Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC COMP BURN GARM FOOT GAUNTLET

Facility

$34.00

Service Code	HCPCS A6512
Hospital Charge Code	98300160
Hospital Revenue Code	270
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$28.90
Rate for Payer: Aetna New Business (MI Preferred)	$22.10
Rate for Payer: BCBS Complete	$13.60
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cofinity Commercial	$23.80
Rate for Payer: Cofinity Commercial	$29.24
Rate for Payer: Healthscope Commercial	$30.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$28.90
Rate for Payer: PHP Commercial	$28.90
Rate for Payer: Priority Health Cigna Priority Health	$23.80
Rate for Payer: Priority Health SBD	$21.42

HC COMP BURN GARM FOOT GAUNTLET

Facility

$34.00

Service Code	HCPCS A6512
Hospital Charge Code	98300160
Hospital Revenue Code	270
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$30.60
Rate for Payer: Aetna Commercial	$28.90
Rate for Payer: Aetna New Business (MI Preferred)	$22.10
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cofinity Commercial	$23.80
Rate for Payer: Cofinity Commercial	$29.24
Rate for Payer: Healthscope Commercial	$30.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$28.90
Rate for Payer: PHP Commercial	$28.90
Rate for Payer: Priority Health Cigna Priority Health	$23.80
Rate for Payer: Priority Health SBD	$21.42

HC COMP BURN GARM FOOT GLOVE

Facility

$110.00

Service Code	HCPCS A6512
Hospital Charge Code	98300161
Hospital Revenue Code	270
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna Commercial	$93.50
Rate for Payer: Aetna New Business (MI Preferred)	$71.50
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cofinity Commercial	$77.00
Rate for Payer: Cofinity Commercial	$94.60
Rate for Payer: Healthscope Commercial	$99.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$93.50
Rate for Payer: PHP Commercial	$93.50
Rate for Payer: Priority Health Cigna Priority Health	$77.00
Rate for Payer: Priority Health SBD	$69.30

HC COMP BURN GARM FOOT GLOVE

Facility

$110.00

Service Code	HCPCS A6512
Hospital Charge Code	98300161
Hospital Revenue Code	270
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$93.50
Rate for Payer: Aetna New Business (MI Preferred)	$71.50
Rate for Payer: BCBS Complete	$44.00
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cofinity Commercial	$94.60
Rate for Payer: Cofinity Commercial	$77.00
Rate for Payer: Healthscope Commercial	$99.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$93.50
Rate for Payer: PHP Commercial	$93.50
Rate for Payer: Priority Health Cigna Priority Health	$77.00
Rate for Payer: Priority Health SBD	$69.30

HC COMP BURN GARM FOOT MITTEN

Facility

$90.00

Service Code	HCPCS A6512
Hospital Charge Code	98300025
Hospital Revenue Code	270
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: Aetna New Business (MI Preferred)	$58.50
Rate for Payer: BCBS Complete	$36.00
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cofinity Commercial	$63.00
Rate for Payer: Cofinity Commercial	$77.40
Rate for Payer: Healthscope Commercial	$81.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.50
Rate for Payer: PHP Commercial	$76.50
Rate for Payer: Priority Health Cigna Priority Health	$63.00
Rate for Payer: Priority Health SBD	$56.70

HC COMP BURN GARM FOOT MITTEN

Facility

$90.00

Service Code	HCPCS A6512
Hospital Charge Code	98300025
Hospital Revenue Code	270
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: Aetna New Business (MI Preferred)	$58.50
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cofinity Commercial	$63.00
Rate for Payer: Cofinity Commercial	$77.40
Rate for Payer: Healthscope Commercial	$81.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.50
Rate for Payer: PHP Commercial	$76.50
Rate for Payer: Priority Health Cigna Priority Health	$63.00
Rate for Payer: Priority Health SBD	$56.70

