Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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

HC COMP BURN GARM HEAD BAND

Facility

$40.80

Service Code	HCPCS A6512
Hospital Charge Code	98300032
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 HEAD BAND

Facility

$40.80

Service Code	HCPCS A6512
Hospital Charge Code	98300032
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 HOOK&LOOP SNAP

Facility

$14.28

Service Code	HCPCS A6512
Hospital Charge Code	98300033
Hospital Revenue Code	270
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$12.85
Rate for Payer: Aetna Commercial	$12.14
Rate for Payer: Aetna New Business (MI Preferred)	$9.28
Rate for Payer: Cash Price	$11.42
Rate for Payer: Cofinity Commercial	$10.00
Rate for Payer: Cofinity Commercial	$12.28
Rate for Payer: Cofinity Medicare Advantage	$10.00
Rate for Payer: Encore Health Key Benefits Commercial	$11.42
Rate for Payer: Healthscope Commercial	$12.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.14
Rate for Payer: PHP Commercial	$12.14
Rate for Payer: Priority Health Cigna Priority Health	$9.28
Rate for Payer: Priority Health SBD	$9.00

HC COMP BURN GARM HOOK&LOOP SNAP

Facility

$14.28

Service Code	HCPCS A6512
Hospital Charge Code	98300033
Hospital Revenue Code	270
Min. Negotiated Rate	$5.71
Max. Negotiated Rate	$12.85
Rate for Payer: Aetna Commercial	$12.14
Rate for Payer: Aetna Medicare	$7.14
Rate for Payer: Aetna New Business (MI Preferred)	$9.28
Rate for Payer: BCBS Complete	$5.71
Rate for Payer: Cash Price	$11.42
Rate for Payer: Cofinity Commercial	$10.00
Rate for Payer: Cofinity Commercial	$12.28
Rate for Payer: Cofinity Medicare Advantage	$10.00
Rate for Payer: Encore Health Key Benefits Commercial	$11.42
Rate for Payer: Healthscope Commercial	$12.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.14
Rate for Payer: PHP Commercial	$12.14
Rate for Payer: Priority Health Cigna Priority Health	$9.28
Rate for Payer: Priority Health SBD	$9.00

HC COMP BURN GARM HOOK&LOOP TAB S

Facility

$8.16

Service Code	HCPCS A6512
Hospital Charge Code	98300034
Hospital Revenue Code	270
Min. Negotiated Rate	$3.26
Max. Negotiated Rate	$7.34
Rate for Payer: Aetna Commercial	$6.94
Rate for Payer: Aetna Medicare	$4.08
Rate for Payer: Aetna New Business (MI Preferred)	$5.30
Rate for Payer: BCBS Complete	$3.26
Rate for Payer: Cash Price	$6.53
Rate for Payer: Cofinity Commercial	$5.71
Rate for Payer: Cofinity Commercial	$7.02
Rate for Payer: Cofinity Medicare Advantage	$5.71
Rate for Payer: Encore Health Key Benefits Commercial	$6.53
Rate for Payer: Healthscope Commercial	$7.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.94
Rate for Payer: PHP Commercial	$6.94
Rate for Payer: Priority Health Cigna Priority Health	$5.30
Rate for Payer: Priority Health SBD	$5.14

HC COMP BURN GARM HOOK&LOOP TAB S

Facility

$8.16

Service Code	HCPCS A6512
Hospital Charge Code	98300034
Hospital Revenue Code	270
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$7.34
Rate for Payer: Aetna Commercial	$6.94
Rate for Payer: Aetna New Business (MI Preferred)	$5.30
Rate for Payer: Cash Price	$6.53
Rate for Payer: Cofinity Commercial	$5.71
Rate for Payer: Cofinity Commercial	$7.02
Rate for Payer: Cofinity Medicare Advantage	$5.71
Rate for Payer: Encore Health Key Benefits Commercial	$6.53
Rate for Payer: Healthscope Commercial	$7.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.94
Rate for Payer: PHP Commercial	$6.94
Rate for Payer: Priority Health Cigna Priority Health	$5.30
Rate for Payer: Priority Health SBD	$5.14

