Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC COMM WORK REINTEGRATION EA 15 MIN

Facility

$98.84

Service Code	CPT 97537
Hospital Charge Code	42000031
Hospital Revenue Code	420
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$84.01
Rate for Payer: Aetna Medicare	$49.42
Rate for Payer: Aetna New Business (MI Preferred)	$64.25
Rate for Payer: BCBS Complete	$39.54
Rate for Payer: BCBS Trust/PPO	$29.85
Rate for Payer: BCN Commercial	$29.85
Rate for Payer: Cash Price	$79.07
Rate for Payer: Cash Price	$79.07
Rate for Payer: Cash Price	$79.07
Rate for Payer: Cofinity Advantage	$69.19
Rate for Payer: Cofinity Commercial	$85.00
Rate for Payer: Encore Health Key Benefits Commercial	$79.07
Rate for Payer: Healthscope Commercial	$88.96
Rate for Payer: MI Amish Medical Board Commercial	$79.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$84.01
Rate for Payer: Nomi Health Commercial	$135.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$74.13
Rate for Payer: PHP Commercial	$84.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$27.00
Rate for Payer: Priority Health SBD	$62.27
Rate for Payer: Priority Health Tiered Network	$21.60
Rate for Payer: UHC All Payor (Choice/PPO)	$64.25
Rate for Payer: UHC Core	$51.50
Rate for Payer: UHC Exchange	$38.84

HC COMM WORK REINTEGRATION EA 15 MIN

Facility

$98.84

Service Code	CPT 97537
Hospital Charge Code	42000031
Hospital Revenue Code	420
Min. Negotiated Rate	$62.27
Max. Negotiated Rate	$88.96
Rate for Payer: Aetna Commercial	$84.01
Rate for Payer: Aetna New Business (MI Preferred)	$64.25
Rate for Payer: Cash Price	$79.07
Rate for Payer: Cofinity Advantage	$69.19
Rate for Payer: Cofinity Commercial	$85.00
Rate for Payer: Encore Health Key Benefits Commercial	$79.07
Rate for Payer: Healthscope Commercial	$88.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$84.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$74.13
Rate for Payer: PHP Commercial	$84.01
Rate for Payer: Priority Health SBD	$62.27

HC COMPARTMENT PRESSURE CHECK

Facility

$671.79

Hospital Charge Code	27000045
Hospital Revenue Code	270
Min. Negotiated Rate	$423.23
Max. Negotiated Rate	$604.61
Rate for Payer: Aetna Commercial	$571.02
Rate for Payer: Aetna New Business (MI Preferred)	$436.66
Rate for Payer: Cash Price	$537.43
Rate for Payer: Cofinity Advantage	$470.25
Rate for Payer: Cofinity Commercial	$577.74
Rate for Payer: Encore Health Key Benefits Commercial	$537.43
Rate for Payer: Healthscope Commercial	$604.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$571.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$503.84
Rate for Payer: PHP Commercial	$571.02
Rate for Payer: Priority Health SBD	$423.23

HC COMPARTMENT PRESSURE CHECK

Facility

$671.79

Hospital Charge Code	27000045
Hospital Revenue Code	270
Min. Negotiated Rate	$264.01
Max. Negotiated Rate	$604.61
Rate for Payer: Aetna Commercial	$571.02
Rate for Payer: Aetna Medicare	$335.89
Rate for Payer: Aetna New Business (MI Preferred)	$436.66
Rate for Payer: BCBS Complete	$268.72
Rate for Payer: Cash Price	$537.43
Rate for Payer: Cofinity Advantage	$470.25
Rate for Payer: Cofinity Commercial	$577.74
Rate for Payer: Encore Health Key Benefits Commercial	$537.43
Rate for Payer: Healthscope Commercial	$604.61
Rate for Payer: MI Amish Medical Board Commercial	$537.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$571.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$503.84
Rate for Payer: PHP Commercial	$571.02
Rate for Payer: Priority Health SBD	$423.23
Rate for Payer: UHC All Payor (Choice/PPO)	$436.66
Rate for Payer: UHC Core	$350.00
Rate for Payer: UHC Exchange	$264.01

