Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC COLPOSCOPY, VULVA

Facility

$322.32

Service Code	CPT 56820
Hospital Charge Code	76100258
Hospital Revenue Code	761
Min. Negotiated Rate	$70.93
Max. Negotiated Rate	$290.09
Rate for Payer: Aetna Commercial	$273.97
Rate for Payer: Aetna Medicare	$184.40
Rate for Payer: Aetna New Business (MI Preferred)	$209.51
Rate for Payer: Allen County Amish Medical Aid Commercial	$221.64
Rate for Payer: Amish Plain Church Group Commercial	$221.64
Rate for Payer: BCBS Complete	$101.85
Rate for Payer: BCBS MAPPO	$177.31
Rate for Payer: BCBS Trust/PPO	$70.93
Rate for Payer: BCN Medicare Advantage	$177.31
Rate for Payer: Cash Price	$257.86
Rate for Payer: Cash Price	$257.86
Rate for Payer: Cofinity Commercial	$277.20
Rate for Payer: Cofinity Commercial	$225.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$177.31
Rate for Payer: Healthscope Commercial	$290.09
Rate for Payer: Mclaren Medicaid	$96.99
Rate for Payer: Mclaren Medicare	$177.31
Rate for Payer: Meridian Medicaid	$101.85
Rate for Payer: Meridian Wellcare - Medicare Advantage	$186.18
Rate for Payer: MI Amish Medical Board Commercial	$203.91
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$273.97
Rate for Payer: PACE Medicare	$168.44
Rate for Payer: PACE SWMI	$177.31
Rate for Payer: PHP Commercial	$273.97
Rate for Payer: PHP Medicare Advantage	$177.31
Rate for Payer: Priority Health Choice Medicaid	$96.99
Rate for Payer: Priority Health Cigna Priority Health	$225.62
Rate for Payer: Priority Health Medicare	$177.31
Rate for Payer: Priority Health SBD	$203.06
Rate for Payer: Railroad Medicare Medicare	$177.31
Rate for Payer: UHC All Payor (Choice/PPO)	$90.77
Rate for Payer: UHC Dual Complete DSNP	$177.31
Rate for Payer: UHC Exchange	$82.52
Rate for Payer: UHC Medicare Advantage	$182.63
Rate for Payer: VA VA	$177.31

HC COLPOSCOPY, VULVA

Facility

$322.32

Service Code	CPT 56820
Hospital Charge Code	76100258
Hospital Revenue Code	761
Min. Negotiated Rate	$203.06
Max. Negotiated Rate	$290.09
Rate for Payer: Aetna Commercial	$273.97
Rate for Payer: Aetna New Business (MI Preferred)	$209.51
Rate for Payer: Cash Price	$257.86
Rate for Payer: Cofinity Commercial	$225.62
Rate for Payer: Cofinity Commercial	$277.20
Rate for Payer: Healthscope Commercial	$290.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$273.97
Rate for Payer: PHP Commercial	$273.97
Rate for Payer: Priority Health Cigna Priority Health	$225.62
Rate for Payer: Priority Health SBD	$203.06