HC COMP BURN GARM FULLY LINED GAR

Facility

$1.00

Service Code	HCPCS A6512
Hospital Charge Code	98300026
Hospital Revenue Code	270
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$0.85
Rate for Payer: Aetna New Business (MI Preferred)	$0.65
Rate for Payer: BCBS Complete	$0.40
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$0.80
Rate for Payer: Cash Price	$0.80
Rate for Payer: Cofinity Commercial	$0.86
Rate for Payer: Cofinity Commercial	$0.70
Rate for Payer: Healthscope Commercial	$0.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$0.85
Rate for Payer: PHP Commercial	$0.85
Rate for Payer: Priority Health Cigna Priority Health	$0.70
Rate for Payer: Priority Health SBD	$0.63

HC COMP BURN GARM FULLY LINED GAR

Facility

$1.00

Service Code	HCPCS A6512
Hospital Charge Code	98300026
Hospital Revenue Code	270
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.90
Rate for Payer: Aetna Commercial	$0.85
Rate for Payer: Aetna New Business (MI Preferred)	$0.65
Rate for Payer: Cash Price	$0.80
Rate for Payer: Cofinity Commercial	$0.70
Rate for Payer: Cofinity Commercial	$0.86
Rate for Payer: Healthscope Commercial	$0.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$0.85
Rate for Payer: PHP Commercial	$0.85
Rate for Payer: Priority Health Cigna Priority Health	$0.70
Rate for Payer: Priority Health SBD	$0.63

HC COMP BURN GARM GAUNTLET TO AXI

Facility

$92.00

Service Code	HCPCS A6512
Hospital Charge Code	98300027
Hospital Revenue Code	270
Min. Negotiated Rate	$57.96
Max. Negotiated Rate	$82.80
Rate for Payer: Aetna Commercial	$78.20
Rate for Payer: Aetna New Business (MI Preferred)	$59.80
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cofinity Commercial	$64.40
Rate for Payer: Cofinity Commercial	$79.12
Rate for Payer: Healthscope Commercial	$82.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$78.20
Rate for Payer: PHP Commercial	$78.20
Rate for Payer: Priority Health Cigna Priority Health	$64.40
Rate for Payer: Priority Health SBD	$57.96

HC COMP BURN GARM GAUNTLET TO AXI

Facility

$92.00

Service Code	HCPCS A6512
Hospital Charge Code	98300027
Hospital Revenue Code	270
Min. Negotiated Rate	$36.80
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$78.20
Rate for Payer: Aetna New Business (MI Preferred)	$59.80
Rate for Payer: BCBS Complete	$36.80
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cofinity Commercial	$79.12
Rate for Payer: Cofinity Commercial	$64.40
Rate for Payer: Healthscope Commercial	$82.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$78.20
Rate for Payer: PHP Commercial	$78.20
Rate for Payer: Priority Health Cigna Priority Health	$64.40
Rate for Payer: Priority Health SBD	$57.96

HC COMP BURN GARM GAUNTLET TO WRI

Facility

$35.00

Service Code	HCPCS A6512
Hospital Charge Code	98300028
Hospital Revenue Code	270
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$29.75
Rate for Payer: Aetna New Business (MI Preferred)	$22.75
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cofinity Commercial	$24.50
Rate for Payer: Cofinity Commercial	$30.10
Rate for Payer: Healthscope Commercial	$31.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$29.75
Rate for Payer: PHP Commercial	$29.75
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: Priority Health SBD	$22.05

HC COMP BURN GARM GAUNTLET TO WRI

Facility

$35.00

Service Code	HCPCS A6512
Hospital Charge Code	98300028
Hospital Revenue Code	270
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna Commercial	$29.75
Rate for Payer: Aetna New Business (MI Preferred)	$22.75
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cofinity Commercial	$30.10
Rate for Payer: Cofinity Commercial	$24.50
Rate for Payer: Healthscope Commercial	$31.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$29.75
Rate for Payer: PHP Commercial	$29.75
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: Priority Health SBD	$22.05

