.22
|
| Rate for Payer: Priority Health Narrow Network |
$65.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.58
|
|
|
HC COMP BURN GARM GAUNTLET TO WRI
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300028
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: Aetna Medicare |
$17.85
|
| Rate for Payer: ASR ASR |
$34.63
|
| Rate for Payer: ASR Commercial |
$34.63
|
| Rate for Payer: BCBS Complete |
$14.28
|
| Rate for Payer: BCBS Trust/PPO |
$29.23
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$35.70
|
| Rate for Payer: Healthscope Whirlpool |
$34.63
|
| Rate for Payer: Mclaren Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: Nomi Health Commercial |
$29.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.28
|
| Rate for Payer: Priority Health Narrow Network |
$25.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.42
|
|
|
HC COMP BURN GARM GAUNTLET TO WRI
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300028
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: ASR ASR |
$34.63
|
| Rate for Payer: ASR Commercial |
$34.63
|
| Rate for Payer: BCBS Trust/PPO |
$29.09
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$35.70
|
| Rate for Payer: Healthscope Whirlpool |
$34.63
|
| Rate for Payer: Mclaren Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: Nomi Health Commercial |
$29.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.42
|
|
|
HC COMP BURN GARM GLOVE-ELBOW
|
Facility
|
IP
|
$163.20
|
|
|
Service Code
|
HCPCS A6505
|
| Hospital Charge Code |
98300030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$146.88
|
| Rate for Payer: ASR ASR |
$158.30
|
| Rate for Payer: ASR Commercial |
$158.30
|
| Rate for Payer: BCBS Trust/PPO |
$132.99
|
| Rate for Payer: BCN Commercial |
$126.53
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cofinity Commercial |
$153.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.56
|
| Rate for Payer: Healthscope Commercial |
$163.20
|
| Rate for Payer: Healthscope Whirlpool |
$158.30
|
| Rate for Payer: Mclaren Commercial |
$146.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.72
|
| Rate for Payer: Nomi Health Commercial |
$133.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.62
|
|
|
HC COMP BURN GARM GLOVE-ELBOW
|
Facility
|
OP
|
$163.20
|
|
|
Service Code
|
HCPCS A6505
|
| Hospital Charge Code |
98300030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$65.28 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$146.88
|
| Rate for Payer: Aetna Medicare |
$81.60
|
| Rate for Payer: ASR ASR |
$158.30
|
| Rate for Payer: ASR Commercial |
$158.30
|
| Rate for Payer: BCBS Complete |
$65.28
|
| Rate for Payer: BCBS Trust/PPO |
$133.64
|
| Rate for Payer: BCN Commercial |
$126.53
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cofinity Commercial |
$153.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.56
|
| Rate for Payer: Healthscope Commercial |
$163.20
|
| Rate for Payer: Healthscope Whirlpool |
$158.30
|
| Rate for Payer: Mclaren Commercial |
$146.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.72
|
| Rate for Payer: Nomi Health Commercial |
$133.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.00
|
| Rate for Payer: Priority Health Narrow Network |
$114.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.62
|
|
|
HC COMP BURN GARM GLOVE TO AXILLA
|
Facility
|
IP
|
$179.52
|
|
|
Service Code
|
HCPCS A6506
|
| Hospital Charge Code |
98300029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.69 |
| Max. Negotiated Rate |
$179.52 |
| Rate for Payer: Aetna Commercial |
$161.57
|
| Rate for Payer: ASR ASR |
$174.13
|
| Rate for Payer: ASR Commercial |
$174.13
|
| Rate for Payer: BCBS Trust/PPO |
$146.29
|
| Rate for Payer: BCN Commercial |
$139.18
|
| Rate for Payer: Cash Price |
$143.62
|
| Rate for Payer: Cofinity Commercial |
$168.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.62
|
| Rate for Payer: Healthscope Commercial |
$179.52
|
| Rate for Payer: Healthscope Whirlpool |
$174.13
|
| Rate for Payer: Mclaren Commercial |
$161.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.59
|
| Rate for Payer: Nomi Health Commercial |
$147.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.98
|
|
|
HC COMP BURN GARM GLOVE TO AXILLA
|
Facility
|
OP
|
$179.52
|
|
|
Service Code
|
HCPCS A6506
|
| Hospital Charge Code |
98300029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$71.81 |
| Max. Negotiated Rate |
$179.52 |
| Rate for Payer: Aetna Commercial |
$161.57
|
| Rate for Payer: Aetna Medicare |
$89.76
|
| Rate for Payer: ASR ASR |
$174.13
|
| Rate for Payer: ASR Commercial |
$174.13
|
| Rate for Payer: BCBS Complete |
$71.81
|
| Rate for Payer: BCBS Trust/PPO |
$147.01
|
| Rate for Payer: BCN Commercial |
$139.18
|
| Rate for Payer: Cash Price |
$143.62
|
| Rate for Payer: Cofinity Commercial |
$168.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.62
|
| Rate for Payer: Healthscope Commercial |
$179.52
|
| Rate for Payer: Healthscope Whirlpool |
$174.13
|
| Rate for Payer: Mclaren Commercial |
$161.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.59
|
| Rate for Payer: Nomi Health Commercial |
$147.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.30
|
| Rate for Payer: Priority Health Narrow Network |
$125.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.98
|
|
|
HC COMP BURN GARM GLOVE-WRIST
|
Facility
|
OP
|
$112.20
|
|
|
Service Code
|
HCPCS A6504
|
| Hospital Charge Code |
98300031
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.88 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Aetna Commercial |
$100.98
|
| Rate for Payer: Aetna Medicare |
$56.10
|
| Rate for Payer: ASR ASR |
$108.83
|
| Rate for Payer: ASR Commercial |
$108.83
|
| Rate for Payer: BCBS Complete |
$44.88
|
| Rate for Payer: BCBS Trust/PPO |
$91.88
|
| Rate for Payer: BCN Commercial |
$86.99
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$105.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Healthscope Commercial |
$112.20
|
| Rate for Payer: Healthscope Whirlpool |
$108.83
|
| Rate for Payer: Mclaren Commercial |
$100.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: Nomi Health Commercial |
$92.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.31
|
| Rate for Payer: Priority Health Narrow Network |
$78.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.74
|
|
|
HC COMP BURN GARM GLOVE-WRIST
|
Facility
|
IP
|
$112.20
|
|
|
Service Code
|
HCPCS A6504
|
| Hospital Charge Code |
98300031
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$72.93 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Aetna Commercial |
$100.98
|
| Rate for Payer: ASR ASR |
$108.83
|
| Rate for Payer: ASR Commercial |
$108.83
|
| Rate for Payer: BCBS Trust/PPO |
$91.43
|
| Rate for Payer: BCN Commercial |
$86.99
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$105.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Healthscope Commercial |
$112.20
|
| Rate for Payer: Healthscope Whirlpool |
$108.83
|
| Rate for Payer: Mclaren Commercial |
$100.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: Nomi Health Commercial |
$92.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.74
|
|
