Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC COMP BURN GARM SILON-TEX UP TO

Facility

$36.72

Service Code	HCPCS A6512
Hospital Charge Code	98300045
Hospital Revenue Code	270
Min. Negotiated Rate	$14.69
Max. Negotiated Rate	$33.05
Rate for Payer: Aetna Commercial	$31.21
Rate for Payer: Aetna Medicare	$18.36
Rate for Payer: Aetna New Business (MI Preferred)	$23.87
Rate for Payer: BCBS Complete	$14.69
Rate for Payer: Cash Price	$29.38
Rate for Payer: Cofinity Commercial	$25.70
Rate for Payer: Cofinity Commercial	$31.58
Rate for Payer: Cofinity Medicare Advantage	$25.70
Rate for Payer: Encore Health Key Benefits Commercial	$29.38
Rate for Payer: Healthscope Commercial	$33.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.21
Rate for Payer: PHP Commercial	$31.21
Rate for Payer: Priority Health Cigna Priority Health	$23.87
Rate for Payer: Priority Health SBD	$23.13

HC COMP BURN GARM SILON-TEX UP TO

Facility

$36.72

Service Code	HCPCS A6512
Hospital Charge Code	98300045
Hospital Revenue Code	270
Min. Negotiated Rate	$23.13
Max. Negotiated Rate	$33.05
Rate for Payer: Aetna Commercial	$31.21
Rate for Payer: Aetna New Business (MI Preferred)	$23.87
Rate for Payer: Cash Price	$29.38
Rate for Payer: Cofinity Commercial	$25.70
Rate for Payer: Cofinity Commercial	$31.58
Rate for Payer: Cofinity Medicare Advantage	$25.70
Rate for Payer: Encore Health Key Benefits Commercial	$29.38
Rate for Payer: Healthscope Commercial	$33.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.21
Rate for Payer: PHP Commercial	$31.21
Rate for Payer: Priority Health Cigna Priority Health	$23.87
Rate for Payer: Priority Health SBD	$23.13

HC COMP BURN GARM SILON-TEX WHOL

Facility

$85.68

Service Code	HCPCS A6512
Hospital Charge Code	98300046
Hospital Revenue Code	270
Min. Negotiated Rate	$53.98
Max. Negotiated Rate	$77.11
Rate for Payer: Aetna Commercial	$72.83
Rate for Payer: Aetna New Business (MI Preferred)	$55.69
Rate for Payer: Cash Price	$68.54
Rate for Payer: Cofinity Commercial	$59.98
Rate for Payer: Cofinity Commercial	$73.68
Rate for Payer: Cofinity Medicare Advantage	$59.98
Rate for Payer: Encore Health Key Benefits Commercial	$68.54
Rate for Payer: Healthscope Commercial	$77.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$72.83
Rate for Payer: PHP Commercial	$72.83
Rate for Payer: Priority Health Cigna Priority Health	$55.69
Rate for Payer: Priority Health SBD	$53.98

HC COMP BURN GARM SILON-TEX WHOL

Facility

$85.68

Service Code	HCPCS A6512
Hospital Charge Code	98300046
Hospital Revenue Code	270
Min. Negotiated Rate	$34.27
Max. Negotiated Rate	$77.11
Rate for Payer: Aetna Commercial	$72.83
Rate for Payer: Aetna Medicare	$42.84
Rate for Payer: Aetna New Business (MI Preferred)	$55.69
Rate for Payer: BCBS Complete	$34.27
Rate for Payer: Cash Price	$68.54
Rate for Payer: Cofinity Commercial	$59.98
Rate for Payer: Cofinity Commercial	$73.68
Rate for Payer: Cofinity Medicare Advantage	$59.98
Rate for Payer: Encore Health Key Benefits Commercial	$68.54
Rate for Payer: Healthscope Commercial	$77.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$72.83
Rate for Payer: PHP Commercial	$72.83
Rate for Payer: Priority Health Cigna Priority Health	$55.69
Rate for Payer: Priority Health SBD	$53.98

