Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC COMP BURN GARM 2 OR MORE FAB/C

Facility

$12.24

Service Code	HCPCS A6512
Hospital Charge Code	98300143
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: Cofinity Medicare Advantage	$8.57
Rate for Payer: Encore Health Key Benefits Commercial	$9.79
Rate for Payer: Healthscope Commercial	$11.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.40
Rate for Payer: PHP Commercial	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$7.96
Rate for Payer: Priority Health SBD	$7.71

HC COMP BURN GARM ABD REINFOR DBL

Facility

$16.32

Service Code	HCPCS A6512
Hospital Charge Code	98300144
Hospital Revenue Code	270
Min. Negotiated Rate	$10.28
Max. Negotiated Rate	$14.69
Rate for Payer: Aetna Commercial	$13.87
Rate for Payer: Aetna New Business (MI Preferred)	$10.61
Rate for Payer: Cash Price	$13.06
Rate for Payer: Cofinity Commercial	$11.42
Rate for Payer: Cofinity Commercial	$14.04
Rate for Payer: Cofinity Medicare Advantage	$11.42
Rate for Payer: Encore Health Key Benefits Commercial	$13.06
Rate for Payer: Healthscope Commercial	$14.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.87
Rate for Payer: PHP Commercial	$13.87
Rate for Payer: Priority Health Cigna Priority Health	$10.61
Rate for Payer: Priority Health SBD	$10.28

HC COMP BURN GARM ABD REINFOR DBL

Facility

$16.32

Service Code	HCPCS A6512
Hospital Charge Code	98300144
Hospital Revenue Code	270
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$14.69
Rate for Payer: Aetna Commercial	$13.87
Rate for Payer: Aetna Medicare	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$10.61
Rate for Payer: BCBS Complete	$6.53
Rate for Payer: Cash Price	$13.06
Rate for Payer: Cofinity Commercial	$11.42
Rate for Payer: Cofinity Commercial	$14.04
Rate for Payer: Cofinity Medicare Advantage	$11.42
Rate for Payer: Encore Health Key Benefits Commercial	$13.06
Rate for Payer: Healthscope Commercial	$14.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.87
Rate for Payer: PHP Commercial	$13.87
Rate for Payer: Priority Health Cigna Priority Health	$10.61
Rate for Payer: Priority Health SBD	$10.28

HC COMP BURN GARM ANKLET

Facility

$63.24

Service Code	HCPCS A6512
Hospital Charge Code	98300145
Hospital Revenue Code	270
Min. Negotiated Rate	$39.84
Max. Negotiated Rate	$56.92
Rate for Payer: Aetna Commercial	$53.75
Rate for Payer: Aetna New Business (MI Preferred)	$41.11
Rate for Payer: Cash Price	$50.59
Rate for Payer: Cofinity Commercial	$44.27
Rate for Payer: Cofinity Commercial	$54.39
Rate for Payer: Cofinity Medicare Advantage	$44.27
Rate for Payer: Encore Health Key Benefits Commercial	$50.59
Rate for Payer: Healthscope Commercial	$56.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.75
Rate for Payer: PHP Commercial	$53.75
Rate for Payer: Priority Health Cigna Priority Health	$41.11
Rate for Payer: Priority Health SBD	$39.84

HC COMP BURN GARM ANKLET

Facility

$63.24

Service Code	HCPCS A6512
Hospital Charge Code	98300145
Hospital Revenue Code	270
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$56.92
Rate for Payer: Aetna Commercial	$53.75
Rate for Payer: Aetna Medicare	$31.62
Rate for Payer: Aetna New Business (MI Preferred)	$41.11
Rate for Payer: BCBS Complete	$25.30
Rate for Payer: Cash Price	$50.59
Rate for Payer: Cofinity Commercial	$44.27
Rate for Payer: Cofinity Commercial	$54.39
Rate for Payer: Cofinity Medicare Advantage	$44.27
Rate for Payer: Encore Health Key Benefits Commercial	$50.59
Rate for Payer: Healthscope Commercial	$56.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.75
Rate for Payer: PHP Commercial	$53.75
Rate for Payer: Priority Health Cigna Priority Health	$41.11
Rate for Payer: Priority Health SBD	$39.84

