Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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	$51.12
Max. Negotiated Rate	$73.03
Rate for Payer: Aetna Commercial	$68.98
Rate for Payer: Aetna New Business (MI Preferred)	$52.75
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: 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

HC COMP BURN GARM CHIN STRP W LIP

Facility

$81.15

Service Code	HCPCS A6502
Hospital Charge Code	98300153
Hospital Revenue Code	270
Min. Negotiated Rate	$51.12
Max. Negotiated Rate	$73.03
Rate for Payer: Aetna Commercial	$68.98
Rate for Payer: Aetna New Business (MI Preferred)	$52.75
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: 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

HC COMP BURN GARM CHIN STRP W LIP

Facility

$81.15

Service Code	HCPCS A6502
Hospital Charge Code	98300153
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

HC COMP BURN GARM COLLAR FOAM

Facility

$41.62

Service Code	HCPCS A6512
Hospital Charge Code	98300154
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 COLLAR FOAM

Facility

$41.62

Service Code	HCPCS A6512
Hospital Charge Code	98300154
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 COLLAR PILLOW

Facility

$70.75

Service Code	HCPCS A6512
Hospital Charge Code	98300155
Hospital Revenue Code	270
Min. Negotiated Rate	$27.80
Max. Negotiated Rate	$435.30
Rate for Payer: Aetna Commercial	$60.14
Rate for Payer: Aetna Medicare	$35.38
Rate for Payer: Aetna New Business (MI Preferred)	$45.99
Rate for Payer: BCBS Complete	$28.30
Rate for Payer: BCBS Trust/PPO	$435.30
Rate for Payer: BCN Commercial	$435.30
Rate for Payer: Cash Price	$56.60
Rate for Payer: Cash Price	$56.60
Rate for Payer: Cofinity Advantage	$49.52
Rate for Payer: Cofinity Commercial	$60.84
Rate for Payer: Encore Health Key Benefits Commercial	$56.60
Rate for Payer: Healthscope Commercial	$63.67
Rate for Payer: MI Amish Medical Board Commercial	$56.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$53.06
Rate for Payer: PHP Commercial	$60.14
Rate for Payer: Priority Health SBD	$44.57
Rate for Payer: UHC All Payor (Choice/PPO)	$45.99
Rate for Payer: UHC Core	$36.86
Rate for Payer: UHC Exchange	$27.80

HC COMP BURN GARM COLLAR PILLOW

Facility

$70.75

Service Code	HCPCS A6512
Hospital Charge Code	98300155
Hospital Revenue Code	270
Min. Negotiated Rate	$44.57
Max. Negotiated Rate	$63.67
Rate for Payer: Aetna Commercial	$60.14
Rate for Payer: Aetna New Business (MI Preferred)	$45.99
Rate for Payer: Cash Price	$56.60
Rate for Payer: Cofinity Advantage	$49.52
Rate for Payer: Cofinity Commercial	$60.84
Rate for Payer: Encore Health Key Benefits Commercial	$56.60
Rate for Payer: Healthscope Commercial	$63.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$53.06
Rate for Payer: PHP Commercial	$60.14
Rate for Payer: Priority Health SBD	$44.57

HC COMP BURN GARM COLLAR TRACH

Facility

$41.62

Service Code	HCPCS A6512
Hospital Charge Code	98300156
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 COLLAR TRACH

Facility

$41.62

Service Code	HCPCS A6512
Hospital Charge Code	98300156
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 ELECTIVE ALTERA

Facility

$20.81

Service Code	HCPCS A6512
Hospital Charge Code	98300157
Hospital Revenue Code	270
Min. Negotiated Rate	$13.11
Max. Negotiated Rate	$18.73
Rate for Payer: Aetna Commercial	$17.69
Rate for Payer: Aetna New Business (MI Preferred)	$13.53
Rate for Payer: Cash Price	$16.65
Rate for Payer: Cofinity Advantage	$14.57
Rate for Payer: Cofinity Commercial	$17.90
Rate for Payer: Encore Health Key Benefits Commercial	$16.65
Rate for Payer: Healthscope Commercial	$18.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.61
Rate for Payer: PHP Commercial	$17.69
Rate for Payer: Priority Health SBD	$13.11

