Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC COMP BURN GARM BELLY BAND

Facility

$40.00

Service Code	HCPCS A6512
Hospital Charge Code	98300147
Hospital Revenue Code	270
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$34.00
Rate for Payer: Aetna New Business (MI Preferred)	$26.00
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

HC COMP BURN GARM BODY BRF SLEEVE

Facility

$236.00

Service Code	HCPCS A6512
Hospital Charge Code	98300148
Hospital Revenue Code	270
Min. Negotiated Rate	$94.40
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$200.60
Rate for Payer: Aetna New Business (MI Preferred)	$153.40
Rate for Payer: BCBS Complete	$94.40
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cofinity Commercial	$165.20
Rate for Payer: Cofinity Commercial	$202.96
Rate for Payer: Healthscope Commercial	$212.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$200.60
Rate for Payer: PHP Commercial	$200.60
Rate for Payer: Priority Health Cigna Priority Health	$165.20
Rate for Payer: Priority Health SBD	$148.68

HC COMP BURN GARM BODY BRF SLEEVE

Facility

$236.00

Service Code	HCPCS A6512
Hospital Charge Code	98300148
Hospital Revenue Code	270
Min. Negotiated Rate	$148.68
Max. Negotiated Rate	$212.40
Rate for Payer: Aetna Commercial	$200.60
Rate for Payer: Aetna New Business (MI Preferred)	$153.40
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cofinity Commercial	$165.20
Rate for Payer: Cofinity Commercial	$202.96
Rate for Payer: Healthscope Commercial	$212.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$200.60
Rate for Payer: PHP Commercial	$200.60
Rate for Payer: Priority Health Cigna Priority Health	$165.20
Rate for Payer: Priority Health SBD	$148.68

HC COMP BURN GARM BRF 2 LEGS ABV

Facility

$150.00

Service Code	HCPCS A6512
Hospital Charge Code	98300149
Hospital Revenue Code	270
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna New Business (MI Preferred)	$97.50
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cofinity Commercial	$105.00
Rate for Payer: Cofinity Commercial	$129.00
Rate for Payer: Healthscope Commercial	$135.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$127.50
Rate for Payer: PHP Commercial	$127.50
Rate for Payer: Priority Health Cigna Priority Health	$105.00
Rate for Payer: Priority Health SBD	$94.50

HC COMP BURN GARM BRF 2 LEGS ABV

Facility

$150.00

Service Code	HCPCS A6512
Hospital Charge Code	98300149
Hospital Revenue Code	270
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna New Business (MI Preferred)	$97.50
Rate for Payer: BCBS Complete	$60.00
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cofinity Commercial	$105.00
Rate for Payer: Cofinity Commercial	$129.00
Rate for Payer: Healthscope Commercial	$135.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$127.50
Rate for Payer: PHP Commercial	$127.50
Rate for Payer: Priority Health Cigna Priority Health	$105.00
Rate for Payer: Priority Health SBD	$94.50

HC COMP BURN GARM BRF&CHAP,LG-MID

Facility

$132.00

Service Code	HCPCS A6512
Hospital Charge Code	98300150
Hospital Revenue Code	270
Min. Negotiated Rate	$83.16
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna Commercial	$112.20
Rate for Payer: Aetna New Business (MI Preferred)	$85.80
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cofinity Commercial	$113.52
Rate for Payer: Cofinity Commercial	$92.40
Rate for Payer: Healthscope Commercial	$118.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$112.20
Rate for Payer: PHP Commercial	$112.20
Rate for Payer: Priority Health Cigna Priority Health	$92.40
Rate for Payer: Priority Health SBD	$83.16

HC COMP BURN GARM BRF&CHAP,LG-MID

Facility

$132.00

Service Code	HCPCS A6512
Hospital Charge Code	98300150
Hospital Revenue Code	270
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$112.20
Rate for Payer: Aetna New Business (MI Preferred)	$85.80
Rate for Payer: BCBS Complete	$52.80
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cofinity Commercial	$113.52
Rate for Payer: Cofinity Commercial	$92.40
Rate for Payer: Healthscope Commercial	$118.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$112.20
Rate for Payer: PHP Commercial	$112.20
Rate for Payer: Priority Health Cigna Priority Health	$92.40
Rate for Payer: Priority Health SBD	$83.16

HC COMP BURN GARM BRIEF

Facility

$132.00

Service Code	HCPCS A6511
Hospital Charge Code	98300151
Hospital Revenue Code	270
Min. Negotiated Rate	$83.16
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna Commercial	$112.20
Rate for Payer: Aetna New Business (MI Preferred)	$85.80
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cofinity Commercial	$92.40
Rate for Payer: Cofinity Commercial	$113.52
Rate for Payer: Healthscope Commercial	$118.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$112.20
Rate for Payer: PHP Commercial	$112.20
Rate for Payer: Priority Health Cigna Priority Health	$92.40
Rate for Payer: Priority Health SBD	$83.16

