Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC COMPARTMENT PRESSURE CHECK

Facility

$645.71

Hospital Charge Code	27000045
Hospital Revenue Code	270
Min. Negotiated Rate	$258.28
Max. Negotiated Rate	$645.71
Rate for Payer: Aetna Commercial	$581.14
Rate for Payer: ASR ASR	$626.34
Rate for Payer: BCBS Complete	$258.28
Rate for Payer: BCBS Trust/PPO	$500.62
Rate for Payer: BCN Commercial	$500.62
Rate for Payer: Cash Price	$516.57
Rate for Payer: Cofinity Commercial	$606.97
Rate for Payer: Encore Health Key Benefits Commercial	$516.57
Rate for Payer: Healthscope Commercial	$645.71
Rate for Payer: Healthscope Whirlpool	$626.34
Rate for Payer: Mclaren Commercial	$581.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$548.85
Rate for Payer: Priority Health Cigna Priority Health	$452.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$587.60
Rate for Payer: Priority Health Narrow Network	$458.45
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$568.22

HC COMPARTMENT PRESSURE CHECK

Facility

$645.71

Hospital Charge Code	27000045
Hospital Revenue Code	270
Min. Negotiated Rate	$452.00
Max. Negotiated Rate	$645.71
Rate for Payer: Aetna Commercial	$581.14
Rate for Payer: ASR ASR	$626.34
Rate for Payer: BCBS Trust/PPO	$500.62
Rate for Payer: BCN Commercial	$500.62
Rate for Payer: Cash Price	$516.57
Rate for Payer: Cofinity Commercial	$606.97
Rate for Payer: Encore Health Key Benefits Commercial	$516.57
Rate for Payer: Healthscope Commercial	$645.71
Rate for Payer: Healthscope Whirlpool	$626.34
Rate for Payer: Mclaren Commercial	$581.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$548.85
Rate for Payer: Priority Health Cigna Priority Health	$452.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$568.22

HC COMP BURN GARM 2 LEGS-WAIST

Facility

$234.00

Service Code	HCPCS A6511
Hospital Charge Code	98300142
Hospital Revenue Code	270
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna Commercial	$210.60
Rate for Payer: ASR ASR	$226.98
Rate for Payer: BCBS Complete	$93.60
Rate for Payer: BCBS Trust/PPO	$181.42
Rate for Payer: BCN Commercial	$181.42
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cofinity Commercial	$219.96
Rate for Payer: Encore Health Key Benefits Commercial	$187.20
Rate for Payer: Healthscope Commercial	$234.00
Rate for Payer: Healthscope Whirlpool	$226.98
Rate for Payer: Mclaren Commercial	$210.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$198.90
Rate for Payer: Priority Health Cigna Priority Health	$163.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$212.94
Rate for Payer: Priority Health Narrow Network	$166.14
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$205.92

HC COMP BURN GARM 2 LEGS-WAIST

Facility

$234.00

Service Code	HCPCS A6511
Hospital Charge Code	98300142
Hospital Revenue Code	270
Min. Negotiated Rate	$163.80
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna Commercial	$210.60
Rate for Payer: ASR ASR	$226.98
Rate for Payer: BCBS Trust/PPO	$181.42
Rate for Payer: BCN Commercial	$181.42
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cofinity Commercial	$219.96
Rate for Payer: Encore Health Key Benefits Commercial	$187.20
Rate for Payer: Healthscope Commercial	$234.00
Rate for Payer: Healthscope Whirlpool	$226.98
Rate for Payer: Mclaren Commercial	$210.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$198.90
Rate for Payer: Priority Health Cigna Priority Health	$163.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$205.92

HC COMP BURN GARM 2 OR MORE FAB/C

Facility

$12.00

Service Code	HCPCS A6512
Hospital Charge Code	98300143
Hospital Revenue Code	270
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$10.80
Rate for Payer: ASR ASR	$11.64
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: BCBS Trust/PPO	$9.30
Rate for Payer: BCN Commercial	$9.30
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cofinity Commercial	$11.28
Rate for Payer: Encore Health Key Benefits Commercial	$9.60
Rate for Payer: Healthscope Commercial	$12.00
Rate for Payer: Healthscope Whirlpool	$11.64
Rate for Payer: Mclaren Commercial	$10.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.20
Rate for Payer: Priority Health Cigna Priority Health	$8.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10.92
Rate for Payer: Priority Health Narrow Network	$8.52
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$10.56