HC COMP BURN GARM ELECTIVE ALTERA

Facility

$20.81

Service Code	HCPCS A6512
Hospital Charge Code	98300157
Hospital Revenue Code	270
Min. Negotiated Rate	$8.18
Max. Negotiated Rate	$435.30
Rate for Payer: Aetna Commercial	$17.69
Rate for Payer: Aetna Medicare	$10.40
Rate for Payer: Aetna New Business (MI Preferred)	$13.53
Rate for Payer: BCBS Complete	$8.32
Rate for Payer: BCBS Trust/PPO	$435.30
Rate for Payer: BCN Commercial	$435.30
Rate for Payer: Cash Price	$16.65
Rate for Payer: Cash Price	$16.65
Rate for Payer: Cofinity Advantage	$14.57
Rate for Payer: Cofinity Commercial	$17.90
Rate for Payer: Encore Health Key Benefits Commercial	$16.65
Rate for Payer: Healthscope Commercial	$18.73
Rate for Payer: MI Amish Medical Board Commercial	$16.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.61
Rate for Payer: PHP Commercial	$17.69
Rate for Payer: Priority Health SBD	$13.11
Rate for Payer: UHC All Payor (Choice/PPO)	$13.53
Rate for Payer: UHC Core	$10.84
Rate for Payer: UHC Exchange	$8.18

HC COMP BURN GARM EXPANSION PANEL

Facility

$29.13

Service Code	HCPCS A6512
Hospital Charge Code	98300158
Hospital Revenue Code	270
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$435.30
Rate for Payer: Aetna Commercial	$24.76
Rate for Payer: Aetna Medicare	$14.56
Rate for Payer: Aetna New Business (MI Preferred)	$18.93
Rate for Payer: BCBS Complete	$11.65
Rate for Payer: BCBS Trust/PPO	$435.30
Rate for Payer: BCN Commercial	$435.30
Rate for Payer: Cash Price	$23.30
Rate for Payer: Cash Price	$23.30
Rate for Payer: Cofinity Advantage	$20.39
Rate for Payer: Cofinity Commercial	$25.05
Rate for Payer: Encore Health Key Benefits Commercial	$23.30
Rate for Payer: Healthscope Commercial	$26.22
Rate for Payer: MI Amish Medical Board Commercial	$23.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.85
Rate for Payer: PHP Commercial	$24.76
Rate for Payer: Priority Health SBD	$18.35
Rate for Payer: UHC All Payor (Choice/PPO)	$18.93
Rate for Payer: UHC Core	$15.18
Rate for Payer: UHC Exchange	$11.45

HC COMP BURN GARM EXPANSION PANEL

Facility

$29.13

Service Code	HCPCS A6512
Hospital Charge Code	98300158
Hospital Revenue Code	270
Min. Negotiated Rate	$18.35
Max. Negotiated Rate	$26.22
Rate for Payer: Aetna Commercial	$24.76
Rate for Payer: Aetna New Business (MI Preferred)	$18.93
Rate for Payer: Cash Price	$23.30
Rate for Payer: Cofinity Advantage	$20.39
Rate for Payer: Cofinity Commercial	$25.05
Rate for Payer: Encore Health Key Benefits Commercial	$23.30
Rate for Payer: Healthscope Commercial	$26.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.85
Rate for Payer: PHP Commercial	$24.76
Rate for Payer: Priority Health SBD	$18.35