HC COMP BURN GARM BDY BRF SLVD LE

Facility

$338.64

Service Code	HCPCS A6510
Hospital Charge Code	98300146
Hospital Revenue Code	270
Min. Negotiated Rate	$135.46
Max. Negotiated Rate	$304.78
Rate for Payer: Aetna Commercial	$287.84
Rate for Payer: Aetna Medicare	$169.32
Rate for Payer: Aetna New Business (MI Preferred)	$220.12
Rate for Payer: BCBS Complete	$135.46
Rate for Payer: Cash Price	$270.91
Rate for Payer: Cofinity Commercial	$237.05
Rate for Payer: Cofinity Commercial	$291.23
Rate for Payer: Cofinity Medicare Advantage	$237.05
Rate for Payer: Encore Health Key Benefits Commercial	$270.91
Rate for Payer: Healthscope Commercial	$304.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$287.84
Rate for Payer: PHP Commercial	$287.84
Rate for Payer: Priority Health Cigna Priority Health	$220.12
Rate for Payer: Priority Health SBD	$213.34

HC COMP BURN GARM BDY BRF SLVD LE

Facility

$338.64

Service Code	HCPCS A6510
Hospital Charge Code	98300146
Hospital Revenue Code	270
Min. Negotiated Rate	$213.34
Max. Negotiated Rate	$304.78
Rate for Payer: Aetna Commercial	$287.84
Rate for Payer: Aetna New Business (MI Preferred)	$220.12
Rate for Payer: Cash Price	$270.91
Rate for Payer: Cofinity Commercial	$237.05
Rate for Payer: Cofinity Commercial	$291.23
Rate for Payer: Cofinity Medicare Advantage	$237.05
Rate for Payer: Encore Health Key Benefits Commercial	$270.91
Rate for Payer: Healthscope Commercial	$304.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$287.84
Rate for Payer: PHP Commercial	$287.84
Rate for Payer: Priority Health Cigna Priority Health	$220.12
Rate for Payer: Priority Health SBD	$213.34

HC COMP BURN GARM BELLY BAND

Facility

$40.80

Service Code	HCPCS A6512
Hospital Charge Code	98300147
Hospital Revenue Code	270
Min. Negotiated Rate	$16.32
Max. Negotiated Rate	$36.72
Rate for Payer: Aetna Commercial	$34.68
Rate for Payer: Aetna Medicare	$20.40
Rate for Payer: Aetna New Business (MI Preferred)	$26.52
Rate for Payer: BCBS Complete	$16.32
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cofinity Commercial	$28.56
Rate for Payer: Cofinity Commercial	$35.09
Rate for Payer: Cofinity Medicare Advantage	$28.56
Rate for Payer: Encore Health Key Benefits Commercial	$32.64
Rate for Payer: Healthscope Commercial	$36.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.68
Rate for Payer: PHP Commercial	$34.68
Rate for Payer: Priority Health Cigna Priority Health	$26.52
Rate for Payer: Priority Health SBD	$25.70

HC COMP BURN GARM BELLY BAND

Facility

$40.80

Service Code	HCPCS A6512
Hospital Charge Code	98300147
Hospital Revenue Code	270
Min. Negotiated Rate	$25.70
Max. Negotiated Rate	$36.72
Rate for Payer: Aetna Commercial	$34.68
Rate for Payer: Aetna New Business (MI Preferred)	$26.52
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cofinity Commercial	$28.56
Rate for Payer: Cofinity Commercial	$35.09
Rate for Payer: Cofinity Medicare Advantage	$28.56
Rate for Payer: Encore Health Key Benefits Commercial	$32.64
Rate for Payer: Healthscope Commercial	$36.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.68
Rate for Payer: PHP Commercial	$34.68
Rate for Payer: Priority Health Cigna Priority Health	$26.52
Rate for Payer: Priority Health SBD	$25.70

