Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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 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	$434.17
Rate for Payer: Aetna Commercial	$61.04
Rate for Payer: Aetna Medicare	$35.90
Rate for Payer: Aetna New Business (MI Preferred)	$46.68
Rate for Payer: BCBS Complete	$28.72
Rate for Payer: BCBS Trust/PPO	$434.17
Rate for Payer: BCN Commercial	$434.17
Rate for Payer: Cash Price	$57.45
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	$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 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 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	$434.17
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	$434.17
Rate for Payer: BCN Commercial	$434.17
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 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	$376.03
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: BCBS Trust/PPO	$376.03
Rate for Payer: BCN Commercial	$376.03
Rate for Payer: Cash Price	$9.98
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	$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	$376.03
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: BCBS Trust/PPO	$376.03
Rate for Payer: BCN Commercial	$376.03
Rate for Payer: Cash Price	$9.98
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	$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 KNE

Facility

$71.40

Service Code	HCPCS A6507
Hospital Charge Code	98300054
Hospital Revenue Code	270
Min. Negotiated Rate	$28.56
Max. Negotiated Rate	$162.19
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: BCBS Trust/PPO	$162.19
Rate for Payer: BCN Commercial	$162.19
Rate for Payer: Cash Price	$57.12
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	$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 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	$192.77
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: BCBS Trust/PPO	$192.77
Rate for Payer: BCN Commercial	$192.77
Rate for Payer: Cash Price	$75.07
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	$25.30
Max. Negotiated Rate	$434.17
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: BCBS Trust/PPO	$434.17
Rate for Payer: BCN Commercial	$434.17
Rate for Payer: Cash Price	$50.59
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	$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 STRETCH INSERT

Facility

$12.48

Service Code	HCPCS A4649
Hospital Charge Code	98300057
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 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	$376.03
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: BCBS Trust/PPO	$376.03
Rate for Payer: BCN Commercial	$376.03
Rate for Payer: Cash Price	$9.98
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 SUEDE/LEATHER G

Facility

$45.90

Service Code	HCPCS A9900
Hospital Charge Code	98300058
Hospital Revenue Code	270
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$560.32
Rate for Payer: Aetna Commercial	$39.02
Rate for Payer: Aetna Medicare	$22.95
Rate for Payer: Aetna New Business (MI Preferred)	$29.84
Rate for Payer: BCBS Complete	$18.36
Rate for Payer: BCBS Trust/PPO	$560.32
Rate for Payer: BCN Commercial	$560.32
Rate for Payer: Cash Price	$36.72
Rate for Payer: Cash Price	$36.72
Rate for Payer: Cofinity Commercial	$32.13
Rate for Payer: Cofinity Commercial	$39.47
Rate for Payer: Cofinity Medicare Advantage	$32.13
Rate for Payer: Encore Health Key Benefits Commercial	$36.72
Rate for Payer: Healthscope Commercial	$41.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.02
Rate for Payer: PHP Commercial	$39.02
Rate for Payer: Priority Health Cigna Priority Health	$29.84
Rate for Payer: Priority Health SBD	$28.92

HC COMP BURN GARM SUEDE/LEATHER G

Facility

$45.90

Service Code	HCPCS A9900
Hospital Charge Code	98300058
Hospital Revenue Code	270
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$41.31
Rate for Payer: Aetna Commercial	$39.02
Rate for Payer: Aetna New Business (MI Preferred)	$29.84
Rate for Payer: Cash Price	$36.72
Rate for Payer: Cofinity Commercial	$32.13
Rate for Payer: Cofinity Commercial	$39.47
Rate for Payer: Cofinity Medicare Advantage	$32.13
Rate for Payer: Encore Health Key Benefits Commercial	$36.72
Rate for Payer: Healthscope Commercial	$41.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.02
Rate for Payer: PHP Commercial	$39.02
Rate for Payer: Priority Health Cigna Priority Health	$29.84
Rate for Payer: Priority Health SBD	$28.92

HC COMP BURN GARM SUIT SLVD ABV K

Facility

$387.60

Service Code	HCPCS A6512
Hospital Charge Code	98300059
Hospital Revenue Code	270
Min. Negotiated Rate	$244.19
Max. Negotiated Rate	$348.84
Rate for Payer: Aetna Commercial	$329.46
Rate for Payer: Aetna New Business (MI Preferred)	$251.94
Rate for Payer: Cash Price	$310.08
Rate for Payer: Cofinity Commercial	$271.32
Rate for Payer: Cofinity Commercial	$333.34
Rate for Payer: Cofinity Medicare Advantage	$271.32
Rate for Payer: Encore Health Key Benefits Commercial	$310.08
Rate for Payer: Healthscope Commercial	$348.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$329.46
Rate for Payer: PHP Commercial	$329.46
Rate for Payer: Priority Health Cigna Priority Health	$251.94
Rate for Payer: Priority Health SBD	$244.19