HC COMP BURN GARM 2 LEGS-WAIST

Facility

$243.45

Service Code	HCPCS A6511
Hospital Charge Code	98300142
Hospital Revenue Code	270
Min. Negotiated Rate	$153.37
Max. Negotiated Rate	$219.10
Rate for Payer: Aetna Commercial	$206.93
Rate for Payer: Aetna New Business (MI Preferred)	$158.24
Rate for Payer: Cash Price	$194.76
Rate for Payer: Cofinity Advantage	$170.41
Rate for Payer: Cofinity Commercial	$209.37
Rate for Payer: Encore Health Key Benefits Commercial	$194.76
Rate for Payer: Healthscope Commercial	$219.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$206.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$182.59
Rate for Payer: PHP Commercial	$206.93
Rate for Payer: Priority Health SBD	$153.37

HC COMP BURN GARM 2 LEGS-WAIST

Facility

$243.45

Service Code	HCPCS A6511
Hospital Charge Code	98300142
Hospital Revenue Code	270
Min. Negotiated Rate	$95.68
Max. Negotiated Rate	$300.21
Rate for Payer: Aetna Commercial	$206.93
Rate for Payer: Aetna Medicare	$121.72
Rate for Payer: Aetna New Business (MI Preferred)	$158.24
Rate for Payer: BCBS Complete	$97.38
Rate for Payer: BCBS Trust/PPO	$300.21
Rate for Payer: BCN Commercial	$300.21
Rate for Payer: Cash Price	$194.76
Rate for Payer: Cash Price	$194.76
Rate for Payer: Cofinity Advantage	$170.41
Rate for Payer: Cofinity Commercial	$209.37
Rate for Payer: Encore Health Key Benefits Commercial	$194.76
Rate for Payer: Healthscope Commercial	$219.10
Rate for Payer: MI Amish Medical Board Commercial	$194.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$206.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$182.59
Rate for Payer: PHP Commercial	$206.93
Rate for Payer: Priority Health SBD	$153.37
Rate for Payer: UHC All Payor (Choice/PPO)	$158.24
Rate for Payer: UHC Core	$126.84
Rate for Payer: UHC Exchange	$95.68

HC COMP BURN GARM 2 OR MORE FAB/C

Facility

$12.48

Service Code	HCPCS A6512
Hospital Charge Code	98300143
Hospital Revenue Code	270
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$11.23
Rate for Payer: Aetna Commercial	$10.61
Rate for Payer: Aetna New Business (MI Preferred)	$8.11
Rate for Payer: Cash Price	$9.98
Rate for Payer: Cofinity Advantage	$8.74
Rate for Payer: Cofinity Commercial	$10.73
Rate for Payer: Encore Health Key Benefits Commercial	$9.98
Rate for Payer: Healthscope Commercial	$11.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.36
Rate for Payer: PHP Commercial	$10.61
Rate for Payer: Priority Health SBD	$7.86

HC COMP BURN GARM 2 OR MORE FAB/C

Facility

$12.48

Service Code	HCPCS A6512
Hospital Charge Code	98300143
Hospital Revenue Code	270
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$435.30
Rate for Payer: Aetna Commercial	$10.61
Rate for Payer: Aetna Medicare	$6.24
Rate for Payer: Aetna New Business (MI Preferred)	$8.11
Rate for Payer: BCBS Complete	$4.99
Rate for Payer: BCBS Trust/PPO	$435.30
Rate for Payer: BCN Commercial	$435.30
Rate for Payer: Cash Price	$9.98
Rate for Payer: Cash Price	$9.98
Rate for Payer: Cofinity Advantage	$8.74
Rate for Payer: Cofinity Commercial	$10.73
Rate for Payer: Encore Health Key Benefits Commercial	$9.98
Rate for Payer: Healthscope Commercial	$11.23
Rate for Payer: MI Amish Medical Board Commercial	$9.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.36
Rate for Payer: PHP Commercial	$10.61
Rate for Payer: Priority Health SBD	$7.86
Rate for Payer: UHC All Payor (Choice/PPO)	$8.11
Rate for Payer: UHC Core	$6.50
Rate for Payer: UHC Exchange	$4.90

HC COMP BURN GARM ABD REINFOR DBL

Facility

$16.65

Service Code	HCPCS A6512
Hospital Charge Code	98300144
Hospital Revenue Code	270
Min. Negotiated Rate	$10.49
Max. Negotiated Rate	$14.98
Rate for Payer: Aetna Commercial	$14.15
Rate for Payer: Aetna New Business (MI Preferred)	$10.82
Rate for Payer: Cash Price	$13.32
Rate for Payer: Cofinity Advantage	$11.65
Rate for Payer: Cofinity Commercial	$14.32
Rate for Payer: Encore Health Key Benefits Commercial	$13.32
Rate for Payer: Healthscope Commercial	$14.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$12.49
Rate for Payer: PHP Commercial	$14.15
Rate for Payer: Priority Health SBD	$10.49