HC COLPOSCOPY VULVA W/BIOPSY

Facility

$837.42

Service Code	CPT 56821
Hospital Charge Code	76100332
Hospital Revenue Code	761
Min. Negotiated Rate	$49.22
Max. Negotiated Rate	$753.68
Rate for Payer: Aetna Commercial	$711.81
Rate for Payer: Aetna Medicare	$296.87
Rate for Payer: Aetna New Business (MI Preferred)	$544.32
Rate for Payer: Allen County Amish Medical Aid Commercial	$356.81
Rate for Payer: Amish Plain Church Group Commercial	$356.81
Rate for Payer: BCBS Complete	$163.96
Rate for Payer: BCBS MAPPO	$285.45
Rate for Payer: BCBS Trust/PPO	$49.22
Rate for Payer: BCN Medicare Advantage	$285.45
Rate for Payer: Cash Price	$669.94
Rate for Payer: Cash Price	$669.94
Rate for Payer: Cofinity Commercial	$720.18
Rate for Payer: Cofinity Commercial	$586.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$285.45
Rate for Payer: Healthscope Commercial	$753.68
Rate for Payer: Mclaren Medicaid	$156.14
Rate for Payer: Mclaren Medicare	$285.45
Rate for Payer: Meridian Medicaid	$163.96
Rate for Payer: Meridian Wellcare - Medicare Advantage	$299.72
Rate for Payer: MI Amish Medical Board Commercial	$328.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$711.81
Rate for Payer: PACE Medicare	$271.18
Rate for Payer: PACE SWMI	$285.45
Rate for Payer: PHP Commercial	$711.81
Rate for Payer: PHP Medicare Advantage	$285.45
Rate for Payer: Priority Health Choice Medicaid	$156.14
Rate for Payer: Priority Health Cigna Priority Health	$586.19
Rate for Payer: Priority Health Medicare	$285.45
Rate for Payer: Priority Health SBD	$527.57
Rate for Payer: Railroad Medicare Medicare	$285.45
Rate for Payer: UHC All Payor (Choice/PPO)	$122.46
Rate for Payer: UHC Dual Complete DSNP	$285.45
Rate for Payer: UHC Exchange	$111.33
Rate for Payer: UHC Medicare Advantage	$294.01
Rate for Payer: VA VA	$285.45

HC COLPOSCOPY VULVA W/BIOPSY

Facility

$837.42

Service Code	CPT 56821
Hospital Charge Code	76100332
Hospital Revenue Code	761
Min. Negotiated Rate	$527.57
Max. Negotiated Rate	$753.68
Rate for Payer: Aetna Commercial	$711.81
Rate for Payer: Aetna New Business (MI Preferred)	$544.32
Rate for Payer: Cash Price	$669.94
Rate for Payer: Cofinity Commercial	$586.19
Rate for Payer: Cofinity Commercial	$720.18
Rate for Payer: Healthscope Commercial	$753.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$711.81
Rate for Payer: PHP Commercial	$711.81
Rate for Payer: Priority Health Cigna Priority Health	$586.19
Rate for Payer: Priority Health SBD	$527.57

HC COMBI CATH SUPPLY

Facility

$121.04

Hospital Charge Code	27200116
Hospital Revenue Code	272
Min. Negotiated Rate	$48.42
Max. Negotiated Rate	$108.94
Rate for Payer: Aetna Commercial	$102.88
Rate for Payer: Aetna New Business (MI Preferred)	$78.68
Rate for Payer: BCBS Complete	$48.42
Rate for Payer: Cash Price	$96.83
Rate for Payer: Cofinity Commercial	$104.09
Rate for Payer: Cofinity Commercial	$84.73
Rate for Payer: Healthscope Commercial	$108.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$102.88
Rate for Payer: PHP Commercial	$102.88
Rate for Payer: Priority Health Cigna Priority Health	$84.73
Rate for Payer: Priority Health SBD	$76.26

HC COMBI CATH SUPPLY

Facility

$121.04

Hospital Charge Code	27200116
Hospital Revenue Code	272
Min. Negotiated Rate	$76.26
Max. Negotiated Rate	$108.94
Rate for Payer: Aetna Commercial	$102.88
Rate for Payer: Aetna New Business (MI Preferred)	$78.68
Rate for Payer: Cash Price	$96.83
Rate for Payer: Cofinity Commercial	$104.09
Rate for Payer: Cofinity Commercial	$84.73
Rate for Payer: Healthscope Commercial	$108.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$102.88
Rate for Payer: PHP Commercial	$102.88
Rate for Payer: Priority Health Cigna Priority Health	$84.73
Rate for Payer: Priority Health SBD	$76.26

