Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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	$434.17
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: BCBS Trust/PPO	$434.17
Rate for Payer: BCN Commercial	$434.17
Rate for Payer: Cash Price	$192.58
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	$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 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	$434.17
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: BCBS Trust/PPO	$434.17
Rate for Payer: BCN Commercial	$434.17
Rate for Payer: Cash Price	$122.40
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	$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&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 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	$434.17
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: BCBS Trust/PPO	$434.17
Rate for Payer: BCN Commercial	$434.17
Rate for Payer: Cash Price	$107.71
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	$299.43
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: BCBS Trust/PPO	$299.43
Rate for Payer: BCN Commercial	$299.43
Rate for Payer: Cash Price	$107.71
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	$179.66
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: BCBS Trust/PPO	$179.66
Rate for Payer: BCN Commercial	$179.66
Rate for Payer: Cash Price	$63.65
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	$179.66
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: BCBS Trust/PPO	$179.66
Rate for Payer: BCN Commercial	$179.66
Rate for Payer: Cash Price	$63.65
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 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 FOAM

Facility

$40.80

Service Code	HCPCS A6512
Hospital Charge Code	98300154
Hospital Revenue Code	270
Min. Negotiated Rate	$16.32
Max. Negotiated Rate	$434.17
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: BCBS Trust/PPO	$434.17
Rate for Payer: BCN Commercial	$434.17
Rate for Payer: Cash Price	$32.64
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	$27.74
Max. Negotiated Rate	$434.17
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: BCBS Trust/PPO	$434.17
Rate for Payer: BCN Commercial	$434.17
Rate for Payer: Cash Price	$55.49
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	$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 TRACH

Facility

$40.80

Service Code	HCPCS A6512
Hospital Charge Code	98300156
Hospital Revenue Code	270
Min. Negotiated Rate	$16.32
Max. Negotiated Rate	$434.17
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: BCBS Trust/PPO	$434.17
Rate for Payer: BCN Commercial	$434.17
Rate for Payer: Cash Price	$32.64
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	$8.16
Max. Negotiated Rate	$434.17
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: BCBS Trust/PPO	$434.17
Rate for Payer: BCN Commercial	$434.17
Rate for Payer: Cash Price	$16.32
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	$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 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	$434.17
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: BCBS Trust/PPO	$434.17
Rate for Payer: BCN Commercial	$434.17
Rate for Payer: Cash Price	$22.85
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	$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 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	$279.47
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: BCBS Trust/PPO	$279.47
Rate for Payer: BCN Commercial	$279.47
Rate for Payer: Cash Price	$109.34
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	$13.87
Max. Negotiated Rate	$434.17
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: BCBS Trust/PPO	$434.17
Rate for Payer: BCN Commercial	$434.17
Rate for Payer: Cash Price	$27.74
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

Know your out-of-pocket cost for care.

All Charges