HC COMP BURN GARM LEG&CHAP TO WAI

Facility

$212.16

Service Code	HCPCS A6512
Hospital Charge Code	98300036
Hospital Revenue Code	270
Min. Negotiated Rate	$84.86
Max. Negotiated Rate	$190.94
Rate for Payer: Aetna Commercial	$180.34
Rate for Payer: Aetna Medicare	$106.08
Rate for Payer: Aetna New Business (MI Preferred)	$137.90
Rate for Payer: BCBS Complete	$84.86
Rate for Payer: Cash Price	$169.73
Rate for Payer: Cofinity Commercial	$148.51
Rate for Payer: Cofinity Commercial	$182.46
Rate for Payer: Cofinity Medicare Advantage	$148.51
Rate for Payer: Encore Health Key Benefits Commercial	$169.73
Rate for Payer: Healthscope Commercial	$190.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$180.34
Rate for Payer: PHP Commercial	$180.34
Rate for Payer: Priority Health Cigna Priority Health	$137.90
Rate for Payer: Priority Health SBD	$133.66

HC COMP BURN GARM LEG&CHAP TO WAI

Facility

$212.16

Service Code	HCPCS A6512
Hospital Charge Code	98300036
Hospital Revenue Code	270
Min. Negotiated Rate	$133.66
Max. Negotiated Rate	$190.94
Rate for Payer: Aetna Commercial	$180.34
Rate for Payer: Aetna New Business (MI Preferred)	$137.90
Rate for Payer: Cash Price	$169.73
Rate for Payer: Cofinity Commercial	$148.51
Rate for Payer: Cofinity Commercial	$182.46
Rate for Payer: Cofinity Medicare Advantage	$148.51
Rate for Payer: Encore Health Key Benefits Commercial	$169.73
Rate for Payer: Healthscope Commercial	$190.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$180.34
Rate for Payer: PHP Commercial	$180.34
Rate for Payer: Priority Health Cigna Priority Health	$137.90
Rate for Payer: Priority Health SBD	$133.66

HC COMP BURN GARM LEG & PANTY

Facility

$226.44

Service Code	HCPCS A6511
Hospital Charge Code	98300035
Hospital Revenue Code	270
Min. Negotiated Rate	$142.66
Max. Negotiated Rate	$203.80
Rate for Payer: Aetna Commercial	$192.47
Rate for Payer: Aetna New Business (MI Preferred)	$147.19
Rate for Payer: Cash Price	$181.15
Rate for Payer: Cofinity Commercial	$158.51
Rate for Payer: Cofinity Commercial	$194.74
Rate for Payer: Cofinity Medicare Advantage	$158.51
Rate for Payer: Encore Health Key Benefits Commercial	$181.15
Rate for Payer: Healthscope Commercial	$203.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$192.47
Rate for Payer: PHP Commercial	$192.47
Rate for Payer: Priority Health Cigna Priority Health	$147.19
Rate for Payer: Priority Health SBD	$142.66

HC COMP BURN GARM LEG & PANTY

Facility

$226.44

Service Code	HCPCS A6511
Hospital Charge Code	98300035
Hospital Revenue Code	270
Min. Negotiated Rate	$90.58
Max. Negotiated Rate	$203.80
Rate for Payer: Aetna Commercial	$192.47
Rate for Payer: Aetna Medicare	$113.22
Rate for Payer: Aetna New Business (MI Preferred)	$147.19
Rate for Payer: BCBS Complete	$90.58
Rate for Payer: Cash Price	$181.15
Rate for Payer: Cofinity Commercial	$158.51
Rate for Payer: Cofinity Commercial	$194.74
Rate for Payer: Cofinity Medicare Advantage	$158.51
Rate for Payer: Encore Health Key Benefits Commercial	$181.15
Rate for Payer: Healthscope Commercial	$203.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$192.47
Rate for Payer: PHP Commercial	$192.47
Rate for Payer: Priority Health Cigna Priority Health	$147.19
Rate for Payer: Priority Health SBD	$142.66