HC COMBINED VACCINE, MMR+VARICELLA, SUBQ

Facility

$209.10

Service Code	CPT 90710
Hospital Charge Code	63600206
Hospital Revenue Code	636
Min. Negotiated Rate	$67.78
Max. Negotiated Rate	$755.48
Rate for Payer: Aetna Commercial	$177.74
Rate for Payer: Aetna Medicare	$128.88
Rate for Payer: Aetna New Business (MI Preferred)	$135.92
Rate for Payer: Allen County Amish Medical Aid Commercial	$154.90
Rate for Payer: Amish Plain Church Group Commercial	$154.90
Rate for Payer: BCBS Complete	$71.18
Rate for Payer: BCBS MAPPO	$123.92
Rate for Payer: BCBS Trust/PPO	$755.48
Rate for Payer: BCN Medicare Advantage	$123.92
Rate for Payer: Cash Price	$167.28
Rate for Payer: Cash Price	$167.28
Rate for Payer: Cofinity Commercial	$146.37
Rate for Payer: Cofinity Commercial	$179.83
Rate for Payer: Health Alliance Plan Medicare Advantage	$123.92
Rate for Payer: Healthscope Commercial	$188.19
Rate for Payer: Mclaren Medicaid	$67.78
Rate for Payer: Mclaren Medicare	$123.92
Rate for Payer: Meridian Medicaid	$71.18
Rate for Payer: Meridian Wellcare - Medicare Advantage	$130.12
Rate for Payer: MI Amish Medical Board Commercial	$142.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$177.74
Rate for Payer: PACE Medicare	$117.72
Rate for Payer: PACE SWMI	$123.92
Rate for Payer: PHP Commercial	$177.74
Rate for Payer: PHP Medicare Advantage	$123.92
Rate for Payer: Priority Health Choice Medicaid	$67.78
Rate for Payer: Priority Health Cigna Priority Health	$146.37
Rate for Payer: Priority Health Medicare	$123.92
Rate for Payer: Priority Health SBD	$131.73
Rate for Payer: Railroad Medicare Medicare	$123.92
Rate for Payer: UHC Dual Complete DSNP	$123.92
Rate for Payer: UHC Medicare Advantage	$127.64
Rate for Payer: VA VA	$123.92

HC COMBINED VACCINE, MMR+VARICELLA, SUBQ

Facility

$209.10

Service Code	CPT 90710
Hospital Charge Code	63600206
Hospital Revenue Code	636
Min. Negotiated Rate	$131.73
Max. Negotiated Rate	$188.19
Rate for Payer: Aetna Commercial	$177.74
Rate for Payer: Aetna New Business (MI Preferred)	$135.92
Rate for Payer: Cash Price	$167.28
Rate for Payer: Cofinity Commercial	$179.83
Rate for Payer: Cofinity Commercial	$146.37
Rate for Payer: Healthscope Commercial	$188.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$177.74
Rate for Payer: PHP Commercial	$177.74
Rate for Payer: Priority Health Cigna Priority Health	$146.37
Rate for Payer: Priority Health SBD	$131.73

HC COMMON REED IGE

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200080
Hospital Revenue Code	302
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$22.40
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna New Business (MI Preferred)	$16.18
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cofinity Commercial	$21.41
Rate for Payer: Cofinity Commercial	$17.42
Rate for Payer: Healthscope Commercial	$22.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.16
Rate for Payer: PHP Commercial	$21.16
Rate for Payer: Priority Health Cigna Priority Health	$17.42
Rate for Payer: Priority Health SBD	$15.68