HC COMP BURN GARM SLEEVE WRIST/AX

Facility

$71.40

Service Code	HCPCS A6512
Hospital Charge Code	98300047
Hospital Revenue Code	270
Min. Negotiated Rate	$44.98
Max. Negotiated Rate	$64.26
Rate for Payer: Aetna Commercial	$60.69
Rate for Payer: Aetna New Business (MI Preferred)	$46.41
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cofinity Commercial	$49.98
Rate for Payer: Cofinity Commercial	$61.40
Rate for Payer: Cofinity Medicare Advantage	$49.98
Rate for Payer: Encore Health Key Benefits Commercial	$57.12
Rate for Payer: Healthscope Commercial	$64.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.69
Rate for Payer: PHP Commercial	$60.69
Rate for Payer: Priority Health Cigna Priority Health	$46.41
Rate for Payer: Priority Health SBD	$44.98

HC COMP BURN GARM SLEEVE WRIST/AX

Facility

$71.40

Service Code	HCPCS A6512
Hospital Charge Code	98300047
Hospital Revenue Code	270
Min. Negotiated Rate	$28.56
Max. Negotiated Rate	$64.26
Rate for Payer: Aetna Commercial	$60.69
Rate for Payer: Aetna Medicare	$35.70
Rate for Payer: Aetna New Business (MI Preferred)	$46.41
Rate for Payer: BCBS Complete	$28.56
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cofinity Commercial	$49.98
Rate for Payer: Cofinity Commercial	$61.40
Rate for Payer: Cofinity Medicare Advantage	$49.98
Rate for Payer: Encore Health Key Benefits Commercial	$57.12
Rate for Payer: Healthscope Commercial	$64.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.69
Rate for Payer: PHP Commercial	$60.69
Rate for Payer: Priority Health Cigna Priority Health	$46.41
Rate for Payer: Priority Health SBD	$44.98

HC COMP BURN GARM SLV WRST-ELB/EL

Facility

$61.20

Service Code	HCPCS A6512
Hospital Charge Code	98300048
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

HC COMP BURN GARM SLV WRST-ELB/EL

Facility

$61.20

Service Code	HCPCS A6512
Hospital Charge Code	98300048
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 STERNAL STRAP

Facility

$69.36

Service Code	HCPCS A6512
Hospital Charge Code	98300049
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 STERNAL STRAP

Facility

$69.36

Service Code	HCPCS A6512
Hospital Charge Code	98300049
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 STKNG KNEE TO T

Facility

$71.81

Service Code	HCPCS A6512
Hospital Charge Code	98300050
Hospital Revenue Code	270
Min. Negotiated Rate	$45.24
Max. Negotiated Rate	$64.63
Rate for Payer: Aetna Commercial	$61.04
Rate for Payer: Aetna New Business (MI Preferred)	$46.68
Rate for Payer: Cash Price	$57.45
Rate for Payer: Cofinity Commercial	$50.27
Rate for Payer: Cofinity Commercial	$61.76
Rate for Payer: Cofinity Medicare Advantage	$50.27
Rate for Payer: Encore Health Key Benefits Commercial	$57.45
Rate for Payer: Healthscope Commercial	$64.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.04
Rate for Payer: PHP Commercial	$61.04
Rate for Payer: Priority Health Cigna Priority Health	$46.68
Rate for Payer: Priority Health SBD	$45.24

