Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC COMP BURN GARM COLLAR TRACH

Facility

$40.80

Service Code	HCPCS A6512
Hospital Charge Code	98300156
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 TRACH

Facility

$40.80

Service Code	HCPCS A6512
Hospital Charge Code	98300156
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 ELECTIVE ALTERA

Facility

$20.40

Service Code	HCPCS A6512
Hospital Charge Code	98300157
Hospital Revenue Code	270
Min. Negotiated Rate	$12.85
Max. Negotiated Rate	$18.36
Rate for Payer: Aetna Commercial	$17.34
Rate for Payer: Aetna New Business (MI Preferred)	$13.26
Rate for Payer: Cash Price	$16.32
Rate for Payer: Cofinity Commercial	$14.28
Rate for Payer: Cofinity Commercial	$17.54
Rate for Payer: Cofinity Medicare Advantage	$14.28
Rate for Payer: Encore Health Key Benefits Commercial	$16.32
Rate for Payer: Healthscope Commercial	$18.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.34
Rate for Payer: PHP Commercial	$17.34
Rate for Payer: Priority Health Cigna Priority Health	$13.26
Rate for Payer: Priority Health SBD	$12.85

HC COMP BURN GARM ELECTIVE ALTERA

Facility

$20.40

Service Code	HCPCS A6512
Hospital Charge Code	98300157
Hospital Revenue Code	270
Min. Negotiated Rate	$8.16
Max. Negotiated Rate	$18.36
Rate for Payer: Aetna Commercial	$17.34
Rate for Payer: Aetna Medicare	$10.20
Rate for Payer: Aetna New Business (MI Preferred)	$13.26
Rate for Payer: BCBS Complete	$8.16
Rate for Payer: Cash Price	$16.32
Rate for Payer: Cofinity Commercial	$14.28
Rate for Payer: Cofinity Commercial	$17.54
Rate for Payer: Cofinity Medicare Advantage	$14.28
Rate for Payer: Encore Health Key Benefits Commercial	$16.32
Rate for Payer: Healthscope Commercial	$18.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.34
Rate for Payer: PHP Commercial	$17.34
Rate for Payer: Priority Health Cigna Priority Health	$13.26
Rate for Payer: Priority Health SBD	$12.85

HC COMP BURN GARM EXPANSION PANEL

Facility

$28.56

Service Code	HCPCS A6512
Hospital Charge Code	98300158
Hospital Revenue Code	270
Min. Negotiated Rate	$17.99
Max. Negotiated Rate	$25.70
Rate for Payer: Aetna Commercial	$24.28
Rate for Payer: Aetna New Business (MI Preferred)	$18.56
Rate for Payer: Cash Price	$22.85
Rate for Payer: Cofinity Commercial	$19.99
Rate for Payer: Cofinity Commercial	$24.56
Rate for Payer: Cofinity Medicare Advantage	$19.99
Rate for Payer: Encore Health Key Benefits Commercial	$22.85
Rate for Payer: Healthscope Commercial	$25.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.28
Rate for Payer: PHP Commercial	$24.28
Rate for Payer: Priority Health Cigna Priority Health	$18.56
Rate for Payer: Priority Health SBD	$17.99

HC COMP BURN GARM EXPANSION PANEL

Facility

$28.56

Service Code	HCPCS A6512
Hospital Charge Code	98300158
Hospital Revenue Code	270
Min. Negotiated Rate	$11.42
Max. Negotiated Rate	$25.70
Rate for Payer: Aetna Commercial	$24.28
Rate for Payer: Aetna Medicare	$14.28
Rate for Payer: Aetna New Business (MI Preferred)	$18.56
Rate for Payer: BCBS Complete	$11.42
Rate for Payer: Cash Price	$22.85
Rate for Payer: Cofinity Commercial	$19.99
Rate for Payer: Cofinity Commercial	$24.56
Rate for Payer: Cofinity Medicare Advantage	$19.99
Rate for Payer: Encore Health Key Benefits Commercial	$22.85
Rate for Payer: Healthscope Commercial	$25.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.28
Rate for Payer: PHP Commercial	$24.28
Rate for Payer: Priority Health Cigna Priority Health	$18.56
Rate for Payer: Priority Health SBD	$17.99