HC COMP BURN GARM BODY BRF SLEEVE

Facility

$240.72

Service Code	HCPCS A6512
Hospital Charge Code	98300148
Hospital Revenue Code	270
Min. Negotiated Rate	$151.65
Max. Negotiated Rate	$216.65
Rate for Payer: Aetna Commercial	$204.61
Rate for Payer: Aetna New Business (MI Preferred)	$156.47
Rate for Payer: Cash Price	$192.58
Rate for Payer: Cofinity Commercial	$168.50
Rate for Payer: Cofinity Commercial	$207.02
Rate for Payer: Cofinity Medicare Advantage	$168.50
Rate for Payer: Encore Health Key Benefits Commercial	$192.58
Rate for Payer: Healthscope Commercial	$216.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$204.61
Rate for Payer: PHP Commercial	$204.61
Rate for Payer: Priority Health Cigna Priority Health	$156.47
Rate for Payer: Priority Health SBD	$151.65

HC COMP BURN GARM BODY BRF SLEEVE

Facility

$240.72

Service Code	HCPCS A6512
Hospital Charge Code	98300148
Hospital Revenue Code	270
Min. Negotiated Rate	$96.29
Max. Negotiated Rate	$216.65
Rate for Payer: Aetna Commercial	$204.61
Rate for Payer: Aetna Medicare	$120.36
Rate for Payer: Aetna New Business (MI Preferred)	$156.47
Rate for Payer: BCBS Complete	$96.29
Rate for Payer: Cash Price	$192.58
Rate for Payer: Cofinity Commercial	$168.50
Rate for Payer: Cofinity Commercial	$207.02
Rate for Payer: Cofinity Medicare Advantage	$168.50
Rate for Payer: Encore Health Key Benefits Commercial	$192.58
Rate for Payer: Healthscope Commercial	$216.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$204.61
Rate for Payer: PHP Commercial	$204.61
Rate for Payer: Priority Health Cigna Priority Health	$156.47
Rate for Payer: Priority Health SBD	$151.65

HC COMP BURN GARM BRF 2 LEGS ABV

Facility

$153.00

Service Code	HCPCS A6512
Hospital Charge Code	98300149
Hospital Revenue Code	270
Min. Negotiated Rate	$96.39
Max. Negotiated Rate	$137.70
Rate for Payer: Aetna Commercial	$130.05
Rate for Payer: Aetna New Business (MI Preferred)	$99.45
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cofinity Commercial	$107.10
Rate for Payer: Cofinity Commercial	$131.58
Rate for Payer: Cofinity Medicare Advantage	$107.10
Rate for Payer: Encore Health Key Benefits Commercial	$122.40
Rate for Payer: Healthscope Commercial	$137.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.05
Rate for Payer: PHP Commercial	$130.05
Rate for Payer: Priority Health Cigna Priority Health	$99.45
Rate for Payer: Priority Health SBD	$96.39

HC COMP BURN GARM BRF 2 LEGS ABV

Facility

$153.00

Service Code	HCPCS A6512
Hospital Charge Code	98300149
Hospital Revenue Code	270
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$137.70
Rate for Payer: Aetna Commercial	$130.05
Rate for Payer: Aetna Medicare	$76.50
Rate for Payer: Aetna New Business (MI Preferred)	$99.45
Rate for Payer: BCBS Complete	$61.20
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cofinity Commercial	$107.10
Rate for Payer: Cofinity Commercial	$131.58
Rate for Payer: Cofinity Medicare Advantage	$107.10
Rate for Payer: Encore Health Key Benefits Commercial	$122.40
Rate for Payer: Healthscope Commercial	$137.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.05
Rate for Payer: PHP Commercial	$130.05
Rate for Payer: Priority Health Cigna Priority Health	$99.45
Rate for Payer: Priority Health SBD	$96.39

