Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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	$131.04
Max. Negotiated Rate	$187.20
Rate for Payer: Aetna Commercial	$176.80
Rate for Payer: Aetna New Business (MI Preferred)	$135.20
Rate for Payer: Cash Price	$166.40
Rate for Payer: Cofinity Commercial	$145.60
Rate for Payer: Cofinity Commercial	$178.88
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

HC COMP BURN GARM LEG & PANTY

Facility

$222.00

Service Code	HCPCS A6511
Hospital Charge Code	98300035
Hospital Revenue Code	270
Min. Negotiated Rate	$88.80
Max. Negotiated Rate	$313.82
Rate for Payer: Aetna Commercial	$188.70
Rate for Payer: Aetna New Business (MI Preferred)	$144.30
Rate for Payer: BCBS Complete	$88.80
Rate for Payer: BCBS Trust/PPO	$313.82
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cofinity Commercial	$155.40
Rate for Payer: Cofinity Commercial	$190.92
Rate for Payer: Healthscope Commercial	$199.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$188.70
Rate for Payer: PHP Commercial	$188.70
Rate for Payer: Priority Health Cigna Priority Health	$155.40
Rate for Payer: Priority Health SBD	$139.86

HC COMP BURN GARM LEG & PANTY

Facility

$222.00

Service Code	HCPCS A6511
Hospital Charge Code	98300035
Hospital Revenue Code	270
Min. Negotiated Rate	$139.86
Max. Negotiated Rate	$199.80
Rate for Payer: Aetna Commercial	$188.70
Rate for Payer: Aetna New Business (MI Preferred)	$144.30
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cofinity Commercial	$155.40
Rate for Payer: Cofinity Commercial	$190.92
Rate for Payer: Healthscope Commercial	$199.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$188.70
Rate for Payer: PHP Commercial	$188.70
Rate for Payer: Priority Health Cigna Priority Health	$155.40
Rate for Payer: Priority Health SBD	$139.86

HC COMP BURN GARM LINING,POCKET,F

Facility

$12.00

Service Code	HCPCS A6512
Hospital Charge Code	98300037
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	$8.40
Rate for Payer: Cofinity Commercial	$10.32
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 LINING,POCKET,F

Facility

$12.00

Service Code	HCPCS A6512
Hospital Charge Code	98300037
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 MITTEN TO WRIST

Facility

$68.00

Service Code	HCPCS A6512
Hospital Charge Code	98300038
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	$58.48
Rate for Payer: Cofinity Commercial	$47.60
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 MITTEN TO WRIST

Facility

$68.00

Service Code	HCPCS A6512
Hospital Charge Code	98300038
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 POCKET & PAD CO

Facility

$14.00

Service Code	HCPCS A6512
Hospital Charge Code	98300039
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 POCKET & PAD CO

Facility

$14.00

Service Code	HCPCS A6512
Hospital Charge Code	98300039
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 REINFORCEMENTS

Facility

$12.00

Service Code	HCPCS A6512
Hospital Charge Code	98300041
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 REINFORCEMENTS

Facility

$12.00

Service Code	HCPCS A6512
Hospital Charge Code	98300041
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	$8.40
Rate for Payer: Cofinity Commercial	$10.32
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 REINF SET HK&LO

Facility

$10.00

Service Code	HCPCS A6512
Hospital Charge Code	98300040
Hospital Revenue Code	270
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$8.50
Rate for Payer: Aetna New Business (MI Preferred)	$6.50
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cofinity Commercial	$7.00
Rate for Payer: Cofinity Commercial	$8.60
Rate for Payer: Healthscope Commercial	$9.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.50
Rate for Payer: PHP Commercial	$8.50
Rate for Payer: Priority Health Cigna Priority Health	$7.00
Rate for Payer: Priority Health SBD	$6.30

HC COMP BURN GARM REINF SET HK&LO

Facility

$10.00

Service Code	HCPCS A6512
Hospital Charge Code	98300040
Hospital Revenue Code	270
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$8.50
Rate for Payer: Aetna New Business (MI Preferred)	$6.50
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cofinity Commercial	$8.60
Rate for Payer: Cofinity Commercial	$7.00
Rate for Payer: Healthscope Commercial	$9.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.50
Rate for Payer: PHP Commercial	$8.50
Rate for Payer: Priority Health Cigna Priority Health	$7.00
Rate for Payer: Priority Health SBD	$6.30

HC COMP BURN GARM SHOULD FLAP REG

Facility

$34.00

Service Code	HCPCS A6512
Hospital Charge Code	98300042
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	$29.24
Rate for Payer: Cofinity Commercial	$23.80
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 SHOULD FLAP REG

Facility

$34.00

Service Code	HCPCS A6512
Hospital Charge Code	98300042
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 SILON-TEX P/D-G

Facility

$60.00

Service Code	HCPCS A6512
Hospital Charge Code	98300044
Hospital Revenue Code	270
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$51.00
Rate for Payer: Aetna New Business (MI Preferred)	$39.00
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cofinity Commercial	$51.60
Rate for Payer: Cofinity Commercial	$42.00
Rate for Payer: Healthscope Commercial	$54.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.00
Rate for Payer: PHP Commercial	$51.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: Priority Health SBD	$37.80