HC COMP BURN GARM STKNG KNEE TO T

Facility

$71.81

Service Code	HCPCS A6512
Hospital Charge Code	98300050
Hospital Revenue Code	270
Min. Negotiated Rate	$28.72
Max. Negotiated Rate	$64.63
Rate for Payer: Aetna Commercial	$61.04
Rate for Payer: Aetna Medicare	$35.91
Rate for Payer: Aetna New Business (MI Preferred)	$46.68
Rate for Payer: BCBS Complete	$28.72
Rate for Payer: Cash Price	$57.45
Rate for Payer: Cofinity Commercial	$50.27
Rate for Payer: Cofinity Commercial	$61.76
Rate for Payer: Cofinity Medicare Advantage	$50.27
Rate for Payer: Encore Health Key Benefits Commercial	$57.45
Rate for Payer: Healthscope Commercial	$64.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.04
Rate for Payer: PHP Commercial	$61.04
Rate for Payer: Priority Health Cigna Priority Health	$46.68
Rate for Payer: Priority Health SBD	$45.24

HC COMP BURN GARM STKNG TO THI NO

Facility

$79.56

Service Code	HCPCS A6512
Hospital Charge Code	98300051
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 STKNG TO THI NO

Facility

$79.56

Service Code	HCPCS A6512
Hospital Charge Code	98300051
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 STMP CLS ORNG P

Facility

$12.48

Service Code	HCPCS A4649
Hospital Charge Code	98300052
Hospital Revenue Code	270
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$11.23
Rate for Payer: Aetna Commercial	$10.61
Rate for Payer: Aetna Medicare	$6.24
Rate for Payer: Aetna New Business (MI Preferred)	$8.11
Rate for Payer: BCBS Complete	$4.99
Rate for Payer: Cash Price	$9.98
Rate for Payer: Cofinity Commercial	$10.73
Rate for Payer: Cofinity Commercial	$8.74
Rate for Payer: Cofinity Medicare Advantage	$8.74
Rate for Payer: Encore Health Key Benefits Commercial	$9.98
Rate for Payer: Healthscope Commercial	$11.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.61
Rate for Payer: PHP Commercial	$10.61
Rate for Payer: Priority Health Cigna Priority Health	$8.11
Rate for Payer: Priority Health SBD	$7.86

HC COMP BURN GARM STMP CLS ORNG P

Facility

$12.48

Service Code	HCPCS A4649
Hospital Charge Code	98300052
Hospital Revenue Code	270
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$11.23
Rate for Payer: Aetna Commercial	$10.61
Rate for Payer: Aetna New Business (MI Preferred)	$8.11
Rate for Payer: Cash Price	$9.98
Rate for Payer: Cofinity Commercial	$10.73
Rate for Payer: Cofinity Commercial	$8.74
Rate for Payer: Cofinity Medicare Advantage	$8.74
Rate for Payer: Encore Health Key Benefits Commercial	$9.98
Rate for Payer: Healthscope Commercial	$11.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.61
Rate for Payer: PHP Commercial	$10.61
Rate for Payer: Priority Health Cigna Priority Health	$8.11
Rate for Payer: Priority Health SBD	$7.86

HC COMP BURN GARM STMP CLS STRCH

Facility

$12.48

Service Code	HCPCS A4649
Hospital Charge Code	98300053
Hospital Revenue Code	270
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$11.23
Rate for Payer: Aetna Commercial	$10.61
Rate for Payer: Aetna Medicare	$6.24
Rate for Payer: Aetna New Business (MI Preferred)	$8.11
Rate for Payer: BCBS Complete	$4.99
Rate for Payer: Cash Price	$9.98
Rate for Payer: Cofinity Commercial	$10.73
Rate for Payer: Cofinity Commercial	$8.74
Rate for Payer: Cofinity Medicare Advantage	$8.74
Rate for Payer: Encore Health Key Benefits Commercial	$9.98
Rate for Payer: Healthscope Commercial	$11.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.61
Rate for Payer: PHP Commercial	$10.61
Rate for Payer: Priority Health Cigna Priority Health	$8.11
Rate for Payer: Priority Health SBD	$7.86