HC COMP BURN GARM FACE MASK

Facility

$139.41

Service Code	HCPCS A6503
Hospital Charge Code	98300159
Hospital Revenue Code	270
Min. Negotiated Rate	$54.79
Max. Negotiated Rate	$280.19
Rate for Payer: Aetna Commercial	$118.50
Rate for Payer: Aetna Medicare	$69.70
Rate for Payer: Aetna New Business (MI Preferred)	$90.62
Rate for Payer: BCBS Complete	$55.76
Rate for Payer: BCBS Trust/PPO	$280.19
Rate for Payer: BCN Commercial	$280.19
Rate for Payer: Cash Price	$111.53
Rate for Payer: Cash Price	$111.53
Rate for Payer: Cofinity Advantage	$97.59
Rate for Payer: Cofinity Commercial	$119.89
Rate for Payer: Encore Health Key Benefits Commercial	$111.53
Rate for Payer: Healthscope Commercial	$125.47
Rate for Payer: MI Amish Medical Board Commercial	$111.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$118.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$104.56
Rate for Payer: PHP Commercial	$118.50
Rate for Payer: Priority Health SBD	$87.83
Rate for Payer: UHC All Payor (Choice/PPO)	$90.62
Rate for Payer: UHC Core	$72.63
Rate for Payer: UHC Exchange	$54.79

HC COMP BURN GARM FACE MASK

Facility

$139.41

Service Code	HCPCS A6503
Hospital Charge Code	98300159
Hospital Revenue Code	270
Min. Negotiated Rate	$87.83
Max. Negotiated Rate	$125.47
Rate for Payer: Aetna Commercial	$118.50
Rate for Payer: Aetna New Business (MI Preferred)	$90.62
Rate for Payer: Cash Price	$111.53
Rate for Payer: Cofinity Advantage	$97.59
Rate for Payer: Cofinity Commercial	$119.89
Rate for Payer: Encore Health Key Benefits Commercial	$111.53
Rate for Payer: Healthscope Commercial	$125.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$118.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$104.56
Rate for Payer: PHP Commercial	$118.50
Rate for Payer: Priority Health SBD	$87.83

HC COMP BURN GARM FOOT GAUNTLET

Facility

$35.37

Service Code	HCPCS A6512
Hospital Charge Code	98300160
Hospital Revenue Code	270
Min. Negotiated Rate	$22.28
Max. Negotiated Rate	$31.83
Rate for Payer: Aetna Commercial	$30.06
Rate for Payer: Aetna New Business (MI Preferred)	$22.99
Rate for Payer: Cash Price	$28.30
Rate for Payer: Cofinity Advantage	$24.76
Rate for Payer: Cofinity Commercial	$30.42
Rate for Payer: Encore Health Key Benefits Commercial	$28.30
Rate for Payer: Healthscope Commercial	$31.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$26.53
Rate for Payer: PHP Commercial	$30.06
Rate for Payer: Priority Health SBD	$22.28

HC COMP BURN GARM FOOT GAUNTLET

Facility

$35.37

Service Code	HCPCS A6512
Hospital Charge Code	98300160
Hospital Revenue Code	270
Min. Negotiated Rate	$13.90
Max. Negotiated Rate	$435.30
Rate for Payer: Aetna Commercial	$30.06
Rate for Payer: Aetna Medicare	$17.68
Rate for Payer: Aetna New Business (MI Preferred)	$22.99
Rate for Payer: BCBS Complete	$14.15
Rate for Payer: BCBS Trust/PPO	$435.30
Rate for Payer: BCN Commercial	$435.30
Rate for Payer: Cash Price	$28.30
Rate for Payer: Cash Price	$28.30
Rate for Payer: Cofinity Advantage	$24.76
Rate for Payer: Cofinity Commercial	$30.42
Rate for Payer: Encore Health Key Benefits Commercial	$28.30
Rate for Payer: Healthscope Commercial	$31.83
Rate for Payer: MI Amish Medical Board Commercial	$28.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$26.53
Rate for Payer: PHP Commercial	$30.06
Rate for Payer: Priority Health SBD	$22.28
Rate for Payer: UHC All Payor (Choice/PPO)	$22.99
Rate for Payer: UHC Core	$18.43
Rate for Payer: UHC Exchange	$13.90