HC COMP BURN GARM ABD REINFOR DBL

Facility

$16.65

Service Code	HCPCS A6512
Hospital Charge Code	98300144
Hospital Revenue Code	270
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$435.30
Rate for Payer: Aetna Commercial	$14.15
Rate for Payer: Aetna Medicare	$8.32
Rate for Payer: Aetna New Business (MI Preferred)	$10.82
Rate for Payer: BCBS Complete	$6.66
Rate for Payer: BCBS Trust/PPO	$435.30
Rate for Payer: BCN Commercial	$435.30
Rate for Payer: Cash Price	$13.32
Rate for Payer: Cash Price	$13.32
Rate for Payer: Cofinity Advantage	$11.65
Rate for Payer: Cofinity Commercial	$14.32
Rate for Payer: Encore Health Key Benefits Commercial	$13.32
Rate for Payer: Healthscope Commercial	$14.98
Rate for Payer: MI Amish Medical Board Commercial	$13.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$12.49
Rate for Payer: PHP Commercial	$14.15
Rate for Payer: Priority Health SBD	$10.49
Rate for Payer: UHC All Payor (Choice/PPO)	$10.82
Rate for Payer: UHC Core	$8.67
Rate for Payer: UHC Exchange	$6.54

HC COMP BURN GARM ANKLET

Facility

$64.50

Service Code	HCPCS A6512
Hospital Charge Code	98300145
Hospital Revenue Code	270
Min. Negotiated Rate	$40.63
Max. Negotiated Rate	$58.05
Rate for Payer: Aetna Commercial	$54.83
Rate for Payer: Aetna New Business (MI Preferred)	$41.92
Rate for Payer: Cash Price	$51.60
Rate for Payer: Cofinity Advantage	$45.15
Rate for Payer: Cofinity Commercial	$55.47
Rate for Payer: Encore Health Key Benefits Commercial	$51.60
Rate for Payer: Healthscope Commercial	$58.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$48.38
Rate for Payer: PHP Commercial	$54.83
Rate for Payer: Priority Health SBD	$40.63

HC COMP BURN GARM ANKLET

Facility

$64.50

Service Code	HCPCS A6512
Hospital Charge Code	98300145
Hospital Revenue Code	270
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$435.30
Rate for Payer: Aetna Commercial	$54.83
Rate for Payer: Aetna Medicare	$32.25
Rate for Payer: Aetna New Business (MI Preferred)	$41.92
Rate for Payer: BCBS Complete	$25.80
Rate for Payer: BCBS Trust/PPO	$435.30
Rate for Payer: BCN Commercial	$435.30
Rate for Payer: Cash Price	$51.60
Rate for Payer: Cash Price	$51.60
Rate for Payer: Cofinity Advantage	$45.15
Rate for Payer: Cofinity Commercial	$55.47
Rate for Payer: Encore Health Key Benefits Commercial	$51.60
Rate for Payer: Healthscope Commercial	$58.05
Rate for Payer: MI Amish Medical Board Commercial	$51.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$48.38
Rate for Payer: PHP Commercial	$54.83
Rate for Payer: Priority Health SBD	$40.63
Rate for Payer: UHC All Payor (Choice/PPO)	$41.92
Rate for Payer: UHC Core	$33.60
Rate for Payer: UHC Exchange	$25.35

HC COMP BURN GARM BDY BRF SLVD LE

Facility

$345.41

Service Code	HCPCS A6510
Hospital Charge Code	98300146
Hospital Revenue Code	270
Min. Negotiated Rate	$217.61
Max. Negotiated Rate	$310.87
Rate for Payer: Aetna Commercial	$293.60
Rate for Payer: Aetna New Business (MI Preferred)	$224.52
Rate for Payer: Cash Price	$276.33
Rate for Payer: Cofinity Advantage	$241.79
Rate for Payer: Cofinity Commercial	$297.05
Rate for Payer: Encore Health Key Benefits Commercial	$276.33
Rate for Payer: Healthscope Commercial	$310.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$293.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$259.06
Rate for Payer: PHP Commercial	$293.60
Rate for Payer: Priority Health SBD	$217.61