HC COMP BURN GARM GLOVE-ELBOW

Facility

$160.00

Service Code	HCPCS A6505
Hospital Charge Code	98300030
Hospital Revenue Code	270
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna Commercial	$136.00
Rate for Payer: Aetna New Business (MI Preferred)	$104.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cofinity Commercial	$112.00
Rate for Payer: Cofinity Commercial	$137.60
Rate for Payer: Healthscope Commercial	$144.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$136.00
Rate for Payer: PHP Commercial	$136.00
Rate for Payer: Priority Health Cigna Priority Health	$112.00
Rate for Payer: Priority Health SBD	$100.80

HC COMP BURN GARM GLOVE-ELBOW

Facility

$160.00

Service Code	HCPCS A6505
Hospital Charge Code	98300030
Hospital Revenue Code	270
Min. Negotiated Rate	$64.00
Max. Negotiated Rate	$418.42
Rate for Payer: Aetna Commercial	$136.00
Rate for Payer: Aetna New Business (MI Preferred)	$104.00
Rate for Payer: BCBS Complete	$64.00
Rate for Payer: BCBS Trust/PPO	$418.42
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cofinity Commercial	$137.60
Rate for Payer: Cofinity Commercial	$112.00
Rate for Payer: Healthscope Commercial	$144.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$136.00
Rate for Payer: PHP Commercial	$136.00
Rate for Payer: Priority Health Cigna Priority Health	$112.00
Rate for Payer: Priority Health SBD	$100.80

HC COMP BURN GARM GLOVE TO AXILLA

Facility

$176.00

Service Code	HCPCS A6506
Hospital Charge Code	98300029
Hospital Revenue Code	270
Min. Negotiated Rate	$110.88
Max. Negotiated Rate	$158.40
Rate for Payer: Aetna Commercial	$149.60
Rate for Payer: Aetna New Business (MI Preferred)	$114.40
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cofinity Commercial	$123.20
Rate for Payer: Cofinity Commercial	$151.36
Rate for Payer: Healthscope Commercial	$158.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$149.60
Rate for Payer: PHP Commercial	$149.60
Rate for Payer: Priority Health Cigna Priority Health	$123.20
Rate for Payer: Priority Health SBD	$110.88

HC COMP BURN GARM GLOVE TO AXILLA

Facility

$176.00

Service Code	HCPCS A6506
Hospital Charge Code	98300029
Hospital Revenue Code	270
Min. Negotiated Rate	$70.40
Max. Negotiated Rate	$444.57
Rate for Payer: Aetna Commercial	$149.60
Rate for Payer: Aetna New Business (MI Preferred)	$114.40
Rate for Payer: BCBS Complete	$70.40
Rate for Payer: BCBS Trust/PPO	$444.57
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cofinity Commercial	$123.20
Rate for Payer: Cofinity Commercial	$151.36
Rate for Payer: Healthscope Commercial	$158.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$149.60
Rate for Payer: PHP Commercial	$149.60
Rate for Payer: Priority Health Cigna Priority Health	$123.20
Rate for Payer: Priority Health SBD	$110.88

HC COMP BURN GARM GLOVE-WRIST

Facility

$110.00

Service Code	HCPCS A6504
Hospital Charge Code	98300031
Hospital Revenue Code	270
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna Commercial	$93.50
Rate for Payer: Aetna New Business (MI Preferred)	$71.50
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cofinity Commercial	$77.00
Rate for Payer: Cofinity Commercial	$94.60
Rate for Payer: Healthscope Commercial	$99.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$93.50
Rate for Payer: PHP Commercial	$93.50
Rate for Payer: Priority Health Cigna Priority Health	$77.00
Rate for Payer: Priority Health SBD	$69.30

HC COMP BURN GARM GLOVE-WRIST

Facility

$110.00

Service Code	HCPCS A6504
Hospital Charge Code	98300031
Hospital Revenue Code	270
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$249.37
Rate for Payer: Aetna Commercial	$93.50
Rate for Payer: Aetna New Business (MI Preferred)	$71.50
Rate for Payer: BCBS Complete	$44.00
Rate for Payer: BCBS Trust/PPO	$249.37
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cofinity Commercial	$77.00
Rate for Payer: Cofinity Commercial	$94.60
Rate for Payer: Healthscope Commercial	$99.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$93.50
Rate for Payer: PHP Commercial	$93.50
Rate for Payer: Priority Health Cigna Priority Health	$77.00
Rate for Payer: Priority Health SBD	$69.30