HC COMP BURN GARM BRIEF

Facility

$132.00

Service Code	HCPCS A6511
Hospital Charge Code	98300151
Hospital Revenue Code	270
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$313.82
Rate for Payer: Aetna Commercial	$112.20
Rate for Payer: Aetna New Business (MI Preferred)	$85.80
Rate for Payer: BCBS Complete	$52.80
Rate for Payer: BCBS Trust/PPO	$313.82
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cofinity Commercial	$113.52
Rate for Payer: Cofinity Commercial	$92.40
Rate for Payer: Healthscope Commercial	$118.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$112.20
Rate for Payer: PHP Commercial	$112.20
Rate for Payer: Priority Health Cigna Priority Health	$92.40
Rate for Payer: Priority Health SBD	$83.16

HC COMP BURN GARM CHIN STRAP REGU

Facility

$78.00

Service Code	HCPCS A6502
Hospital Charge Code	98300152
Hospital Revenue Code	270
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$188.29
Rate for Payer: Aetna Commercial	$66.30
Rate for Payer: Aetna New Business (MI Preferred)	$50.70
Rate for Payer: BCBS Complete	$31.20
Rate for Payer: BCBS Trust/PPO	$188.29
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cofinity Commercial	$54.60
Rate for Payer: Cofinity Commercial	$67.08
Rate for Payer: Healthscope Commercial	$70.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$66.30
Rate for Payer: PHP Commercial	$66.30
Rate for Payer: Priority Health Cigna Priority Health	$54.60
Rate for Payer: Priority Health SBD	$49.14

HC COMP BURN GARM CHIN STRAP REGU

Facility

$78.00

Service Code	HCPCS A6502
Hospital Charge Code	98300152
Hospital Revenue Code	270
Min. Negotiated Rate	$49.14
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna Commercial	$66.30
Rate for Payer: Aetna New Business (MI Preferred)	$50.70
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cofinity Commercial	$54.60
Rate for Payer: Cofinity Commercial	$67.08
Rate for Payer: Healthscope Commercial	$70.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$66.30
Rate for Payer: PHP Commercial	$66.30
Rate for Payer: Priority Health Cigna Priority Health	$54.60
Rate for Payer: Priority Health SBD	$49.14

HC COMP BURN GARM CHIN STRP W LIP

Facility

$78.00

Service Code	HCPCS A6502
Hospital Charge Code	98300153
Hospital Revenue Code	270
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$188.29
Rate for Payer: Aetna Commercial	$66.30
Rate for Payer: Aetna New Business (MI Preferred)	$50.70
Rate for Payer: BCBS Complete	$31.20
Rate for Payer: BCBS Trust/PPO	$188.29
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cofinity Commercial	$67.08
Rate for Payer: Cofinity Commercial	$54.60
Rate for Payer: Healthscope Commercial	$70.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$66.30
Rate for Payer: PHP Commercial	$66.30
Rate for Payer: Priority Health Cigna Priority Health	$54.60
Rate for Payer: Priority Health SBD	$49.14

HC COMP BURN GARM CHIN STRP W LIP

Facility

$78.00

Service Code	HCPCS A6502
Hospital Charge Code	98300153
Hospital Revenue Code	270
Min. Negotiated Rate	$49.14
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna Commercial	$66.30
Rate for Payer: Aetna New Business (MI Preferred)	$50.70
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cofinity Commercial	$54.60
Rate for Payer: Cofinity Commercial	$67.08
Rate for Payer: Healthscope Commercial	$70.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$66.30
Rate for Payer: PHP Commercial	$66.30
Rate for Payer: Priority Health Cigna Priority Health	$54.60
Rate for Payer: Priority Health SBD	$49.14

HC COMP BURN GARM COLLAR FOAM

Facility

$40.00

Service Code	HCPCS A6512
Hospital Charge Code	98300154
Hospital Revenue Code	270
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$34.00
Rate for Payer: Aetna New Business (MI Preferred)	$26.00
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

HC COMP BURN GARM COLLAR FOAM

Facility

$40.00

Service Code	HCPCS A6512
Hospital Charge Code	98300154
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	$34.40
Rate for Payer: Cofinity Commercial	$28.00
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

HC COMP BURN GARM COLLAR PILLOW

Facility

$68.00

Service Code	HCPCS A6512
Hospital Charge Code	98300155
Hospital Revenue Code	270
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$61.20
Rate for Payer: Aetna Commercial	$57.80
Rate for Payer: Aetna New Business (MI Preferred)	$44.20
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cofinity Commercial	$47.60
Rate for Payer: Cofinity Commercial	$58.48
Rate for Payer: Healthscope Commercial	$61.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$57.80
Rate for Payer: PHP Commercial	$57.80
Rate for Payer: Priority Health Cigna Priority Health	$47.60
Rate for Payer: Priority Health SBD	$42.84

HC COMP BURN GARM COLLAR PILLOW

Facility

$68.00

Service Code	HCPCS A6512
Hospital Charge Code	98300155
Hospital Revenue Code	270
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$57.80
Rate for Payer: Aetna New Business (MI Preferred)	$44.20
Rate for Payer: BCBS Complete	$27.20
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cofinity Commercial	$47.60
Rate for Payer: Cofinity Commercial	$58.48
Rate for Payer: Healthscope Commercial	$61.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$57.80
Rate for Payer: PHP Commercial	$57.80
Rate for Payer: Priority Health Cigna Priority Health	$47.60
Rate for Payer: Priority Health SBD	$42.84