HC COMP BURN GARM BDY BRF SLVD LE

Facility

$345.41

Service Code	HCPCS A6510
Hospital Charge Code	98300146
Hospital Revenue Code	270
Min. Negotiated Rate	$135.75
Max. Negotiated Rate	$550.38
Rate for Payer: Aetna Commercial	$293.60
Rate for Payer: Aetna Medicare	$172.71
Rate for Payer: Aetna New Business (MI Preferred)	$224.52
Rate for Payer: BCBS Complete	$138.16
Rate for Payer: BCBS Trust/PPO	$550.38
Rate for Payer: BCN Commercial	$550.38
Rate for Payer: Cash Price	$276.33
Rate for Payer: Cash Price	$276.33
Rate for Payer: Cofinity Advantage	$241.79
Rate for Payer: Cofinity Commercial	$297.05
Rate for Payer: Encore Health Key Benefits Commercial	$276.33
Rate for Payer: Healthscope Commercial	$310.87
Rate for Payer: MI Amish Medical Board Commercial	$276.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$293.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$259.06
Rate for Payer: PHP Commercial	$293.60
Rate for Payer: Priority Health SBD	$217.61
Rate for Payer: UHC All Payor (Choice/PPO)	$224.52
Rate for Payer: UHC Core	$179.96
Rate for Payer: UHC Exchange	$135.75

HC COMP BURN GARM BELLY BAND

Facility

$41.62

Service Code	HCPCS A6512
Hospital Charge Code	98300147
Hospital Revenue Code	270
Min. Negotiated Rate	$26.22
Max. Negotiated Rate	$37.46
Rate for Payer: Aetna Commercial	$35.38
Rate for Payer: Aetna New Business (MI Preferred)	$27.05
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cofinity Advantage	$29.13
Rate for Payer: Cofinity Commercial	$35.79
Rate for Payer: Encore Health Key Benefits Commercial	$33.30
Rate for Payer: Healthscope Commercial	$37.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.21
Rate for Payer: PHP Commercial	$35.38
Rate for Payer: Priority Health SBD	$26.22

HC COMP BURN GARM BELLY BAND

Facility

$41.62

Service Code	HCPCS A6512
Hospital Charge Code	98300147
Hospital Revenue Code	270
Min. Negotiated Rate	$16.36
Max. Negotiated Rate	$435.30
Rate for Payer: Aetna Commercial	$35.38
Rate for Payer: Aetna Medicare	$20.81
Rate for Payer: Aetna New Business (MI Preferred)	$27.05
Rate for Payer: BCBS Complete	$16.65
Rate for Payer: BCBS Trust/PPO	$435.30
Rate for Payer: BCN Commercial	$435.30
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cofinity Advantage	$29.13
Rate for Payer: Cofinity Commercial	$35.79
Rate for Payer: Encore Health Key Benefits Commercial	$33.30
Rate for Payer: Healthscope Commercial	$37.46
Rate for Payer: MI Amish Medical Board Commercial	$33.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.21
Rate for Payer: PHP Commercial	$35.38
Rate for Payer: Priority Health SBD	$26.22
Rate for Payer: UHC All Payor (Choice/PPO)	$27.05
Rate for Payer: UHC Core	$21.68
Rate for Payer: UHC Exchange	$16.36

HC COMP BURN GARM BODY BRF SLEEVE

Facility

$245.53

Service Code	HCPCS A6512
Hospital Charge Code	98300148
Hospital Revenue Code	270
Min. Negotiated Rate	$154.68
Max. Negotiated Rate	$220.98
Rate for Payer: Aetna Commercial	$208.70
Rate for Payer: Aetna New Business (MI Preferred)	$159.59
Rate for Payer: Cash Price	$196.42
Rate for Payer: Cofinity Advantage	$171.87
Rate for Payer: Cofinity Commercial	$211.16
Rate for Payer: Encore Health Key Benefits Commercial	$196.42
Rate for Payer: Healthscope Commercial	$220.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$208.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$184.15
Rate for Payer: PHP Commercial	$208.70
Rate for Payer: Priority Health SBD	$154.68