HC COMP BURN GARM FOOT GLOVE

Facility

$114.44

Service Code	HCPCS A6512
Hospital Charge Code	98300161
Hospital Revenue Code	270
Min. Negotiated Rate	$72.10
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$97.27
Rate for Payer: Aetna New Business (MI Preferred)	$74.39
Rate for Payer: Cash Price	$91.55
Rate for Payer: Cofinity Advantage	$80.11
Rate for Payer: Cofinity Commercial	$98.42
Rate for Payer: Encore Health Key Benefits Commercial	$91.55
Rate for Payer: Healthscope Commercial	$103.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$97.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$85.83
Rate for Payer: PHP Commercial	$97.27
Rate for Payer: Priority Health SBD	$72.10

HC COMP BURN GARM FOOT GLOVE

Facility

$114.44

Service Code	HCPCS A6512
Hospital Charge Code	98300161
Hospital Revenue Code	270
Min. Negotiated Rate	$44.97
Max. Negotiated Rate	$435.30
Rate for Payer: Aetna Commercial	$97.27
Rate for Payer: Aetna Medicare	$57.22
Rate for Payer: Aetna New Business (MI Preferred)	$74.39
Rate for Payer: BCBS Complete	$45.78
Rate for Payer: BCBS Trust/PPO	$435.30
Rate for Payer: BCN Commercial	$435.30
Rate for Payer: Cash Price	$91.55
Rate for Payer: Cash Price	$91.55
Rate for Payer: Cofinity Advantage	$80.11
Rate for Payer: Cofinity Commercial	$98.42
Rate for Payer: Encore Health Key Benefits Commercial	$91.55
Rate for Payer: Healthscope Commercial	$103.00
Rate for Payer: MI Amish Medical Board Commercial	$91.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$97.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$85.83
Rate for Payer: PHP Commercial	$97.27
Rate for Payer: Priority Health SBD	$72.10
Rate for Payer: UHC All Payor (Choice/PPO)	$74.39
Rate for Payer: UHC Core	$59.62
Rate for Payer: UHC Exchange	$44.97

HC COMP BURN GARM FOOT MITTEN

Facility

$93.64

Service Code	HCPCS A6512
Hospital Charge Code	98300025
Hospital Revenue Code	270
Min. Negotiated Rate	$36.80
Max. Negotiated Rate	$435.30
Rate for Payer: Aetna Commercial	$79.59
Rate for Payer: Aetna Medicare	$46.82
Rate for Payer: Aetna New Business (MI Preferred)	$60.87
Rate for Payer: BCBS Complete	$37.46
Rate for Payer: BCBS Trust/PPO	$435.30
Rate for Payer: BCN Commercial	$435.30
Rate for Payer: Cash Price	$74.91
Rate for Payer: Cash Price	$74.91
Rate for Payer: Cofinity Advantage	$65.55
Rate for Payer: Cofinity Commercial	$80.53
Rate for Payer: Encore Health Key Benefits Commercial	$74.91
Rate for Payer: Healthscope Commercial	$84.28
Rate for Payer: MI Amish Medical Board Commercial	$74.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.23
Rate for Payer: PHP Commercial	$79.59
Rate for Payer: Priority Health SBD	$58.99
Rate for Payer: UHC All Payor (Choice/PPO)	$60.87
Rate for Payer: UHC Core	$48.79
Rate for Payer: UHC Exchange	$36.80

HC COMP BURN GARM FOOT MITTEN

Facility

$93.64

Service Code	HCPCS A6512
Hospital Charge Code	98300025
Hospital Revenue Code	270
Min. Negotiated Rate	$58.99
Max. Negotiated Rate	$84.28
Rate for Payer: Aetna Commercial	$79.59
Rate for Payer: Aetna New Business (MI Preferred)	$60.87
Rate for Payer: Cash Price	$74.91
Rate for Payer: Cofinity Advantage	$65.55
Rate for Payer: Cofinity Commercial	$80.53
Rate for Payer: Encore Health Key Benefits Commercial	$74.91
Rate for Payer: Healthscope Commercial	$84.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.23
Rate for Payer: PHP Commercial	$79.59
Rate for Payer: Priority Health SBD	$58.99