HC COMP BURN GARM 2 OR MORE FAB/C

Facility

$12.00

Service Code	HCPCS A6512
Hospital Charge Code	98300143
Hospital Revenue Code	270
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$10.80
Rate for Payer: ASR ASR	$11.64
Rate for Payer: BCBS Trust/PPO	$9.30
Rate for Payer: BCN Commercial	$9.30
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cofinity Commercial	$11.28
Rate for Payer: Encore Health Key Benefits Commercial	$9.60
Rate for Payer: Healthscope Commercial	$12.00
Rate for Payer: Healthscope Whirlpool	$11.64
Rate for Payer: Mclaren Commercial	$10.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.20
Rate for Payer: Priority Health Cigna Priority Health	$8.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$10.56

HC COMP BURN GARM ABD REINFOR DBL

Facility

$16.00

Service Code	HCPCS A6512
Hospital Charge Code	98300144
Hospital Revenue Code	270
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: ASR ASR	$15.52
Rate for Payer: BCBS Complete	$6.40
Rate for Payer: BCBS Trust/PPO	$12.40
Rate for Payer: BCN Commercial	$12.40
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cofinity Commercial	$15.04
Rate for Payer: Encore Health Key Benefits Commercial	$12.80
Rate for Payer: Healthscope Commercial	$16.00
Rate for Payer: Healthscope Whirlpool	$15.52
Rate for Payer: Mclaren Commercial	$14.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.60
Rate for Payer: Priority Health Cigna Priority Health	$11.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.56
Rate for Payer: Priority Health Narrow Network	$11.36
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$14.08

HC COMP BURN GARM ABD REINFOR DBL

Facility

$16.00

Service Code	HCPCS A6512
Hospital Charge Code	98300144
Hospital Revenue Code	270
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: ASR ASR	$15.52
Rate for Payer: BCBS Trust/PPO	$12.40
Rate for Payer: BCN Commercial	$12.40
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cofinity Commercial	$15.04
Rate for Payer: Encore Health Key Benefits Commercial	$12.80
Rate for Payer: Healthscope Commercial	$16.00
Rate for Payer: Healthscope Whirlpool	$15.52
Rate for Payer: Mclaren Commercial	$14.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.60
Rate for Payer: Priority Health Cigna Priority Health	$11.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$14.08

HC COMP BURN GARM ANKLET

Facility

$62.00

Service Code	HCPCS A6512
Hospital Charge Code	98300145
Hospital Revenue Code	270
Min. Negotiated Rate	$43.40
Max. Negotiated Rate	$62.00
Rate for Payer: Aetna Commercial	$55.80
Rate for Payer: ASR ASR	$60.14
Rate for Payer: BCBS Trust/PPO	$48.07
Rate for Payer: BCN Commercial	$48.07
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cofinity Commercial	$58.28
Rate for Payer: Encore Health Key Benefits Commercial	$49.60
Rate for Payer: Healthscope Commercial	$62.00
Rate for Payer: Healthscope Whirlpool	$60.14
Rate for Payer: Mclaren Commercial	$55.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52.70
Rate for Payer: Priority Health Cigna Priority Health	$43.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$54.56

HC COMP BURN GARM ANKLET

Facility

$62.00

Service Code	HCPCS A6512
Hospital Charge Code	98300145
Hospital Revenue Code	270
Min. Negotiated Rate	$24.80
Max. Negotiated Rate	$62.00
Rate for Payer: Aetna Commercial	$55.80
Rate for Payer: ASR ASR	$60.14
Rate for Payer: BCBS Complete	$24.80
Rate for Payer: BCBS Trust/PPO	$48.07
Rate for Payer: BCN Commercial	$48.07
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cofinity Commercial	$58.28
Rate for Payer: Encore Health Key Benefits Commercial	$49.60
Rate for Payer: Healthscope Commercial	$62.00
Rate for Payer: Healthscope Whirlpool	$60.14
Rate for Payer: Mclaren Commercial	$55.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52.70
Rate for Payer: Priority Health Cigna Priority Health	$43.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56.42
Rate for Payer: Priority Health Narrow Network	$44.02
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$54.56