HC COMP BURN GARM BODY BRF SLEEVE

Facility

$245.53

Service Code	HCPCS A6512
Hospital Charge Code	98300148
Hospital Revenue Code	270
Min. Negotiated Rate	$96.49
Max. Negotiated Rate	$435.30
Rate for Payer: Aetna Commercial	$208.70
Rate for Payer: Aetna Medicare	$122.77
Rate for Payer: Aetna New Business (MI Preferred)	$159.59
Rate for Payer: BCBS Complete	$98.21
Rate for Payer: BCBS Trust/PPO	$435.30
Rate for Payer: BCN Commercial	$435.30
Rate for Payer: Cash Price	$196.42
Rate for Payer: Cash Price	$196.42
Rate for Payer: Cofinity Advantage	$171.87
Rate for Payer: Cofinity Commercial	$211.16
Rate for Payer: Encore Health Key Benefits Commercial	$196.42
Rate for Payer: Healthscope Commercial	$220.98
Rate for Payer: MI Amish Medical Board Commercial	$196.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$208.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$184.15
Rate for Payer: PHP Commercial	$208.70
Rate for Payer: Priority Health SBD	$154.68
Rate for Payer: UHC All Payor (Choice/PPO)	$159.59
Rate for Payer: UHC Core	$127.92
Rate for Payer: UHC Exchange	$96.49

HC COMP BURN GARM BRF 2 LEGS ABV

Facility

$156.06

Service Code	HCPCS A6512
Hospital Charge Code	98300149
Hospital Revenue Code	270
Min. Negotiated Rate	$61.33
Max. Negotiated Rate	$435.30
Rate for Payer: BCN Commercial	$435.30
Rate for Payer: Aetna Commercial	$132.65
Rate for Payer: Aetna Medicare	$78.03
Rate for Payer: Aetna New Business (MI Preferred)	$101.44
Rate for Payer: BCBS Complete	$62.42
Rate for Payer: BCBS Trust/PPO	$435.30
Rate for Payer: Cash Price	$124.85
Rate for Payer: Cash Price	$124.85
Rate for Payer: Cofinity Advantage	$109.24
Rate for Payer: Cofinity Commercial	$134.21
Rate for Payer: Encore Health Key Benefits Commercial	$124.85
Rate for Payer: Healthscope Commercial	$140.45
Rate for Payer: MI Amish Medical Board Commercial	$124.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$132.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$117.05
Rate for Payer: PHP Commercial	$132.65
Rate for Payer: Priority Health SBD	$98.32
Rate for Payer: UHC All Payor (Choice/PPO)	$101.44
Rate for Payer: UHC Core	$81.31
Rate for Payer: UHC Exchange	$61.33

HC COMP BURN GARM BRF 2 LEGS ABV

Facility

$156.06

Service Code	HCPCS A6512
Hospital Charge Code	98300149
Hospital Revenue Code	270
Min. Negotiated Rate	$98.32
Max. Negotiated Rate	$140.45
Rate for Payer: Aetna Commercial	$132.65
Rate for Payer: Aetna New Business (MI Preferred)	$101.44
Rate for Payer: Cash Price	$124.85
Rate for Payer: Cofinity Advantage	$109.24
Rate for Payer: Cofinity Commercial	$134.21
Rate for Payer: Encore Health Key Benefits Commercial	$124.85
Rate for Payer: Healthscope Commercial	$140.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$132.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$117.05
Rate for Payer: PHP Commercial	$132.65
Rate for Payer: Priority Health SBD	$98.32

HC COMP BURN GARM BRF&CHAP,LG-MID

Facility

$137.33

Service Code	HCPCS A6512
Hospital Charge Code	98300150
Hospital Revenue Code	270
Min. Negotiated Rate	$53.97
Max. Negotiated Rate	$435.30
Rate for Payer: Aetna Commercial	$116.73
Rate for Payer: Aetna Medicare	$68.67
Rate for Payer: Aetna New Business (MI Preferred)	$89.26
Rate for Payer: BCBS Complete	$54.93
Rate for Payer: BCBS Trust/PPO	$435.30
Rate for Payer: BCN Commercial	$435.30
Rate for Payer: Cash Price	$109.86
Rate for Payer: Cash Price	$109.86
Rate for Payer: Cofinity Advantage	$96.13
Rate for Payer: Cofinity Commercial	$118.10
Rate for Payer: Encore Health Key Benefits Commercial	$109.86
Rate for Payer: Healthscope Commercial	$123.60
Rate for Payer: MI Amish Medical Board Commercial	$109.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$103.00
Rate for Payer: PHP Commercial	$116.73
Rate for Payer: Priority Health SBD	$86.52
Rate for Payer: UHC All Payor (Choice/PPO)	$89.26
Rate for Payer: UHC Core	$71.55
Rate for Payer: UHC Exchange	$53.97