HC COMMON REED IGE

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200080
Hospital Revenue Code	302
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$22.40
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna Medicare	$5.43
Rate for Payer: Aetna New Business (MI Preferred)	$16.18
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.52
Rate for Payer: Amish Plain Church Group Commercial	$6.52
Rate for Payer: BCBS Complete	$3.00
Rate for Payer: BCBS MAPPO	$5.22
Rate for Payer: BCBS Trust/PPO	$4.09
Rate for Payer: BCN Medicare Advantage	$5.22
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cofinity Commercial	$17.42
Rate for Payer: Cofinity Commercial	$21.41
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.22
Rate for Payer: Healthscope Commercial	$22.40
Rate for Payer: Mclaren Medicaid	$2.86
Rate for Payer: Mclaren Medicare	$5.22
Rate for Payer: Meridian Medicaid	$3.00
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5.48
Rate for Payer: MI Amish Medical Board Commercial	$6.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.16
Rate for Payer: PACE Medicare	$4.96
Rate for Payer: PACE SWMI	$5.22
Rate for Payer: PHP Commercial	$21.16
Rate for Payer: PHP Medicare Advantage	$5.22
Rate for Payer: Priority Health Choice Medicaid	$2.86
Rate for Payer: Priority Health Cigna Priority Health	$17.42
Rate for Payer: Priority Health Medicare	$5.22
Rate for Payer: Priority Health SBD	$15.68
Rate for Payer: Railroad Medicare Medicare	$5.22
Rate for Payer: UHC All Payor (Choice/PPO)	$6.26
Rate for Payer: UHC Core	$8.87
Rate for Payer: UHC Dual Complete DSNP	$5.22
Rate for Payer: UHC Exchange	$5.22
Rate for Payer: UHC Medicare Advantage	$5.38
Rate for Payer: VA VA	$5.22

HC COMM WORK REINTEGRATION EA 15 MIN

Facility

$95.00

Service Code	CPT 97537
Hospital Charge Code	42000031
Hospital Revenue Code	420
Min. Negotiated Rate	$59.85
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna Commercial	$80.75
Rate for Payer: Aetna New Business (MI Preferred)	$61.75
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cofinity Commercial	$66.50
Rate for Payer: Cofinity Commercial	$81.70
Rate for Payer: Healthscope Commercial	$85.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$80.75
Rate for Payer: PHP Commercial	$80.75
Rate for Payer: Priority Health Cigna Priority Health	$66.50
Rate for Payer: Priority Health SBD	$59.85

HC COMM WORK REINTEGRATION EA 15 MIN

Facility

$95.00

Service Code	CPT 97537
Hospital Charge Code	42000031
Hospital Revenue Code	420
Min. Negotiated Rate	$21.22
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna Commercial	$80.75
Rate for Payer: Aetna New Business (MI Preferred)	$61.75
Rate for Payer: BCBS Complete	$38.00
Rate for Payer: BCBS Trust/PPO	$21.22
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cofinity Commercial	$66.50
Rate for Payer: Cofinity Commercial	$81.70
Rate for Payer: Healthscope Commercial	$85.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$80.75
Rate for Payer: PHP Commercial	$80.75
Rate for Payer: Priority Health Cigna Priority Health	$66.50
Rate for Payer: Priority Health SBD	$59.85
Rate for Payer: UHC All Payor (Choice/PPO)	$34.22
Rate for Payer: UHC Exchange	$31.11

HC COMPARTMENT PRESSURE CHECK

Facility

$645.71

Hospital Charge Code	27000045
Hospital Revenue Code	270
Min. Negotiated Rate	$258.28
Max. Negotiated Rate	$581.14
Rate for Payer: Aetna Commercial	$548.85
Rate for Payer: Aetna New Business (MI Preferred)	$419.71
Rate for Payer: BCBS Complete	$258.28
Rate for Payer: Cash Price	$516.57
Rate for Payer: Cofinity Commercial	$452.00
Rate for Payer: Cofinity Commercial	$555.31
Rate for Payer: Healthscope Commercial	$581.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$548.85
Rate for Payer: PHP Commercial	$548.85
Rate for Payer: Priority Health Cigna Priority Health	$452.00
Rate for Payer: Priority Health SBD	$406.80

HC COMPARTMENT PRESSURE CHECK

Facility

$645.71

Hospital Charge Code	27000045
Hospital Revenue Code	270
Min. Negotiated Rate	$406.80
Max. Negotiated Rate	$581.14
Rate for Payer: Aetna Commercial	$548.85
Rate for Payer: Aetna New Business (MI Preferred)	$419.71
Rate for Payer: Cash Price	$516.57
Rate for Payer: Cofinity Commercial	$452.00
Rate for Payer: Cofinity Commercial	$555.31
Rate for Payer: Healthscope Commercial	$581.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$548.85
Rate for Payer: PHP Commercial	$548.85
Rate for Payer: Priority Health Cigna Priority Health	$452.00
Rate for Payer: Priority Health SBD	$406.80