HC COMP BURN GARM BDY BRF SLVD LE

Facility

$332.00

Service Code	HCPCS A6510
Hospital Charge Code	98300146
Hospital Revenue Code	270
Min. Negotiated Rate	$232.40
Max. Negotiated Rate	$332.00
Rate for Payer: Aetna Commercial	$298.80
Rate for Payer: ASR ASR	$322.04
Rate for Payer: BCBS Trust/PPO	$257.40
Rate for Payer: BCN Commercial	$257.40
Rate for Payer: Cash Price	$265.60
Rate for Payer: Cofinity Commercial	$312.08
Rate for Payer: Encore Health Key Benefits Commercial	$265.60
Rate for Payer: Healthscope Commercial	$332.00
Rate for Payer: Healthscope Whirlpool	$322.04
Rate for Payer: Mclaren Commercial	$298.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$282.20
Rate for Payer: Priority Health Cigna Priority Health	$232.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$292.16

HC COMP BURN GARM BDY BRF SLVD LE

Facility

$332.00

Service Code	HCPCS A6510
Hospital Charge Code	98300146
Hospital Revenue Code	270
Min. Negotiated Rate	$132.80
Max. Negotiated Rate	$332.00
Rate for Payer: Aetna Commercial	$298.80
Rate for Payer: ASR ASR	$322.04
Rate for Payer: BCBS Complete	$132.80
Rate for Payer: BCBS Trust/PPO	$257.40
Rate for Payer: BCN Commercial	$257.40
Rate for Payer: Cash Price	$265.60
Rate for Payer: Cofinity Commercial	$312.08
Rate for Payer: Encore Health Key Benefits Commercial	$265.60
Rate for Payer: Healthscope Commercial	$332.00
Rate for Payer: Healthscope Whirlpool	$322.04
Rate for Payer: Mclaren Commercial	$298.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$282.20
Rate for Payer: Priority Health Cigna Priority Health	$232.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$302.12
Rate for Payer: Priority Health Narrow Network	$235.72
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$292.16

HC COMP BURN GARM BELLY BAND

Facility

$40.00

Service Code	HCPCS A6512
Hospital Charge Code	98300147
Hospital Revenue Code	270
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$36.00
Rate for Payer: ASR ASR	$38.80
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: BCBS Trust/PPO	$31.01
Rate for Payer: BCN Commercial	$31.01
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cofinity Commercial	$37.60
Rate for Payer: Encore Health Key Benefits Commercial	$32.00
Rate for Payer: Healthscope Commercial	$40.00
Rate for Payer: Healthscope Whirlpool	$38.80
Rate for Payer: Mclaren Commercial	$36.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$34.00
Rate for Payer: Priority Health Cigna Priority Health	$28.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36.40
Rate for Payer: Priority Health Narrow Network	$28.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$35.20

HC COMP BURN GARM BELLY BAND

Facility

$40.00

Service Code	HCPCS A6512
Hospital Charge Code	98300147
Hospital Revenue Code	270
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$36.00
Rate for Payer: ASR ASR	$38.80
Rate for Payer: BCBS Trust/PPO	$31.01
Rate for Payer: BCN Commercial	$31.01
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cofinity Commercial	$37.60
Rate for Payer: Encore Health Key Benefits Commercial	$32.00
Rate for Payer: Healthscope Commercial	$40.00
Rate for Payer: Healthscope Whirlpool	$38.80
Rate for Payer: Mclaren Commercial	$36.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$34.00
Rate for Payer: Priority Health Cigna Priority Health	$28.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$35.20