HC COMP BURN GARM BRF&CHAP,LG-MID

Facility

$137.33

Service Code	HCPCS A6512
Hospital Charge Code	98300150
Hospital Revenue Code	270
Min. Negotiated Rate	$86.52
Max. Negotiated Rate	$123.60
Rate for Payer: Aetna Commercial	$116.73
Rate for Payer: Aetna New Business (MI Preferred)	$89.26
Rate for Payer: Cash Price	$109.86
Rate for Payer: Cofinity Advantage	$96.13
Rate for Payer: Cofinity Commercial	$118.10
Rate for Payer: Encore Health Key Benefits Commercial	$109.86
Rate for Payer: Healthscope Commercial	$123.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$103.00
Rate for Payer: PHP Commercial	$116.73
Rate for Payer: Priority Health SBD	$86.52

HC COMP BURN GARM BRIEF

Facility

$137.33

Service Code	HCPCS A6511
Hospital Charge Code	98300151
Hospital Revenue Code	270
Min. Negotiated Rate	$86.52
Max. Negotiated Rate	$123.60
Rate for Payer: Aetna Commercial	$116.73
Rate for Payer: Aetna New Business (MI Preferred)	$89.26
Rate for Payer: Cash Price	$109.86
Rate for Payer: Cofinity Advantage	$96.13
Rate for Payer: Cofinity Commercial	$118.10
Rate for Payer: Encore Health Key Benefits Commercial	$109.86
Rate for Payer: Healthscope Commercial	$123.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$103.00
Rate for Payer: PHP Commercial	$116.73
Rate for Payer: Priority Health SBD	$86.52

HC COMP BURN GARM BRIEF

Facility

$137.33

Service Code	HCPCS A6511
Hospital Charge Code	98300151
Hospital Revenue Code	270
Min. Negotiated Rate	$53.97
Max. Negotiated Rate	$300.21
Rate for Payer: Aetna Commercial	$116.73
Rate for Payer: Aetna Medicare	$68.67
Rate for Payer: Aetna New Business (MI Preferred)	$89.26
Rate for Payer: BCBS Complete	$54.93
Rate for Payer: BCBS Trust/PPO	$300.21
Rate for Payer: BCN Commercial	$300.21
Rate for Payer: Cash Price	$109.86
Rate for Payer: Cash Price	$109.86
Rate for Payer: Cofinity Advantage	$96.13
Rate for Payer: Cofinity Commercial	$118.10
Rate for Payer: Encore Health Key Benefits Commercial	$109.86
Rate for Payer: Healthscope Commercial	$123.60
Rate for Payer: MI Amish Medical Board Commercial	$109.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$103.00
Rate for Payer: PHP Commercial	$116.73
Rate for Payer: Priority Health SBD	$86.52
Rate for Payer: UHC All Payor (Choice/PPO)	$89.26
Rate for Payer: UHC Core	$71.55
Rate for Payer: UHC Exchange	$53.97

HC COMP BURN GARM CHIN STRAP REGU

Facility

$81.15

Service Code	HCPCS A6502
Hospital Charge Code	98300152
Hospital Revenue Code	270
Min. Negotiated Rate	$31.89
Max. Negotiated Rate	$180.12
Rate for Payer: Aetna Commercial	$68.98
Rate for Payer: Aetna Medicare	$40.58
Rate for Payer: Aetna New Business (MI Preferred)	$52.75
Rate for Payer: BCBS Complete	$32.46
Rate for Payer: BCBS Trust/PPO	$180.12
Rate for Payer: BCN Commercial	$180.12
Rate for Payer: Cash Price	$64.92
Rate for Payer: Cash Price	$64.92
Rate for Payer: Cofinity Advantage	$56.80
Rate for Payer: Cofinity Commercial	$69.79
Rate for Payer: Encore Health Key Benefits Commercial	$64.92
Rate for Payer: Healthscope Commercial	$73.03
Rate for Payer: MI Amish Medical Board Commercial	$64.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$60.86
Rate for Payer: PHP Commercial	$68.98
Rate for Payer: Priority Health SBD	$51.12
Rate for Payer: UHC All Payor (Choice/PPO)	$52.75
Rate for Payer: UHC Core	$42.28
Rate for Payer: UHC Exchange	$31.89

Know your out-of-pocket cost for care.

All Charges