HC COMP BURN GARM 2 LEGS-WAIST

Facility

$234.00

Service Code	HCPCS A6511
Hospital Charge Code	98300142
Hospital Revenue Code	270
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$313.82
Rate for Payer: Aetna Commercial	$198.90
Rate for Payer: Aetna New Business (MI Preferred)	$152.10
Rate for Payer: BCBS Complete	$93.60
Rate for Payer: BCBS Trust/PPO	$313.82
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cofinity Commercial	$163.80
Rate for Payer: Cofinity Commercial	$201.24
Rate for Payer: Healthscope Commercial	$210.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$198.90
Rate for Payer: PHP Commercial	$198.90
Rate for Payer: Priority Health Cigna Priority Health	$163.80
Rate for Payer: Priority Health SBD	$147.42

HC COMP BURN GARM 2 LEGS-WAIST

Facility

$234.00

Service Code	HCPCS A6511
Hospital Charge Code	98300142
Hospital Revenue Code	270
Min. Negotiated Rate	$147.42
Max. Negotiated Rate	$210.60
Rate for Payer: Aetna Commercial	$198.90
Rate for Payer: Aetna New Business (MI Preferred)	$152.10
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cofinity Commercial	$163.80
Rate for Payer: Cofinity Commercial	$201.24
Rate for Payer: Healthscope Commercial	$210.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$198.90
Rate for Payer: PHP Commercial	$198.90
Rate for Payer: Priority Health Cigna Priority Health	$163.80
Rate for Payer: Priority Health SBD	$147.42

HC COMP BURN GARM 2 OR MORE FAB/C

Facility

$12.00

Service Code	HCPCS A6512
Hospital Charge Code	98300143
Hospital Revenue Code	270
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna Commercial	$10.20
Rate for Payer: Aetna New Business (MI Preferred)	$7.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cofinity Commercial	$10.32
Rate for Payer: Cofinity Commercial	$8.40
Rate for Payer: Healthscope Commercial	$10.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.20
Rate for Payer: PHP Commercial	$10.20
Rate for Payer: Priority Health Cigna Priority Health	$8.40
Rate for Payer: Priority Health SBD	$7.56

HC COMP BURN GARM 2 OR MORE FAB/C

Facility

$12.00

Service Code	HCPCS A6512
Hospital Charge Code	98300143
Hospital Revenue Code	270
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$10.20
Rate for Payer: Aetna New Business (MI Preferred)	$7.80
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cofinity Commercial	$10.32
Rate for Payer: Cofinity Commercial	$8.40
Rate for Payer: Healthscope Commercial	$10.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.20
Rate for Payer: PHP Commercial	$10.20
Rate for Payer: Priority Health Cigna Priority Health	$8.40
Rate for Payer: Priority Health SBD	$7.56

HC COMP BURN GARM ABD REINFOR DBL

Facility

$16.00

Service Code	HCPCS A6512
Hospital Charge Code	98300144
Hospital Revenue Code	270
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna Commercial	$13.60
Rate for Payer: Aetna New Business (MI Preferred)	$10.40
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cofinity Commercial	$11.20
Rate for Payer: Cofinity Commercial	$13.76
Rate for Payer: Healthscope Commercial	$14.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.60
Rate for Payer: PHP Commercial	$13.60
Rate for Payer: Priority Health Cigna Priority Health	$11.20
Rate for Payer: Priority Health SBD	$10.08

HC COMP BURN GARM ABD REINFOR DBL

Facility

$16.00

Service Code	HCPCS A6512
Hospital Charge Code	98300144
Hospital Revenue Code	270
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$13.60
Rate for Payer: Aetna New Business (MI Preferred)	$10.40
Rate for Payer: BCBS Complete	$6.40
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cofinity Commercial	$11.20
Rate for Payer: Cofinity Commercial	$13.76
Rate for Payer: Healthscope Commercial	$14.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.60
Rate for Payer: PHP Commercial	$13.60
Rate for Payer: Priority Health Cigna Priority Health	$11.20
Rate for Payer: Priority Health SBD	$10.08