HC COMP BURN GARM LINING,POCKET,F

Facility

$12.24

Service Code	HCPCS A6512
Hospital Charge Code	98300037
Hospital Revenue Code	270
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$11.02
Rate for Payer: Aetna Commercial	$10.40
Rate for Payer: Aetna Medicare	$6.12
Rate for Payer: Aetna New Business (MI Preferred)	$7.96
Rate for Payer: BCBS Complete	$4.90
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 LINING,POCKET,F

Facility

$12.24

Service Code	HCPCS A6512
Hospital Charge Code	98300037
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 MITTEN TO WRIST

Facility

$69.36

Service Code	HCPCS A6512
Hospital Charge Code	98300038
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

HC COMP BURN GARM MITTEN TO WRIST

Facility

$69.36

Service Code	HCPCS A6512
Hospital Charge Code	98300038
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 POCKET & PAD CO

Facility

$14.28

Service Code	HCPCS A6512
Hospital Charge Code	98300039
Hospital Revenue Code	270
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$12.85
Rate for Payer: Aetna Commercial	$12.14
Rate for Payer: Aetna New Business (MI Preferred)	$9.28
Rate for Payer: Cash Price	$11.42
Rate for Payer: Cofinity Commercial	$10.00
Rate for Payer: Cofinity Commercial	$12.28
Rate for Payer: Cofinity Medicare Advantage	$10.00
Rate for Payer: Encore Health Key Benefits Commercial	$11.42
Rate for Payer: Healthscope Commercial	$12.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.14
Rate for Payer: PHP Commercial	$12.14
Rate for Payer: Priority Health Cigna Priority Health	$9.28
Rate for Payer: Priority Health SBD	$9.00

HC COMP BURN GARM POCKET & PAD CO

Facility

$14.28

Service Code	HCPCS A6512
Hospital Charge Code	98300039
Hospital Revenue Code	270
Min. Negotiated Rate	$5.71
Max. Negotiated Rate	$12.85
Rate for Payer: Aetna Commercial	$12.14
Rate for Payer: Aetna Medicare	$7.14
Rate for Payer: Aetna New Business (MI Preferred)	$9.28
Rate for Payer: BCBS Complete	$5.71
Rate for Payer: Cash Price	$11.42
Rate for Payer: Cofinity Commercial	$10.00
Rate for Payer: Cofinity Commercial	$12.28
Rate for Payer: Cofinity Medicare Advantage	$10.00
Rate for Payer: Encore Health Key Benefits Commercial	$11.42
Rate for Payer: Healthscope Commercial	$12.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.14
Rate for Payer: PHP Commercial	$12.14
Rate for Payer: Priority Health Cigna Priority Health	$9.28
Rate for Payer: Priority Health SBD	$9.00

HC COMP BURN GARM REINFORCEMENTS

Facility

$12.24

Service Code	HCPCS A6512
Hospital Charge Code	98300041
Hospital Revenue Code	270
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$11.02
Rate for Payer: Aetna Commercial	$10.40
Rate for Payer: Aetna Medicare	$6.12
Rate for Payer: Aetna New Business (MI Preferred)	$7.96
Rate for Payer: BCBS Complete	$4.90
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 REINFORCEMENTS

Facility

$12.24

Service Code	HCPCS A6512
Hospital Charge Code	98300041
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 REINF SET HK&LO