HC COMP BURN GARM FACE MASK

Facility

$136.68

Service Code	HCPCS A6503
Hospital Charge Code	98300159
Hospital Revenue Code	270
Min. Negotiated Rate	$54.67
Max. Negotiated Rate	$123.01
Rate for Payer: Aetna Commercial	$116.18
Rate for Payer: Aetna Medicare	$68.34
Rate for Payer: Aetna New Business (MI Preferred)	$88.84
Rate for Payer: BCBS Complete	$54.67
Rate for Payer: Cash Price	$109.34
Rate for Payer: Cofinity Commercial	$117.54
Rate for Payer: Cofinity Commercial	$95.68
Rate for Payer: Cofinity Medicare Advantage	$95.68
Rate for Payer: Encore Health Key Benefits Commercial	$109.34
Rate for Payer: Healthscope Commercial	$123.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.18
Rate for Payer: PHP Commercial	$116.18
Rate for Payer: Priority Health Cigna Priority Health	$88.84
Rate for Payer: Priority Health SBD	$86.11

HC COMP BURN GARM FACE MASK

Facility

$136.68

Service Code	HCPCS A6503
Hospital Charge Code	98300159
Hospital Revenue Code	270
Min. Negotiated Rate	$86.11
Max. Negotiated Rate	$123.01
Rate for Payer: Aetna Commercial	$116.18
Rate for Payer: Aetna New Business (MI Preferred)	$88.84
Rate for Payer: Cash Price	$109.34
Rate for Payer: Cofinity Commercial	$117.54
Rate for Payer: Cofinity Commercial	$95.68
Rate for Payer: Cofinity Medicare Advantage	$95.68
Rate for Payer: Encore Health Key Benefits Commercial	$109.34
Rate for Payer: Healthscope Commercial	$123.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.18
Rate for Payer: PHP Commercial	$116.18
Rate for Payer: Priority Health Cigna Priority Health	$88.84
Rate for Payer: Priority Health SBD	$86.11

HC COMP BURN GARM FOOT GAUNTLET

Facility

$34.68

Service Code	HCPCS A6512
Hospital Charge Code	98300160
Hospital Revenue Code	270
Min. Negotiated Rate	$21.85
Max. Negotiated Rate	$31.21
Rate for Payer: Aetna Commercial	$29.48
Rate for Payer: Aetna New Business (MI Preferred)	$22.54
Rate for Payer: Cash Price	$27.74
Rate for Payer: Cofinity Commercial	$24.28
Rate for Payer: Cofinity Commercial	$29.82
Rate for Payer: Cofinity Medicare Advantage	$24.28
Rate for Payer: Encore Health Key Benefits Commercial	$27.74
Rate for Payer: Healthscope Commercial	$31.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.48
Rate for Payer: PHP Commercial	$29.48
Rate for Payer: Priority Health Cigna Priority Health	$22.54
Rate for Payer: Priority Health SBD	$21.85

HC COMP BURN GARM FOOT GAUNTLET

Facility

$34.68

Service Code	HCPCS A6512
Hospital Charge Code	98300160
Hospital Revenue Code	270
Min. Negotiated Rate	$13.87
Max. Negotiated Rate	$31.21
Rate for Payer: Aetna Commercial	$29.48
Rate for Payer: Aetna Medicare	$17.34
Rate for Payer: Aetna New Business (MI Preferred)	$22.54
Rate for Payer: BCBS Complete	$13.87
Rate for Payer: Cash Price	$27.74
Rate for Payer: Cofinity Commercial	$24.28
Rate for Payer: Cofinity Commercial	$29.82
Rate for Payer: Cofinity Medicare Advantage	$24.28
Rate for Payer: Encore Health Key Benefits Commercial	$27.74
Rate for Payer: Healthscope Commercial	$31.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.48
Rate for Payer: PHP Commercial	$29.48
Rate for Payer: Priority Health Cigna Priority Health	$22.54
Rate for Payer: Priority Health SBD	$21.85

HC COMP BURN GARM FOOT GLOVE

Facility

$112.20

Service Code	HCPCS A6512
Hospital Charge Code	98300161
Hospital Revenue Code	270
Min. Negotiated Rate	$44.88
Max. Negotiated Rate	$100.98
Rate for Payer: Aetna Commercial	$95.37
Rate for Payer: Aetna Medicare	$56.10
Rate for Payer: Aetna New Business (MI Preferred)	$72.93
Rate for Payer: BCBS Complete	$44.88
Rate for Payer: Cash Price	$89.76
Rate for Payer: Cofinity Commercial	$78.54
Rate for Payer: Cofinity Commercial	$96.49
Rate for Payer: Cofinity Medicare Advantage	$78.54
Rate for Payer: Encore Health Key Benefits Commercial	$89.76
Rate for Payer: Healthscope Commercial	$100.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$95.37
Rate for Payer: PHP Commercial	$95.37
Rate for Payer: Priority Health Cigna Priority Health	$72.93
Rate for Payer: Priority Health SBD	$70.69