HC COMP BURN GARM ANKLET

Facility

$62.00

Service Code	HCPCS A6512
Hospital Charge Code	98300145
Hospital Revenue Code	270
Min. Negotiated Rate	$24.80
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$52.70
Rate for Payer: Aetna New Business (MI Preferred)	$40.30
Rate for Payer: BCBS Complete	$24.80
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cofinity Commercial	$43.40
Rate for Payer: Cofinity Commercial	$53.32
Rate for Payer: Healthscope Commercial	$55.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52.70
Rate for Payer: PHP Commercial	$52.70
Rate for Payer: Priority Health Cigna Priority Health	$43.40
Rate for Payer: Priority Health SBD	$39.06

HC COMP BURN GARM ANKLET

Facility

$62.00

Service Code	HCPCS A6512
Hospital Charge Code	98300145
Hospital Revenue Code	270
Min. Negotiated Rate	$39.06
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna Commercial	$52.70
Rate for Payer: Aetna New Business (MI Preferred)	$40.30
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cofinity Commercial	$43.40
Rate for Payer: Cofinity Commercial	$53.32
Rate for Payer: Healthscope Commercial	$55.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52.70
Rate for Payer: PHP Commercial	$52.70
Rate for Payer: Priority Health Cigna Priority Health	$43.40
Rate for Payer: Priority Health SBD	$39.06

HC COMP BURN GARM BDY BRF SLVD LE

Facility

$332.00

Service Code	HCPCS A6510
Hospital Charge Code	98300146
Hospital Revenue Code	270
Min. Negotiated Rate	$209.16
Max. Negotiated Rate	$298.80
Rate for Payer: Aetna Commercial	$282.20
Rate for Payer: Aetna New Business (MI Preferred)	$215.80
Rate for Payer: Cash Price	$265.60
Rate for Payer: Cofinity Commercial	$232.40
Rate for Payer: Cofinity Commercial	$285.52
Rate for Payer: Healthscope Commercial	$298.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$282.20
Rate for Payer: PHP Commercial	$282.20
Rate for Payer: Priority Health Cigna Priority Health	$232.40
Rate for Payer: Priority Health SBD	$209.16

HC COMP BURN GARM BDY BRF SLVD LE

Facility

$332.00

Service Code	HCPCS A6510
Hospital Charge Code	98300146
Hospital Revenue Code	270
Min. Negotiated Rate	$132.80
Max. Negotiated Rate	$575.33
Rate for Payer: Aetna Commercial	$282.20
Rate for Payer: Aetna New Business (MI Preferred)	$215.80
Rate for Payer: BCBS Complete	$132.80
Rate for Payer: BCBS Trust/PPO	$575.33
Rate for Payer: Cash Price	$265.60
Rate for Payer: Cash Price	$265.60
Rate for Payer: Cofinity Commercial	$232.40
Rate for Payer: Cofinity Commercial	$285.52
Rate for Payer: Healthscope Commercial	$298.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$282.20
Rate for Payer: PHP Commercial	$282.20
Rate for Payer: Priority Health Cigna Priority Health	$232.40
Rate for Payer: Priority Health SBD	$209.16

HC COMP BURN GARM BELLY BAND

Facility

$40.00

Service Code	HCPCS A6512
Hospital Charge Code	98300147
Hospital Revenue Code	270
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$34.00
Rate for Payer: Aetna New Business (MI Preferred)	$26.00
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cofinity Commercial	$28.00
Rate for Payer: Cofinity Commercial	$34.40
Rate for Payer: Healthscope Commercial	$36.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$34.00
Rate for Payer: PHP Commercial	$34.00
Rate for Payer: Priority Health Cigna Priority Health	$28.00
Rate for Payer: Priority Health SBD	$25.20

Know your out-of-pocket cost for care.

All Charges