HC COMP BURN GARM BRF&CHAP,LG-MID

Facility

$134.64

Service Code	HCPCS A6512
Hospital Charge Code	98300150
Hospital Revenue Code	270
Min. Negotiated Rate	$53.86
Max. Negotiated Rate	$121.18
Rate for Payer: Aetna Commercial	$114.44
Rate for Payer: Aetna Medicare	$67.32
Rate for Payer: Aetna New Business (MI Preferred)	$87.52
Rate for Payer: BCBS Complete	$53.86
Rate for Payer: Cash Price	$107.71
Rate for Payer: Cofinity Commercial	$115.79
Rate for Payer: Cofinity Commercial	$94.25
Rate for Payer: Cofinity Medicare Advantage	$94.25
Rate for Payer: Encore Health Key Benefits Commercial	$107.71
Rate for Payer: Healthscope Commercial	$121.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$114.44
Rate for Payer: PHP Commercial	$114.44
Rate for Payer: Priority Health Cigna Priority Health	$87.52
Rate for Payer: Priority Health SBD	$84.82

HC COMP BURN GARM BRF&CHAP,LG-MID

Facility

$134.64

Service Code	HCPCS A6512
Hospital Charge Code	98300150
Hospital Revenue Code	270
Min. Negotiated Rate	$84.82
Max. Negotiated Rate	$121.18
Rate for Payer: Aetna Commercial	$114.44
Rate for Payer: Aetna New Business (MI Preferred)	$87.52
Rate for Payer: Cash Price	$107.71
Rate for Payer: Cofinity Commercial	$115.79
Rate for Payer: Cofinity Commercial	$94.25
Rate for Payer: Cofinity Medicare Advantage	$94.25
Rate for Payer: Encore Health Key Benefits Commercial	$107.71
Rate for Payer: Healthscope Commercial	$121.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$114.44
Rate for Payer: PHP Commercial	$114.44
Rate for Payer: Priority Health Cigna Priority Health	$87.52
Rate for Payer: Priority Health SBD	$84.82

HC COMP BURN GARM BRIEF

Facility

$134.64

Service Code	HCPCS A6511
Hospital Charge Code	98300151
Hospital Revenue Code	270
Min. Negotiated Rate	$53.86
Max. Negotiated Rate	$121.18
Rate for Payer: Aetna Commercial	$114.44
Rate for Payer: Aetna Medicare	$67.32
Rate for Payer: Aetna New Business (MI Preferred)	$87.52
Rate for Payer: BCBS Complete	$53.86
Rate for Payer: Cash Price	$107.71
Rate for Payer: Cofinity Commercial	$115.79
Rate for Payer: Cofinity Commercial	$94.25
Rate for Payer: Cofinity Medicare Advantage	$94.25
Rate for Payer: Encore Health Key Benefits Commercial	$107.71
Rate for Payer: Healthscope Commercial	$121.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$114.44
Rate for Payer: PHP Commercial	$114.44
Rate for Payer: Priority Health Cigna Priority Health	$87.52
Rate for Payer: Priority Health SBD	$84.82

HC COMP BURN GARM BRIEF

Facility

$134.64

Service Code	HCPCS A6511
Hospital Charge Code	98300151
Hospital Revenue Code	270
Min. Negotiated Rate	$84.82
Max. Negotiated Rate	$121.18
Rate for Payer: Aetna Commercial	$114.44
Rate for Payer: Aetna New Business (MI Preferred)	$87.52
Rate for Payer: Cash Price	$107.71
Rate for Payer: Cofinity Commercial	$115.79
Rate for Payer: Cofinity Commercial	$94.25
Rate for Payer: Cofinity Medicare Advantage	$94.25
Rate for Payer: Encore Health Key Benefits Commercial	$107.71
Rate for Payer: Healthscope Commercial	$121.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$114.44
Rate for Payer: PHP Commercial	$114.44
Rate for Payer: Priority Health Cigna Priority Health	$87.52
Rate for Payer: Priority Health SBD	$84.82