HC COMP BURN GARM FOOT GLOVE

Facility

$112.20

Service Code	HCPCS A6512
Hospital Charge Code	98300161
Hospital Revenue Code	270
Min. Negotiated Rate	$70.69
Max. Negotiated Rate	$100.98
Rate for Payer: Aetna Commercial	$95.37
Rate for Payer: Aetna New Business (MI Preferred)	$72.93
Rate for Payer: Cash Price	$89.76
Rate for Payer: Cofinity Commercial	$78.54
Rate for Payer: Cofinity Commercial	$96.49
Rate for Payer: Cofinity Medicare Advantage	$78.54
Rate for Payer: Encore Health Key Benefits Commercial	$89.76
Rate for Payer: Healthscope Commercial	$100.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$95.37
Rate for Payer: PHP Commercial	$95.37
Rate for Payer: Priority Health Cigna Priority Health	$72.93
Rate for Payer: Priority Health SBD	$70.69

HC COMP BURN GARM FOOT MITTEN

Facility

$91.80

Service Code	HCPCS A6512
Hospital Charge Code	98300025
Hospital Revenue Code	270
Min. Negotiated Rate	$57.83
Max. Negotiated Rate	$82.62
Rate for Payer: Aetna Commercial	$78.03
Rate for Payer: Aetna New Business (MI Preferred)	$59.67
Rate for Payer: Cash Price	$73.44
Rate for Payer: Cofinity Commercial	$64.26
Rate for Payer: Cofinity Commercial	$78.95
Rate for Payer: Cofinity Medicare Advantage	$64.26
Rate for Payer: Encore Health Key Benefits Commercial	$73.44
Rate for Payer: Healthscope Commercial	$82.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.03
Rate for Payer: PHP Commercial	$78.03
Rate for Payer: Priority Health Cigna Priority Health	$59.67
Rate for Payer: Priority Health SBD	$57.83

HC COMP BURN GARM FOOT MITTEN

Facility

$91.80

Service Code	HCPCS A6512
Hospital Charge Code	98300025
Hospital Revenue Code	270
Min. Negotiated Rate	$36.72
Max. Negotiated Rate	$82.62
Rate for Payer: Aetna Commercial	$78.03
Rate for Payer: Aetna Medicare	$45.90
Rate for Payer: Aetna New Business (MI Preferred)	$59.67
Rate for Payer: BCBS Complete	$36.72
Rate for Payer: Cash Price	$73.44
Rate for Payer: Cofinity Commercial	$64.26
Rate for Payer: Cofinity Commercial	$78.95
Rate for Payer: Cofinity Medicare Advantage	$64.26
Rate for Payer: Encore Health Key Benefits Commercial	$73.44
Rate for Payer: Healthscope Commercial	$82.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.03
Rate for Payer: PHP Commercial	$78.03
Rate for Payer: Priority Health Cigna Priority Health	$59.67
Rate for Payer: Priority Health SBD	$57.83

HC COMP BURN GARM FULLY LINED GAR

Facility

$1.02

Service Code	HCPCS A6512
Hospital Charge Code	98300026
Hospital Revenue Code	270
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.92
Rate for Payer: Aetna Commercial	$0.87
Rate for Payer: Aetna Medicare	$0.51
Rate for Payer: Aetna New Business (MI Preferred)	$0.66
Rate for Payer: BCBS Complete	$0.41
Rate for Payer: Cash Price	$0.82
Rate for Payer: Cofinity Commercial	$0.71
Rate for Payer: Cofinity Commercial	$0.88
Rate for Payer: Cofinity Medicare Advantage	$0.71
Rate for Payer: Encore Health Key Benefits Commercial	$0.82
Rate for Payer: Healthscope Commercial	$0.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.87
Rate for Payer: PHP Commercial	$0.87
Rate for Payer: Priority Health Cigna Priority Health	$0.66
Rate for Payer: Priority Health SBD	$0.64

HC COMP BURN GARM FULLY LINED GAR

Facility

$1.02

Service Code	HCPCS A6512
Hospital Charge Code	98300026
Hospital Revenue Code	270
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.92
Rate for Payer: Aetna Commercial	$0.87
Rate for Payer: Aetna New Business (MI Preferred)	$0.66
Rate for Payer: Cash Price	$0.82
Rate for Payer: Cofinity Commercial	$0.71
Rate for Payer: Cofinity Commercial	$0.88
Rate for Payer: Cofinity Medicare Advantage	$0.71
Rate for Payer: Encore Health Key Benefits Commercial	$0.82
Rate for Payer: Healthscope Commercial	$0.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.87
Rate for Payer: PHP Commercial	$0.87
Rate for Payer: Priority Health Cigna Priority Health	$0.66
Rate for Payer: Priority Health SBD	$0.64

