Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC COMP BURN GARM STERNAL STRAP

Facility

$68.00

Service Code	HCPCS A6512
Hospital Charge Code	98300049
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 STERNAL STRAP

Facility

$68.00

Service Code	HCPCS A6512
Hospital Charge Code	98300049
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 STKNG KNEE TO T

Facility

$70.40

Service Code	HCPCS A6512
Hospital Charge Code	98300050
Hospital Revenue Code	270
Min. Negotiated Rate	$44.35
Max. Negotiated Rate	$63.36
Rate for Payer: Aetna Commercial	$59.84
Rate for Payer: Aetna New Business (MI Preferred)	$45.76
Rate for Payer: Cash Price	$56.32
Rate for Payer: Cofinity Commercial	$49.28
Rate for Payer: Cofinity Commercial	$60.54
Rate for Payer: Healthscope Commercial	$63.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.84
Rate for Payer: PHP Commercial	$59.84
Rate for Payer: Priority Health Cigna Priority Health	$49.28
Rate for Payer: Priority Health SBD	$44.35

HC COMP BURN GARM STKNG KNEE TO T

Facility

$70.40

Service Code	HCPCS A6512
Hospital Charge Code	98300050
Hospital Revenue Code	270
Min. Negotiated Rate	$28.16
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$59.84
Rate for Payer: Aetna New Business (MI Preferred)	$45.76
Rate for Payer: BCBS Complete	$28.16
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$56.32
Rate for Payer: Cash Price	$56.32
Rate for Payer: Cofinity Commercial	$49.28
Rate for Payer: Cofinity Commercial	$60.54
Rate for Payer: Healthscope Commercial	$63.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.84
Rate for Payer: PHP Commercial	$59.84
Rate for Payer: Priority Health Cigna Priority Health	$49.28
Rate for Payer: Priority Health SBD	$44.35

HC COMP BURN GARM STKNG TO THI NO

Facility

$78.00

Service Code	HCPCS A6512
Hospital Charge Code	98300051
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 STKNG TO THI NO

Facility

$78.00

Service Code	HCPCS A6512
Hospital Charge Code	98300051
Hospital Revenue Code	270
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$455.03
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	$455.03
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 STMP CLS ORNG P

Facility

$12.24

Service Code	HCPCS A4649
Hospital Charge Code	98300052
Hospital Revenue Code	270
Min. Negotiated Rate	$7.71
Max. Negotiated Rate	$11.02
Rate for Payer: Aetna Commercial	$10.40
Rate for Payer: Aetna New Business (MI Preferred)	$7.96
Rate for Payer: Cash Price	$9.79
Rate for Payer: Cofinity Commercial	$10.53
Rate for Payer: Cofinity Commercial	$8.57
Rate for Payer: Healthscope Commercial	$11.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.40
Rate for Payer: PHP Commercial	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$8.57
Rate for Payer: Priority Health SBD	$7.71

HC COMP BURN GARM STMP CLS ORNG P

Facility

$12.24

Service Code	HCPCS A4649
Hospital Charge Code	98300052
Hospital Revenue Code	270
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$394.10
Rate for Payer: Aetna Commercial	$10.40
Rate for Payer: Aetna New Business (MI Preferred)	$7.96
Rate for Payer: BCBS Complete	$4.90
Rate for Payer: BCBS Trust/PPO	$394.10
Rate for Payer: Cash Price	$9.79
Rate for Payer: Cash Price	$9.79
Rate for Payer: Cofinity Commercial	$10.53
Rate for Payer: Cofinity Commercial	$8.57
Rate for Payer: Healthscope Commercial	$11.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.40
Rate for Payer: PHP Commercial	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$8.57
Rate for Payer: Priority Health SBD	$7.71

HC COMP BURN GARM STMP CLS STRCH

Facility

$12.24

Service Code	HCPCS A4649
Hospital Charge Code	98300053
Hospital Revenue Code	270
Min. Negotiated Rate	$7.71
Max. Negotiated Rate	$11.02
Rate for Payer: Aetna Commercial	$10.40
Rate for Payer: Aetna New Business (MI Preferred)	$7.96
Rate for Payer: Cash Price	$9.79
Rate for Payer: Cofinity Commercial	$10.53
Rate for Payer: Cofinity Commercial	$8.57
Rate for Payer: Healthscope Commercial	$11.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.40
Rate for Payer: PHP Commercial	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$8.57
Rate for Payer: Priority Health SBD	$7.71