HC COMP BURN GARM CHIN STRAP REGU

Facility

$79.56

Service Code	HCPCS A6502
Hospital Charge Code	98300152
Hospital Revenue Code	270
Min. Negotiated Rate	$50.12
Max. Negotiated Rate	$71.60
Rate for Payer: Aetna Commercial	$67.63
Rate for Payer: Aetna New Business (MI Preferred)	$51.71
Rate for Payer: Cash Price	$63.65
Rate for Payer: Cofinity Commercial	$55.69
Rate for Payer: Cofinity Commercial	$68.42
Rate for Payer: Cofinity Medicare Advantage	$55.69
Rate for Payer: Encore Health Key Benefits Commercial	$63.65
Rate for Payer: Healthscope Commercial	$71.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.63
Rate for Payer: PHP Commercial	$67.63
Rate for Payer: Priority Health Cigna Priority Health	$51.71
Rate for Payer: Priority Health SBD	$50.12

HC COMP BURN GARM CHIN STRAP REGU

Facility

$79.56

Service Code	HCPCS A6502
Hospital Charge Code	98300152
Hospital Revenue Code	270
Min. Negotiated Rate	$31.82
Max. Negotiated Rate	$71.60
Rate for Payer: Aetna Commercial	$67.63
Rate for Payer: Aetna Medicare	$39.78
Rate for Payer: Aetna New Business (MI Preferred)	$51.71
Rate for Payer: BCBS Complete	$31.82
Rate for Payer: Cash Price	$63.65
Rate for Payer: Cofinity Commercial	$55.69
Rate for Payer: Cofinity Commercial	$68.42
Rate for Payer: Cofinity Medicare Advantage	$55.69
Rate for Payer: Encore Health Key Benefits Commercial	$63.65
Rate for Payer: Healthscope Commercial	$71.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.63
Rate for Payer: PHP Commercial	$67.63
Rate for Payer: Priority Health Cigna Priority Health	$51.71
Rate for Payer: Priority Health SBD	$50.12

HC COMP BURN GARM CHIN STRP W LIP

Facility

$79.56

Service Code	HCPCS A6502
Hospital Charge Code	98300153
Hospital Revenue Code	270
Min. Negotiated Rate	$50.12
Max. Negotiated Rate	$71.60
Rate for Payer: Aetna Commercial	$67.63
Rate for Payer: Aetna New Business (MI Preferred)	$51.71
Rate for Payer: Cash Price	$63.65
Rate for Payer: Cofinity Commercial	$55.69
Rate for Payer: Cofinity Commercial	$68.42
Rate for Payer: Cofinity Medicare Advantage	$55.69
Rate for Payer: Encore Health Key Benefits Commercial	$63.65
Rate for Payer: Healthscope Commercial	$71.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.63
Rate for Payer: PHP Commercial	$67.63
Rate for Payer: Priority Health Cigna Priority Health	$51.71
Rate for Payer: Priority Health SBD	$50.12

HC COMP BURN GARM CHIN STRP W LIP

Facility

$79.56

Service Code	HCPCS A6502
Hospital Charge Code	98300153
Hospital Revenue Code	270
Min. Negotiated Rate	$31.82
Max. Negotiated Rate	$71.60
Rate for Payer: Aetna Commercial	$67.63
Rate for Payer: Aetna Medicare	$39.78
Rate for Payer: Aetna New Business (MI Preferred)	$51.71
Rate for Payer: BCBS Complete	$31.82
Rate for Payer: Cash Price	$63.65
Rate for Payer: Cofinity Commercial	$55.69
Rate for Payer: Cofinity Commercial	$68.42
Rate for Payer: Cofinity Medicare Advantage	$55.69
Rate for Payer: Encore Health Key Benefits Commercial	$63.65
Rate for Payer: Healthscope Commercial	$71.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.63
Rate for Payer: PHP Commercial	$67.63
Rate for Payer: Priority Health Cigna Priority Health	$51.71
Rate for Payer: Priority Health SBD	$50.12