HC COMP BURN GARM FULLY LINED GAR

Facility

$1.04

Service Code	HCPCS A6512
Hospital Charge Code	98300026
Hospital Revenue Code	270
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$435.30
Rate for Payer: Aetna Commercial	$0.88
Rate for Payer: Aetna Medicare	$0.52
Rate for Payer: Aetna New Business (MI Preferred)	$0.68
Rate for Payer: BCBS Complete	$0.42
Rate for Payer: BCBS Trust/PPO	$435.30
Rate for Payer: BCN Commercial	$435.30
Rate for Payer: Cash Price	$0.83
Rate for Payer: Cash Price	$0.83
Rate for Payer: Cofinity Advantage	$0.73
Rate for Payer: Cofinity Commercial	$0.89
Rate for Payer: Encore Health Key Benefits Commercial	$0.83
Rate for Payer: Healthscope Commercial	$0.94
Rate for Payer: MI Amish Medical Board Commercial	$0.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.78
Rate for Payer: PHP Commercial	$0.88
Rate for Payer: Priority Health SBD	$0.66
Rate for Payer: UHC All Payor (Choice/PPO)	$0.68
Rate for Payer: UHC Core	$0.54
Rate for Payer: UHC Exchange	$0.41

HC COMP BURN GARM FULLY LINED GAR

Facility

$1.04

Service Code	HCPCS A6512
Hospital Charge Code	98300026
Hospital Revenue Code	270
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.94
Rate for Payer: Aetna Commercial	$0.88
Rate for Payer: Aetna New Business (MI Preferred)	$0.68
Rate for Payer: Cash Price	$0.83
Rate for Payer: Cofinity Advantage	$0.73
Rate for Payer: Cofinity Commercial	$0.89
Rate for Payer: Encore Health Key Benefits Commercial	$0.83
Rate for Payer: Healthscope Commercial	$0.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.78
Rate for Payer: PHP Commercial	$0.88
Rate for Payer: Priority Health SBD	$0.66

HC COMP BURN GARM GAUNTLET TO AXI

Facility

$95.72

Service Code	HCPCS A6512
Hospital Charge Code	98300027
Hospital Revenue Code	270
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$86.15
Rate for Payer: Aetna Commercial	$81.36
Rate for Payer: Aetna New Business (MI Preferred)	$62.22
Rate for Payer: Cash Price	$76.58
Rate for Payer: Cofinity Advantage	$67.00
Rate for Payer: Cofinity Commercial	$82.32
Rate for Payer: Encore Health Key Benefits Commercial	$76.58
Rate for Payer: Healthscope Commercial	$86.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$71.79
Rate for Payer: PHP Commercial	$81.36
Rate for Payer: Priority Health SBD	$60.30

HC COMP BURN GARM GAUNTLET TO AXI

Facility

$95.72

Service Code	HCPCS A6512
Hospital Charge Code	98300027
Hospital Revenue Code	270
Min. Negotiated Rate	$37.62
Max. Negotiated Rate	$435.30
Rate for Payer: Aetna Commercial	$81.36
Rate for Payer: Aetna Medicare	$47.86
Rate for Payer: Aetna New Business (MI Preferred)	$62.22
Rate for Payer: BCBS Complete	$38.29
Rate for Payer: BCBS Trust/PPO	$435.30
Rate for Payer: BCN Commercial	$435.30
Rate for Payer: Cash Price	$76.58
Rate for Payer: Cash Price	$76.58
Rate for Payer: Cofinity Advantage	$67.00
Rate for Payer: Cofinity Commercial	$82.32
Rate for Payer: Encore Health Key Benefits Commercial	$76.58
Rate for Payer: Healthscope Commercial	$86.15
Rate for Payer: MI Amish Medical Board Commercial	$76.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$71.79
Rate for Payer: PHP Commercial	$81.36
Rate for Payer: Priority Health SBD	$60.30
Rate for Payer: UHC All Payor (Choice/PPO)	$62.22
Rate for Payer: UHC Core	$49.87
Rate for Payer: UHC Exchange	$37.62

Know your out-of-pocket cost for care.

All Charges