HC COMP BURN GARM STMP CLS STRCH

Facility

$12.48

Service Code	HCPCS A4649
Hospital Charge Code	98300053
Hospital Revenue Code	270
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$11.23
Rate for Payer: Aetna Commercial	$10.61
Rate for Payer: Aetna New Business (MI Preferred)	$8.11
Rate for Payer: Cash Price	$9.98
Rate for Payer: Cofinity Commercial	$10.73
Rate for Payer: Cofinity Commercial	$8.74
Rate for Payer: Cofinity Medicare Advantage	$8.74
Rate for Payer: Encore Health Key Benefits Commercial	$9.98
Rate for Payer: Healthscope Commercial	$11.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.61
Rate for Payer: PHP Commercial	$10.61
Rate for Payer: Priority Health Cigna Priority Health	$8.11
Rate for Payer: Priority Health SBD	$7.86

HC COMP BURN GARM STOCKING TO KNE

Facility

$71.40

Service Code	HCPCS A6507
Hospital Charge Code	98300054
Hospital Revenue Code	270
Min. Negotiated Rate	$28.56
Max. Negotiated Rate	$64.26
Rate for Payer: Aetna Commercial	$60.69
Rate for Payer: Aetna Medicare	$35.70
Rate for Payer: Aetna New Business (MI Preferred)	$46.41
Rate for Payer: BCBS Complete	$28.56
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cofinity Commercial	$49.98
Rate for Payer: Cofinity Commercial	$61.40
Rate for Payer: Cofinity Medicare Advantage	$49.98
Rate for Payer: Encore Health Key Benefits Commercial	$57.12
Rate for Payer: Healthscope Commercial	$64.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.69
Rate for Payer: PHP Commercial	$60.69
Rate for Payer: Priority Health Cigna Priority Health	$46.41
Rate for Payer: Priority Health SBD	$44.98

HC COMP BURN GARM STOCKING TO KNE

Facility

$71.40

Service Code	HCPCS A6507
Hospital Charge Code	98300054
Hospital Revenue Code	270
Min. Negotiated Rate	$44.98
Max. Negotiated Rate	$64.26
Rate for Payer: Aetna Commercial	$60.69
Rate for Payer: Aetna New Business (MI Preferred)	$46.41
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cofinity Commercial	$49.98
Rate for Payer: Cofinity Commercial	$61.40
Rate for Payer: Cofinity Medicare Advantage	$49.98
Rate for Payer: Encore Health Key Benefits Commercial	$57.12
Rate for Payer: Healthscope Commercial	$64.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.69
Rate for Payer: PHP Commercial	$60.69
Rate for Payer: Priority Health Cigna Priority Health	$46.41
Rate for Payer: Priority Health SBD	$44.98

HC COMP BURN GARM STOCKING TO THI

Facility

$93.84

Service Code	HCPCS A6508
Hospital Charge Code	98300055
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 STOCKING TO THI

Facility

$93.84

Service Code	HCPCS A6508
Hospital Charge Code	98300055
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 STOCK-KNEE/NO F

Facility

$63.24

Service Code	HCPCS A6512
Hospital Charge Code	98300056
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 STOCK-KNEE/NO F

Facility

$63.24

Service Code	HCPCS A6512
Hospital Charge Code	98300056
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 STRETCH INSERT

Facility

$12.48

Service Code	HCPCS A4649
Hospital Charge Code	98300057
Hospital Revenue Code	270
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$11.23
Rate for Payer: Aetna Commercial	$10.61
Rate for Payer: Aetna Medicare	$6.24
Rate for Payer: Aetna New Business (MI Preferred)	$8.11
Rate for Payer: BCBS Complete	$4.99
Rate for Payer: Cash Price	$9.98
Rate for Payer: Cofinity Commercial	$10.73
Rate for Payer: Cofinity Commercial	$8.74
Rate for Payer: Cofinity Medicare Advantage	$8.74
Rate for Payer: Encore Health Key Benefits Commercial	$9.98
Rate for Payer: Healthscope Commercial	$11.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.61
Rate for Payer: PHP Commercial	$10.61
Rate for Payer: Priority Health Cigna Priority Health	$8.11
Rate for Payer: Priority Health SBD	$7.86

Know your out-of-pocket cost for care.

All Charges