HC COMP BURN GARM STMP CLS STRCH

Facility

$12.24

Service Code	HCPCS A4649
Hospital Charge Code	98300053
Hospital Revenue Code	270
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$394.10
Rate for Payer: Aetna Commercial	$10.40
Rate for Payer: Aetna New Business (MI Preferred)	$7.96
Rate for Payer: BCBS Complete	$4.90
Rate for Payer: BCBS Trust/PPO	$394.10
Rate for Payer: Cash Price	$9.79
Rate for Payer: Cash Price	$9.79
Rate for Payer: Cofinity Commercial	$10.53
Rate for Payer: Cofinity Commercial	$8.57
Rate for Payer: Healthscope Commercial	$11.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.40
Rate for Payer: PHP Commercial	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$8.57
Rate for Payer: Priority Health SBD	$7.71

HC COMP BURN GARM STOCKING TO KNE

Facility

$70.00

Service Code	HCPCS A6507
Hospital Charge Code	98300054
Hospital Revenue Code	270
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$169.98
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	$169.98
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 STOCKING TO KNE

Facility

$70.00

Service Code	HCPCS A6507
Hospital Charge Code	98300054
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 STOCKING TO THI

Facility

$92.00

Service Code	HCPCS A6508
Hospital Charge Code	98300055
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 STOCKING TO THI

Facility

$92.00

Service Code	HCPCS A6508
Hospital Charge Code	98300055
Hospital Revenue Code	270
Min. Negotiated Rate	$36.80
Max. Negotiated Rate	$202.03
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	$202.03
Rate for Payer: Cash Price	$73.60
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 STOCK-KNEE/NO F

Facility

$62.00

Service Code	HCPCS A6512
Hospital Charge Code	98300056
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 STOCK-KNEE/NO F

Facility

$62.00

Service Code	HCPCS A6512
Hospital Charge Code	98300056
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 STRETCH INSERT

Facility

$12.24

Service Code	HCPCS A4649
Hospital Charge Code	98300057
Hospital Revenue Code	270
Min. Negotiated Rate	$7.71
Max. Negotiated Rate	$11.02
Rate for Payer: Aetna Commercial	$10.40
Rate for Payer: Aetna New Business (MI Preferred)	$7.96
Rate for Payer: Cash Price	$9.79
Rate for Payer: Cofinity Commercial	$10.53
Rate for Payer: Cofinity Commercial	$8.57
Rate for Payer: Healthscope Commercial	$11.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.40
Rate for Payer: PHP Commercial	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$8.57
Rate for Payer: Priority Health SBD	$7.71

HC COMP BURN GARM STRETCH INSERT

Facility

$12.24

Service Code	HCPCS A4649
Hospital Charge Code	98300057
Hospital Revenue Code	270
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$394.10
Rate for Payer: Aetna Commercial	$10.40
Rate for Payer: Aetna New Business (MI Preferred)	$7.96
Rate for Payer: BCBS Complete	$4.90
Rate for Payer: BCBS Trust/PPO	$394.10
Rate for Payer: Cash Price	$9.79
Rate for Payer: Cash Price	$9.79
Rate for Payer: Cofinity Commercial	$10.53
Rate for Payer: Cofinity Commercial	$8.57
Rate for Payer: Healthscope Commercial	$11.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.40
Rate for Payer: PHP Commercial	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$8.57
Rate for Payer: Priority Health SBD	$7.71

HC COMP BURN GARM SUEDE/LEATHER G

Facility

$45.00

Service Code	HCPCS A9900
Hospital Charge Code	98300058
Hospital Revenue Code	270
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$587.24
Rate for Payer: Aetna Commercial	$38.25
Rate for Payer: Aetna New Business (MI Preferred)	$29.25
Rate for Payer: BCBS Complete	$18.00
Rate for Payer: BCBS Trust/PPO	$587.24
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cofinity Commercial	$38.70
Rate for Payer: Cofinity Commercial	$31.50
Rate for Payer: Healthscope Commercial	$40.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$38.25
Rate for Payer: PHP Commercial	$38.25
Rate for Payer: Priority Health Cigna Priority Health	$31.50
Rate for Payer: Priority Health SBD	$28.35

HC COMP BURN GARM SUEDE/LEATHER G

Facility

$45.00

Service Code	HCPCS A9900
Hospital Charge Code	98300058
Hospital Revenue Code	270
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna Commercial	$38.25
Rate for Payer: Aetna New Business (MI Preferred)	$29.25
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cofinity Commercial	$31.50
Rate for Payer: Cofinity Commercial	$38.70
Rate for Payer: Healthscope Commercial	$40.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$38.25
Rate for Payer: PHP Commercial	$38.25
Rate for Payer: Priority Health Cigna Priority Health	$31.50
Rate for Payer: Priority Health SBD	$28.35