HC COMP BURN GARM GAUNTLET TO AXI

Facility

$93.84

Service Code	HCPCS A6512
Hospital Charge Code	98300027
Hospital Revenue Code	270
Min. Negotiated Rate	$37.54
Max. Negotiated Rate	$84.46
Rate for Payer: Aetna Commercial	$79.76
Rate for Payer: Aetna Medicare	$46.92
Rate for Payer: Aetna New Business (MI Preferred)	$61.00
Rate for Payer: BCBS Complete	$37.54
Rate for Payer: Cash Price	$75.07
Rate for Payer: Cofinity Commercial	$65.69
Rate for Payer: Cofinity Commercial	$80.70
Rate for Payer: Cofinity Medicare Advantage	$65.69
Rate for Payer: Encore Health Key Benefits Commercial	$75.07
Rate for Payer: Healthscope Commercial	$84.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.76
Rate for Payer: PHP Commercial	$79.76
Rate for Payer: Priority Health Cigna Priority Health	$61.00
Rate for Payer: Priority Health SBD	$59.12

HC COMP BURN GARM GAUNTLET TO AXI

Facility

$93.84

Service Code	HCPCS A6512
Hospital Charge Code	98300027
Hospital Revenue Code	270
Min. Negotiated Rate	$59.12
Max. Negotiated Rate	$84.46
Rate for Payer: Aetna Commercial	$79.76
Rate for Payer: Aetna New Business (MI Preferred)	$61.00
Rate for Payer: Cash Price	$75.07
Rate for Payer: Cofinity Commercial	$65.69
Rate for Payer: Cofinity Commercial	$80.70
Rate for Payer: Cofinity Medicare Advantage	$65.69
Rate for Payer: Encore Health Key Benefits Commercial	$75.07
Rate for Payer: Healthscope Commercial	$84.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.76
Rate for Payer: PHP Commercial	$79.76
Rate for Payer: Priority Health Cigna Priority Health	$61.00
Rate for Payer: Priority Health SBD	$59.12

HC COMP BURN GARM GAUNTLET TO WRI

Facility

$35.70

Service Code	HCPCS A6512
Hospital Charge Code	98300028
Hospital Revenue Code	270
Min. Negotiated Rate	$22.49
Max. Negotiated Rate	$32.13
Rate for Payer: Aetna Commercial	$30.34
Rate for Payer: Aetna New Business (MI Preferred)	$23.20
Rate for Payer: Cash Price	$28.56
Rate for Payer: Cofinity Commercial	$24.99
Rate for Payer: Cofinity Commercial	$30.70
Rate for Payer: Cofinity Medicare Advantage	$24.99
Rate for Payer: Encore Health Key Benefits Commercial	$28.56
Rate for Payer: Healthscope Commercial	$32.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.34
Rate for Payer: PHP Commercial	$30.34
Rate for Payer: Priority Health Cigna Priority Health	$23.20
Rate for Payer: Priority Health SBD	$22.49

HC COMP BURN GARM GAUNTLET TO WRI

Facility

$35.70

Service Code	HCPCS A6512
Hospital Charge Code	98300028
Hospital Revenue Code	270
Min. Negotiated Rate	$14.28
Max. Negotiated Rate	$32.13
Rate for Payer: Aetna Commercial	$30.34
Rate for Payer: Aetna Medicare	$17.85
Rate for Payer: Aetna New Business (MI Preferred)	$23.20
Rate for Payer: BCBS Complete	$14.28
Rate for Payer: Cash Price	$28.56
Rate for Payer: Cofinity Commercial	$24.99
Rate for Payer: Cofinity Commercial	$30.70
Rate for Payer: Cofinity Medicare Advantage	$24.99
Rate for Payer: Encore Health Key Benefits Commercial	$28.56
Rate for Payer: Healthscope Commercial	$32.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.34
Rate for Payer: PHP Commercial	$30.34
Rate for Payer: Priority Health Cigna Priority Health	$23.20
Rate for Payer: Priority Health SBD	$22.49