HC COMP BURN GARM COLLAR FOAM

Facility

$40.80

Service Code	HCPCS A6512
Hospital Charge Code	98300154
Hospital Revenue Code	270
Min. Negotiated Rate	$16.32
Max. Negotiated Rate	$36.72
Rate for Payer: Aetna Commercial	$34.68
Rate for Payer: Aetna Medicare	$20.40
Rate for Payer: Aetna New Business (MI Preferred)	$26.52
Rate for Payer: BCBS Complete	$16.32
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cofinity Commercial	$28.56
Rate for Payer: Cofinity Commercial	$35.09
Rate for Payer: Cofinity Medicare Advantage	$28.56
Rate for Payer: Encore Health Key Benefits Commercial	$32.64
Rate for Payer: Healthscope Commercial	$36.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.68
Rate for Payer: PHP Commercial	$34.68
Rate for Payer: Priority Health Cigna Priority Health	$26.52
Rate for Payer: Priority Health SBD	$25.70

HC COMP BURN GARM COLLAR FOAM

Facility

$40.80

Service Code	HCPCS A6512
Hospital Charge Code	98300154
Hospital Revenue Code	270
Min. Negotiated Rate	$25.70
Max. Negotiated Rate	$36.72
Rate for Payer: Aetna Commercial	$34.68
Rate for Payer: Aetna New Business (MI Preferred)	$26.52
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cofinity Commercial	$28.56
Rate for Payer: Cofinity Commercial	$35.09
Rate for Payer: Cofinity Medicare Advantage	$28.56
Rate for Payer: Encore Health Key Benefits Commercial	$32.64
Rate for Payer: Healthscope Commercial	$36.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.68
Rate for Payer: PHP Commercial	$34.68
Rate for Payer: Priority Health Cigna Priority Health	$26.52
Rate for Payer: Priority Health SBD	$25.70

HC COMP BURN GARM COLLAR PILLOW

Facility

$69.36

Service Code	HCPCS A6512
Hospital Charge Code	98300155
Hospital Revenue Code	270
Min. Negotiated Rate	$43.70
Max. Negotiated Rate	$62.42
Rate for Payer: Aetna Commercial	$58.96
Rate for Payer: Aetna New Business (MI Preferred)	$45.08
Rate for Payer: Cash Price	$55.49
Rate for Payer: Cofinity Commercial	$48.55
Rate for Payer: Cofinity Commercial	$59.65
Rate for Payer: Cofinity Medicare Advantage	$48.55
Rate for Payer: Encore Health Key Benefits Commercial	$55.49
Rate for Payer: Healthscope Commercial	$62.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.96
Rate for Payer: PHP Commercial	$58.96
Rate for Payer: Priority Health Cigna Priority Health	$45.08
Rate for Payer: Priority Health SBD	$43.70

HC COMP BURN GARM COLLAR PILLOW

Facility

$69.36

Service Code	HCPCS A6512
Hospital Charge Code	98300155
Hospital Revenue Code	270
Min. Negotiated Rate	$27.74
Max. Negotiated Rate	$62.42
Rate for Payer: Aetna Commercial	$58.96
Rate for Payer: Aetna Medicare	$34.68
Rate for Payer: Aetna New Business (MI Preferred)	$45.08
Rate for Payer: BCBS Complete	$27.74
Rate for Payer: Cash Price	$55.49
Rate for Payer: Cofinity Commercial	$48.55
Rate for Payer: Cofinity Commercial	$59.65
Rate for Payer: Cofinity Medicare Advantage	$48.55
Rate for Payer: Encore Health Key Benefits Commercial	$55.49
Rate for Payer: Healthscope Commercial	$62.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.96
Rate for Payer: PHP Commercial	$58.96
Rate for Payer: Priority Health Cigna Priority Health	$45.08
Rate for Payer: Priority Health SBD	$43.70

Know your out-of-pocket cost for care.

All Charges