HC COMP BURN GARM HEAD BAND

Facility

$40.00

Service Code	HCPCS A6512
Hospital Charge Code	98300032
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 HEAD BAND

Facility

$40.00

Service Code	HCPCS A6512
Hospital Charge Code	98300032
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 HOOK&LOOP SNAP

Facility

$14.00

Service Code	HCPCS A6512
Hospital Charge Code	98300033
Hospital Revenue Code	270
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$11.90
Rate for Payer: Aetna New Business (MI Preferred)	$9.10
Rate for Payer: BCBS Complete	$5.60
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cofinity Commercial	$9.80
Rate for Payer: Cofinity Commercial	$12.04
Rate for Payer: Healthscope Commercial	$12.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.90
Rate for Payer: PHP Commercial	$11.90
Rate for Payer: Priority Health Cigna Priority Health	$9.80
Rate for Payer: Priority Health SBD	$8.82

HC COMP BURN GARM HOOK&LOOP SNAP

Facility

$14.00

Service Code	HCPCS A6512
Hospital Charge Code	98300033
Hospital Revenue Code	270
Min. Negotiated Rate	$8.82
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna Commercial	$11.90
Rate for Payer: Aetna New Business (MI Preferred)	$9.10
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cofinity Commercial	$12.04
Rate for Payer: Cofinity Commercial	$9.80
Rate for Payer: Healthscope Commercial	$12.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.90
Rate for Payer: PHP Commercial	$11.90
Rate for Payer: Priority Health Cigna Priority Health	$9.80
Rate for Payer: Priority Health SBD	$8.82

HC COMP BURN GARM HOOK&LOOP TAB S

Facility

$8.00

Service Code	HCPCS A6512
Hospital Charge Code	98300034
Hospital Revenue Code	270
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna Commercial	$6.80
Rate for Payer: Aetna New Business (MI Preferred)	$5.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cofinity Commercial	$5.60
Rate for Payer: Cofinity Commercial	$6.88
Rate for Payer: Healthscope Commercial	$7.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6.80
Rate for Payer: PHP Commercial	$6.80
Rate for Payer: Priority Health Cigna Priority Health	$5.60
Rate for Payer: Priority Health SBD	$5.04

HC COMP BURN GARM HOOK&LOOP TAB S

Facility

$8.00

Service Code	HCPCS A6512
Hospital Charge Code	98300034
Hospital Revenue Code	270
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$6.80
Rate for Payer: Aetna New Business (MI Preferred)	$5.20
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cofinity Commercial	$6.88
Rate for Payer: Cofinity Commercial	$5.60
Rate for Payer: Healthscope Commercial	$7.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6.80
Rate for Payer: PHP Commercial	$6.80
Rate for Payer: Priority Health Cigna Priority Health	$5.60
Rate for Payer: Priority Health SBD	$5.04

HC COMP BURN GARM LEG&CHAP TO WAI

Facility

$208.00

Service Code	HCPCS A6512
Hospital Charge Code	98300036
Hospital Revenue Code	270
Min. Negotiated Rate	$83.20
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$176.80
Rate for Payer: Aetna New Business (MI Preferred)	$135.20
Rate for Payer: BCBS Complete	$83.20
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$166.40
Rate for Payer: Cash Price	$166.40
Rate for Payer: Cofinity Commercial	$178.88
Rate for Payer: Cofinity Commercial	$145.60
Rate for Payer: Healthscope Commercial	$187.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$176.80
Rate for Payer: PHP Commercial	$176.80
Rate for Payer: Priority Health Cigna Priority Health	$145.60
Rate for Payer: Priority Health SBD	$131.04

Know your out-of-pocket cost for care.

All Charges