HC COMP BURN GARM GLOVE-ELBOW

Facility

$163.20

Service Code	HCPCS A6505
Hospital Charge Code	98300030
Hospital Revenue Code	270
Min. Negotiated Rate	$65.28
Max. Negotiated Rate	$146.88
Rate for Payer: Aetna Commercial	$138.72
Rate for Payer: Aetna Medicare	$81.60
Rate for Payer: Aetna New Business (MI Preferred)	$106.08
Rate for Payer: BCBS Complete	$65.28
Rate for Payer: Cash Price	$130.56
Rate for Payer: Cofinity Commercial	$114.24
Rate for Payer: Cofinity Commercial	$140.35
Rate for Payer: Cofinity Medicare Advantage	$114.24
Rate for Payer: Encore Health Key Benefits Commercial	$130.56
Rate for Payer: Healthscope Commercial	$146.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$138.72
Rate for Payer: PHP Commercial	$138.72
Rate for Payer: Priority Health Cigna Priority Health	$106.08
Rate for Payer: Priority Health SBD	$102.82

HC COMP BURN GARM GLOVE-ELBOW

Facility

$163.20

Service Code	HCPCS A6505
Hospital Charge Code	98300030
Hospital Revenue Code	270
Min. Negotiated Rate	$102.82
Max. Negotiated Rate	$146.88
Rate for Payer: Aetna Commercial	$138.72
Rate for Payer: Aetna New Business (MI Preferred)	$106.08
Rate for Payer: Cash Price	$130.56
Rate for Payer: Cofinity Commercial	$114.24
Rate for Payer: Cofinity Commercial	$140.35
Rate for Payer: Cofinity Medicare Advantage	$114.24
Rate for Payer: Encore Health Key Benefits Commercial	$130.56
Rate for Payer: Healthscope Commercial	$146.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$138.72
Rate for Payer: PHP Commercial	$138.72
Rate for Payer: Priority Health Cigna Priority Health	$106.08
Rate for Payer: Priority Health SBD	$102.82

HC COMP BURN GARM GLOVE TO AXILLA

Facility

$179.52

Service Code	HCPCS A6506
Hospital Charge Code	98300029
Hospital Revenue Code	270
Min. Negotiated Rate	$113.10
Max. Negotiated Rate	$161.57
Rate for Payer: Aetna Commercial	$152.59
Rate for Payer: Aetna New Business (MI Preferred)	$116.69
Rate for Payer: Cash Price	$143.62
Rate for Payer: Cofinity Commercial	$125.66
Rate for Payer: Cofinity Commercial	$154.39
Rate for Payer: Cofinity Medicare Advantage	$125.66
Rate for Payer: Encore Health Key Benefits Commercial	$143.62
Rate for Payer: Healthscope Commercial	$161.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$152.59
Rate for Payer: PHP Commercial	$152.59
Rate for Payer: Priority Health Cigna Priority Health	$116.69
Rate for Payer: Priority Health SBD	$113.10

HC COMP BURN GARM GLOVE TO AXILLA

Facility

$179.52

Service Code	HCPCS A6506
Hospital Charge Code	98300029
Hospital Revenue Code	270
Min. Negotiated Rate	$71.81
Max. Negotiated Rate	$161.57
Rate for Payer: Aetna Commercial	$152.59
Rate for Payer: Aetna Medicare	$89.76
Rate for Payer: Aetna New Business (MI Preferred)	$116.69
Rate for Payer: BCBS Complete	$71.81
Rate for Payer: Cash Price	$143.62
Rate for Payer: Cofinity Commercial	$125.66
Rate for Payer: Cofinity Commercial	$154.39
Rate for Payer: Cofinity Medicare Advantage	$125.66
Rate for Payer: Encore Health Key Benefits Commercial	$143.62
Rate for Payer: Healthscope Commercial	$161.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$152.59
Rate for Payer: PHP Commercial	$152.59
Rate for Payer: Priority Health Cigna Priority Health	$116.69
Rate for Payer: Priority Health SBD	$113.10

HC COMP BURN GARM GLOVE-WRIST

Facility

$112.20

Service Code	HCPCS A6504
Hospital Charge Code	98300031
Hospital Revenue Code	270
Min. Negotiated Rate	$44.88
Max. Negotiated Rate	$100.98
Rate for Payer: Aetna Commercial	$95.37
Rate for Payer: Aetna Medicare	$56.10
Rate for Payer: Aetna New Business (MI Preferred)	$72.93
Rate for Payer: BCBS Complete	$44.88
Rate for Payer: Cash Price	$89.76
Rate for Payer: Cofinity Commercial	$78.54
Rate for Payer: Cofinity Commercial	$96.49
Rate for Payer: Cofinity Medicare Advantage	$78.54
Rate for Payer: Encore Health Key Benefits Commercial	$89.76
Rate for Payer: Healthscope Commercial	$100.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$95.37
Rate for Payer: PHP Commercial	$95.37
Rate for Payer: Priority Health Cigna Priority Health	$72.93
Rate for Payer: Priority Health SBD	$70.69

Know your out-of-pocket cost for care.

All Charges