HC COMP BURN GARM SUIT SLVD ABV K

Facility

$387.60

Service Code	HCPCS A6512
Hospital Charge Code	98300059
Hospital Revenue Code	270
Min. Negotiated Rate	$155.04
Max. Negotiated Rate	$434.17
Rate for Payer: Aetna Commercial	$329.46
Rate for Payer: Aetna Medicare	$193.80
Rate for Payer: Aetna New Business (MI Preferred)	$251.94
Rate for Payer: BCBS Complete	$155.04
Rate for Payer: BCBS Trust/PPO	$434.17
Rate for Payer: BCN Commercial	$434.17
Rate for Payer: Cash Price	$310.08
Rate for Payer: Cash Price	$310.08
Rate for Payer: Cofinity Commercial	$271.32
Rate for Payer: Cofinity Commercial	$333.34
Rate for Payer: Cofinity Medicare Advantage	$271.32
Rate for Payer: Encore Health Key Benefits Commercial	$310.08
Rate for Payer: Healthscope Commercial	$348.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$329.46
Rate for Payer: PHP Commercial	$329.46
Rate for Payer: Priority Health Cigna Priority Health	$251.94
Rate for Payer: Priority Health SBD	$244.19

HC COMP BURN GARM SUIT SLVD TWO LEGS

Facility

$491.64

Service Code	HCPCS A6501
Hospital Charge Code	98300060
Hospital Revenue Code	270
Min. Negotiated Rate	$309.73
Max. Negotiated Rate	$442.48
Rate for Payer: Aetna Commercial	$417.89
Rate for Payer: Aetna New Business (MI Preferred)	$319.57
Rate for Payer: Cash Price	$393.31
Rate for Payer: Cofinity Commercial	$344.15
Rate for Payer: Cofinity Commercial	$422.81
Rate for Payer: Cofinity Medicare Advantage	$344.15
Rate for Payer: Encore Health Key Benefits Commercial	$393.31
Rate for Payer: Healthscope Commercial	$442.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$417.89
Rate for Payer: PHP Commercial	$417.89
Rate for Payer: Priority Health Cigna Priority Health	$319.57
Rate for Payer: Priority Health SBD	$309.73

HC COMP BURN GARM SUIT SLVD TWO LEGS

Facility

$491.64

Service Code	HCPCS A6501
Hospital Charge Code	98300060
Hospital Revenue Code	270
Min. Negotiated Rate	$196.66
Max. Negotiated Rate	$1,060.48
Rate for Payer: Aetna Commercial	$417.89
Rate for Payer: Aetna Medicare	$245.82
Rate for Payer: Aetna New Business (MI Preferred)	$319.57
Rate for Payer: BCBS Complete	$196.66
Rate for Payer: BCBS Trust/PPO	$1,060.48
Rate for Payer: BCN Commercial	$1,060.48
Rate for Payer: Cash Price	$393.31
Rate for Payer: Cash Price	$393.31
Rate for Payer: Cofinity Commercial	$344.15
Rate for Payer: Cofinity Commercial	$422.81
Rate for Payer: Cofinity Medicare Advantage	$344.15
Rate for Payer: Encore Health Key Benefits Commercial	$393.31
Rate for Payer: Healthscope Commercial	$442.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$417.89
Rate for Payer: PHP Commercial	$417.89
Rate for Payer: Priority Health Cigna Priority Health	$319.57
Rate for Payer: Priority Health SBD	$309.73

HC COMP BURN GARM SUIT SLVLS ABV

Facility

$320.28

Service Code	HCPCS A6512
Hospital Charge Code	98300061
Hospital Revenue Code	270
Min. Negotiated Rate	$201.78
Max. Negotiated Rate	$288.25
Rate for Payer: Aetna Commercial	$272.24
Rate for Payer: Aetna New Business (MI Preferred)	$208.18
Rate for Payer: Cash Price	$256.22
Rate for Payer: Cofinity Commercial	$224.20
Rate for Payer: Cofinity Commercial	$275.44
Rate for Payer: Cofinity Medicare Advantage	$224.20
Rate for Payer: Encore Health Key Benefits Commercial	$256.22
Rate for Payer: Healthscope Commercial	$288.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$272.24
Rate for Payer: PHP Commercial	$272.24
Rate for Payer: Priority Health Cigna Priority Health	$208.18
Rate for Payer: Priority Health SBD	$201.78

HC COMP BURN GARM SUIT SLVLS ABV

Facility

$320.28

Service Code	HCPCS A6512
Hospital Charge Code	98300061
Hospital Revenue Code	270
Min. Negotiated Rate	$128.11
Max. Negotiated Rate	$434.17
Rate for Payer: Aetna Commercial	$272.24
Rate for Payer: Aetna Medicare	$160.14
Rate for Payer: Aetna New Business (MI Preferred)	$208.18
Rate for Payer: BCBS Complete	$128.11
Rate for Payer: BCBS Trust/PPO	$434.17
Rate for Payer: BCN Commercial	$434.17
Rate for Payer: Cash Price	$256.22
Rate for Payer: Cash Price	$256.22
Rate for Payer: Cofinity Commercial	$224.20
Rate for Payer: Cofinity Commercial	$275.44
Rate for Payer: Cofinity Medicare Advantage	$224.20
Rate for Payer: Encore Health Key Benefits Commercial	$256.22
Rate for Payer: Healthscope Commercial	$288.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$272.24
Rate for Payer: PHP Commercial	$272.24
Rate for Payer: Priority Health Cigna Priority Health	$208.18
Rate for Payer: Priority Health SBD	$201.78

Know your out-of-pocket cost for care.

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