Facility

$10.20

Service Code	HCPCS A6512
Hospital Charge Code	98300040
Hospital Revenue Code	270
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$9.18
Rate for Payer: Aetna Commercial	$8.67
Rate for Payer: Aetna New Business (MI Preferred)	$6.63
Rate for Payer: Cash Price	$8.16
Rate for Payer: Cofinity Commercial	$7.14
Rate for Payer: Cofinity Commercial	$8.77
Rate for Payer: Cofinity Medicare Advantage	$7.14
Rate for Payer: Encore Health Key Benefits Commercial	$8.16
Rate for Payer: Healthscope Commercial	$9.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.67
Rate for Payer: PHP Commercial	$8.67
Rate for Payer: Priority Health Cigna Priority Health	$6.63
Rate for Payer: Priority Health SBD	$6.43

HC COMP BURN GARM REINF SET HK&LO

Facility

$10.20

Service Code	HCPCS A6512
Hospital Charge Code	98300040
Hospital Revenue Code	270
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$9.18
Rate for Payer: Aetna Commercial	$8.67
Rate for Payer: Aetna Medicare	$5.10
Rate for Payer: Aetna New Business (MI Preferred)	$6.63
Rate for Payer: BCBS Complete	$4.08
Rate for Payer: Cash Price	$8.16
Rate for Payer: Cofinity Commercial	$7.14
Rate for Payer: Cofinity Commercial	$8.77
Rate for Payer: Cofinity Medicare Advantage	$7.14
Rate for Payer: Encore Health Key Benefits Commercial	$8.16
Rate for Payer: Healthscope Commercial	$9.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.67
Rate for Payer: PHP Commercial	$8.67
Rate for Payer: Priority Health Cigna Priority Health	$6.63
Rate for Payer: Priority Health SBD	$6.43

HC COMP BURN GARM SHOULD FLAP REG

Facility

$34.68

Service Code	HCPCS A6512
Hospital Charge Code	98300042
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 SHOULD FLAP REG

Facility

$34.68

Service Code	HCPCS A6512
Hospital Charge Code	98300042
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 SILON-TEX P/D-G

Facility

$61.20

Service Code	HCPCS A6512
Hospital Charge Code	98300044
Hospital Revenue Code	270
Min. Negotiated Rate	$24.48
Max. Negotiated Rate	$55.08
Rate for Payer: Aetna Commercial	$52.02
Rate for Payer: Aetna Medicare	$30.60
Rate for Payer: Aetna New Business (MI Preferred)	$39.78
Rate for Payer: BCBS Complete	$24.48
Rate for Payer: Cash Price	$48.96
Rate for Payer: Cofinity Commercial	$42.84
Rate for Payer: Cofinity Commercial	$52.63
Rate for Payer: Cofinity Medicare Advantage	$42.84
Rate for Payer: Encore Health Key Benefits Commercial	$48.96
Rate for Payer: Healthscope Commercial	$55.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.02
Rate for Payer: PHP Commercial	$52.02
Rate for Payer: Priority Health Cigna Priority Health	$39.78
Rate for Payer: Priority Health SBD	$38.56

HC COMP BURN GARM SILON-TEX P/D-G

Facility

$61.20

Service Code	HCPCS A6512
Hospital Charge Code	98300044
Hospital Revenue Code	270
Min. Negotiated Rate	$38.56
Max. Negotiated Rate	$55.08
Rate for Payer: Aetna Commercial	$52.02
Rate for Payer: Aetna New Business (MI Preferred)	$39.78
Rate for Payer: Cash Price	$48.96
Rate for Payer: Cofinity Commercial	$42.84
Rate for Payer: Cofinity Commercial	$52.63
Rate for Payer: Cofinity Medicare Advantage	$42.84
Rate for Payer: Encore Health Key Benefits Commercial	$48.96
Rate for Payer: Healthscope Commercial	$55.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.02
Rate for Payer: PHP Commercial	$52.02
Rate for Payer: Priority Health Cigna Priority Health	$39.78
Rate for Payer: Priority Health SBD	$38.56

Know your out-of-pocket cost for care.

All Charges