HC COMP BURN GARM SUIT SLVD ABV K

Facility

$380.00

Service Code	HCPCS A6512
Hospital Charge Code	98300059
Hospital Revenue Code	270
Min. Negotiated Rate	$152.00
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna New Business (MI Preferred)	$247.00
Rate for Payer: BCBS Complete	$152.00
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$304.00
Rate for Payer: Cash Price	$304.00
Rate for Payer: Cofinity Commercial	$326.80
Rate for Payer: Cofinity Commercial	$266.00
Rate for Payer: Healthscope Commercial	$342.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$323.00
Rate for Payer: PHP Commercial	$323.00
Rate for Payer: Priority Health Cigna Priority Health	$266.00
Rate for Payer: Priority Health SBD	$239.40

HC COMP BURN GARM SUIT SLVD ABV K

Facility

$380.00

Service Code	HCPCS A6512
Hospital Charge Code	98300059
Hospital Revenue Code	270
Min. Negotiated Rate	$239.40
Max. Negotiated Rate	$342.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna New Business (MI Preferred)	$247.00
Rate for Payer: Cash Price	$304.00
Rate for Payer: Cofinity Commercial	$266.00
Rate for Payer: Cofinity Commercial	$326.80
Rate for Payer: Healthscope Commercial	$342.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$323.00
Rate for Payer: PHP Commercial	$323.00
Rate for Payer: Priority Health Cigna Priority Health	$266.00
Rate for Payer: Priority Health SBD	$239.40

HC COMP BURN GARM SUIT SLVD TWO LEGS

Facility

$482.00

Service Code	HCPCS A6501
Hospital Charge Code	98300060
Hospital Revenue Code	270
Min. Negotiated Rate	$303.66
Max. Negotiated Rate	$433.80
Rate for Payer: Aetna Commercial	$409.70
Rate for Payer: Aetna New Business (MI Preferred)	$313.30
Rate for Payer: Cash Price	$385.60
Rate for Payer: Cofinity Commercial	$337.40
Rate for Payer: Cofinity Commercial	$414.52
Rate for Payer: Healthscope Commercial	$433.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$409.70
Rate for Payer: PHP Commercial	$409.70
Rate for Payer: Priority Health Cigna Priority Health	$337.40
Rate for Payer: Priority Health SBD	$303.66

HC COMP BURN GARM SUIT SLVD TWO LEGS

Facility

$482.00

Service Code	HCPCS A6501
Hospital Charge Code	98300060
Hospital Revenue Code	270
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$1,111.43
Rate for Payer: Aetna Commercial	$409.70
Rate for Payer: Aetna New Business (MI Preferred)	$313.30
Rate for Payer: BCBS Complete	$192.80
Rate for Payer: BCBS Trust/PPO	$1,111.43
Rate for Payer: Cash Price	$385.60
Rate for Payer: Cash Price	$385.60
Rate for Payer: Cofinity Commercial	$414.52
Rate for Payer: Cofinity Commercial	$337.40
Rate for Payer: Healthscope Commercial	$433.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$409.70
Rate for Payer: PHP Commercial	$409.70
Rate for Payer: Priority Health Cigna Priority Health	$337.40
Rate for Payer: Priority Health SBD	$303.66

HC COMP BURN GARM SUIT SLVLS ABV

Facility

$314.00

Service Code	HCPCS A6512
Hospital Charge Code	98300061
Hospital Revenue Code	270
Min. Negotiated Rate	$125.60
Max. Negotiated Rate	$455.03
Rate for Payer: Aetna Commercial	$266.90
Rate for Payer: Aetna New Business (MI Preferred)	$204.10
Rate for Payer: BCBS Complete	$125.60
Rate for Payer: BCBS Trust/PPO	$455.03
Rate for Payer: Cash Price	$251.20
Rate for Payer: Cash Price	$251.20
Rate for Payer: Cofinity Commercial	$270.04
Rate for Payer: Cofinity Commercial	$219.80
Rate for Payer: Healthscope Commercial	$282.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$266.90
Rate for Payer: PHP Commercial	$266.90
Rate for Payer: Priority Health Cigna Priority Health	$219.80
Rate for Payer: Priority Health SBD	$197.82

Know your out-of-pocket cost for care.

All Charges