HC COMP BURN GARM SILON-TEX P/D-G

Facility

$60.00

Service Code	HCPCS A6512
Hospital Charge Code	98300044
Hospital Revenue Code	270
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna Commercial	$51.00
Rate for Payer: Aetna New Business (MI Preferred)	$39.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cofinity Commercial	$42.00
Rate for Payer: Cofinity Commercial	$51.60
Rate for Payer: Healthscope Commercial	$54.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.00
Rate for Payer: PHP Commercial	$51.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: Priority Health SBD	$37.80

HC COMP BURN GARM SILON-TEX UP TO

Facility

$36.00

Service Code	HCPCS A6512
Hospital Charge Code	98300045
Hospital Revenue Code	270
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$30.60
Rate for Payer: Aetna New Business (MI Preferred)	$23.40
Rate for Payer: BCBS Complete	$14.40
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cofinity Commercial	$25.20
Rate for Payer: Cofinity Commercial	$30.96
Rate for Payer: Healthscope Commercial	$32.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$30.60
Rate for Payer: PHP Commercial	$30.60
Rate for Payer: Priority Health Cigna Priority Health	$25.20
Rate for Payer: Priority Health SBD	$22.68

HC COMP BURN GARM SILON-TEX UP TO

Facility

$36.00

Service Code	HCPCS A6512
Hospital Charge Code	98300045
Hospital Revenue Code	270
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna Commercial	$30.60
Rate for Payer: Aetna New Business (MI Preferred)	$23.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cofinity Commercial	$25.20
Rate for Payer: Cofinity Commercial	$30.96
Rate for Payer: Healthscope Commercial	$32.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$30.60
Rate for Payer: PHP Commercial	$30.60
Rate for Payer: Priority Health Cigna Priority Health	$25.20
Rate for Payer: Priority Health SBD	$22.68

HC COMP BURN GARM SILON-TEX WHOL

Facility

$84.00

Service Code	HCPCS A6512
Hospital Charge Code	98300046
Hospital Revenue Code	270
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$71.40
Rate for Payer: Aetna New Business (MI Preferred)	$54.60
Rate for Payer: BCBS Complete	$33.60
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cofinity Commercial	$58.80
Rate for Payer: Cofinity Commercial	$72.24
Rate for Payer: Healthscope Commercial	$75.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$71.40
Rate for Payer: PHP Commercial	$71.40
Rate for Payer: Priority Health Cigna Priority Health	$58.80
Rate for Payer: Priority Health SBD	$52.92

HC COMP BURN GARM SILON-TEX WHOL

Facility

$84.00

Service Code	HCPCS A6512
Hospital Charge Code	98300046
Hospital Revenue Code	270
Min. Negotiated Rate	$52.92
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna Commercial	$71.40
Rate for Payer: Aetna New Business (MI Preferred)	$54.60
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cofinity Commercial	$58.80
Rate for Payer: Cofinity Commercial	$72.24
Rate for Payer: Healthscope Commercial	$75.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$71.40
Rate for Payer: PHP Commercial	$71.40
Rate for Payer: Priority Health Cigna Priority Health	$58.80
Rate for Payer: Priority Health SBD	$52.92

HC COMP BURN GARM SLEEVE WRIST/AX

Facility

$70.00

Service Code	HCPCS A6512
Hospital Charge Code	98300047
Hospital Revenue Code	270
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$59.50
Rate for Payer: Aetna New Business (MI Preferred)	$45.50
Rate for Payer: BCBS Complete	$28.00
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cofinity Commercial	$49.00
Rate for Payer: Cofinity Commercial	$60.20
Rate for Payer: Healthscope Commercial	$63.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.50
Rate for Payer: PHP Commercial	$59.50
Rate for Payer: Priority Health Cigna Priority Health	$49.00
Rate for Payer: Priority Health SBD	$44.10

HC COMP BURN GARM SLEEVE WRIST/AX

Facility

$70.00

Service Code	HCPCS A6512
Hospital Charge Code	98300047
Hospital Revenue Code	270
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna Commercial	$59.50
Rate for Payer: Aetna New Business (MI Preferred)	$45.50
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cofinity Commercial	$49.00
Rate for Payer: Cofinity Commercial	$60.20
Rate for Payer: Healthscope Commercial	$63.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.50
Rate for Payer: PHP Commercial	$59.50
Rate for Payer: Priority Health Cigna Priority Health	$49.00
Rate for Payer: Priority Health SBD	$44.10

HC COMP BURN GARM SLV WRST-ELB/EL

Facility

$60.00

Service Code	HCPCS A6512
Hospital Charge Code	98300048
Hospital Revenue Code	270
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna Commercial	$51.00
Rate for Payer: Aetna New Business (MI Preferred)	$39.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cofinity Commercial	$42.00
Rate for Payer: Cofinity Commercial	$51.60
Rate for Payer: Healthscope Commercial	$54.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.00
Rate for Payer: PHP Commercial	$51.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: Priority Health SBD	$37.80

HC COMP BURN GARM SLV WRST-ELB/EL

Facility

$60.00

Service Code	HCPCS A6512
Hospital Charge Code	98300048
Hospital Revenue Code	270
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$51.00
Rate for Payer: Aetna New Business (MI Preferred)	$39.00
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cofinity Commercial	$42.00
Rate for Payer: Cofinity Commercial	$51.60
Rate for Payer: Healthscope Commercial	$54.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.00
Rate for Payer: PHP Commercial	$51.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: Priority Health SBD	$37.80

Know your out-of-pocket cost for care.

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