HC COMP BURN GARM COLLAR TRACH

Facility

$40.00

Service Code	HCPCS A6512
Hospital Charge Code	98300156
Hospital Revenue Code	270
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$34.00
Rate for Payer: Aetna New Business (MI Preferred)	$26.00
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

HC COMP BURN GARM COLLAR TRACH

Facility

$40.00

Service Code	HCPCS A6512
Hospital Charge Code	98300156
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

HC COMP BURN GARM ELECTIVE ALTERA

Facility

$20.00

Service Code	HCPCS A6512
Hospital Charge Code	98300157
Hospital Revenue Code	270
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$17.00
Rate for Payer: Aetna New Business (MI Preferred)	$13.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cofinity Commercial	$14.00
Rate for Payer: Cofinity Commercial	$17.20
Rate for Payer: Healthscope Commercial	$18.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.00
Rate for Payer: PHP Commercial	$17.00
Rate for Payer: Priority Health Cigna Priority Health	$14.00
Rate for Payer: Priority Health SBD	$12.60

HC COMP BURN GARM ELECTIVE ALTERA

Facility

$20.00

Service Code	HCPCS A6512
Hospital Charge Code	98300157
Hospital Revenue Code	270
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$17.00
Rate for Payer: Aetna New Business (MI Preferred)	$13.00
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cofinity Commercial	$14.00
Rate for Payer: Cofinity Commercial	$17.20
Rate for Payer: Healthscope Commercial	$18.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.00
Rate for Payer: PHP Commercial	$17.00
Rate for Payer: Priority Health Cigna Priority Health	$14.00
Rate for Payer: Priority Health SBD	$12.60

HC COMP BURN GARM EXPANSION PANEL

Facility

$28.00

Service Code	HCPCS A6512
Hospital Charge Code	98300158
Hospital Revenue Code	270
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$23.80
Rate for Payer: Aetna New Business (MI Preferred)	$18.20
Rate for Payer: BCBS Complete	$11.20
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cofinity Commercial	$19.60
Rate for Payer: Cofinity Commercial	$24.08
Rate for Payer: Healthscope Commercial	$25.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23.80
Rate for Payer: PHP Commercial	$23.80
Rate for Payer: Priority Health Cigna Priority Health	$19.60
Rate for Payer: Priority Health SBD	$17.64

HC COMP BURN GARM EXPANSION PANEL

Facility

$28.00

Service Code	HCPCS A6512
Hospital Charge Code	98300158
Hospital Revenue Code	270
Min. Negotiated Rate	$17.64
Max. Negotiated Rate	$25.20
Rate for Payer: Aetna Commercial	$23.80
Rate for Payer: Aetna New Business (MI Preferred)	$18.20
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cofinity Commercial	$19.60
Rate for Payer: Cofinity Commercial	$24.08
Rate for Payer: Healthscope Commercial	$25.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23.80
Rate for Payer: PHP Commercial	$23.80
Rate for Payer: Priority Health Cigna Priority Health	$19.60
Rate for Payer: Priority Health SBD	$17.64

HC COMP BURN GARM FACE MASK

Facility

$134.00

Service Code	HCPCS A6503
Hospital Charge Code	98300159
Hospital Revenue Code	270
Min. Negotiated Rate	$84.42
Max. Negotiated Rate	$120.60
Rate for Payer: Aetna Commercial	$113.90
Rate for Payer: Aetna New Business (MI Preferred)	$87.10
Rate for Payer: Cash Price	$107.20
Rate for Payer: Cofinity Commercial	$115.24
Rate for Payer: Cofinity Commercial	$93.80
Rate for Payer: Healthscope Commercial	$120.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$113.90
Rate for Payer: PHP Commercial	$113.90
Rate for Payer: Priority Health Cigna Priority Health	$93.80
Rate for Payer: Priority Health SBD	$84.42

HC COMP BURN GARM FACE MASK

Facility

$134.00

Service Code	HCPCS A6503
Hospital Charge Code	98300159
Hospital Revenue Code	270
Min. Negotiated Rate	$53.60
Max. Negotiated Rate	$292.89
Rate for Payer: Aetna Commercial	$113.90
Rate for Payer: Aetna New Business (MI Preferred)	$87.10
Rate for Payer: BCBS Complete	$53.60
Rate for Payer: BCBS Trust/PPO	$292.89
Rate for Payer: Cash Price	$107.20
Rate for Payer: Cash Price	$107.20
Rate for Payer: Cofinity Commercial	$115.24
Rate for Payer: Cofinity Commercial	$93.80
Rate for Payer: Healthscope Commercial	$120.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$113.90
Rate for Payer: PHP Commercial	$113.90
Rate for Payer: Priority Health Cigna Priority Health	$93.80
Rate for Payer: Priority Health SBD	$84.42

Know your out-of-pocket cost for care.

All Charges