HC COMP BURN GARM BODY BRF SLEEVE

Facility

$236.00

Service Code	HCPCS A6512
Hospital Charge Code	98300148
Hospital Revenue Code	270
Min. Negotiated Rate	$94.40
Max. Negotiated Rate	$236.00
Rate for Payer: Aetna Commercial	$212.40
Rate for Payer: ASR ASR	$228.92
Rate for Payer: BCBS Complete	$94.40
Rate for Payer: BCBS Trust/PPO	$182.97
Rate for Payer: BCN Commercial	$182.97
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cofinity Commercial	$221.84
Rate for Payer: Encore Health Key Benefits Commercial	$188.80
Rate for Payer: Healthscope Commercial	$236.00
Rate for Payer: Healthscope Whirlpool	$228.92
Rate for Payer: Mclaren Commercial	$212.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$200.60
Rate for Payer: Priority Health Cigna Priority Health	$165.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$214.76
Rate for Payer: Priority Health Narrow Network	$167.56
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$207.68

HC COMP BURN GARM BODY BRF SLEEVE

Facility

$236.00

Service Code	HCPCS A6512
Hospital Charge Code	98300148
Hospital Revenue Code	270
Min. Negotiated Rate	$165.20
Max. Negotiated Rate	$236.00
Rate for Payer: Aetna Commercial	$212.40
Rate for Payer: ASR ASR	$228.92
Rate for Payer: BCBS Trust/PPO	$182.97
Rate for Payer: BCN Commercial	$182.97
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cofinity Commercial	$221.84
Rate for Payer: Encore Health Key Benefits Commercial	$188.80
Rate for Payer: Healthscope Commercial	$236.00
Rate for Payer: Healthscope Whirlpool	$228.92
Rate for Payer: Mclaren Commercial	$212.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$200.60
Rate for Payer: Priority Health Cigna Priority Health	$165.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$207.68

HC COMP BURN GARM BRF 2 LEGS ABV

Facility

$150.00

Service Code	HCPCS A6512
Hospital Charge Code	98300149
Hospital Revenue Code	270
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$135.00
Rate for Payer: ASR ASR	$145.50
Rate for Payer: BCBS Complete	$60.00
Rate for Payer: BCBS Trust/PPO	$116.30
Rate for Payer: BCN Commercial	$116.30
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cofinity Commercial	$141.00
Rate for Payer: Encore Health Key Benefits Commercial	$120.00
Rate for Payer: Healthscope Commercial	$150.00
Rate for Payer: Healthscope Whirlpool	$145.50
Rate for Payer: Mclaren Commercial	$135.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$127.50
Rate for Payer: Priority Health Cigna Priority Health	$105.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$136.50
Rate for Payer: Priority Health Narrow Network	$106.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$132.00

HC COMP BURN GARM BRF 2 LEGS ABV

Facility

$150.00

Service Code	HCPCS A6512
Hospital Charge Code	98300149
Hospital Revenue Code	270
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$135.00
Rate for Payer: ASR ASR	$145.50
Rate for Payer: BCBS Trust/PPO	$116.30
Rate for Payer: BCN Commercial	$116.30
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cofinity Commercial	$141.00
Rate for Payer: Encore Health Key Benefits Commercial	$120.00
Rate for Payer: Healthscope Commercial	$150.00
Rate for Payer: Healthscope Whirlpool	$145.50
Rate for Payer: Mclaren Commercial	$135.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$127.50
Rate for Payer: Priority Health Cigna Priority Health	$105.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$132.00

HC COMP BURN GARM BRF&CHAP,LG-MID

Facility

$132.00

Service Code	HCPCS A6512
Hospital Charge Code	98300150
Hospital Revenue Code	270
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$132.00
Rate for Payer: Aetna Commercial	$118.80
Rate for Payer: ASR ASR	$128.04
Rate for Payer: BCBS Trust/PPO	$102.34
Rate for Payer: BCN Commercial	$102.34
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cofinity Commercial	$124.08
Rate for Payer: Encore Health Key Benefits Commercial	$105.60
Rate for Payer: Healthscope Commercial	$132.00
Rate for Payer: Healthscope Whirlpool	$128.04
Rate for Payer: Mclaren Commercial	$118.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$112.20
Rate for Payer: Priority Health Cigna Priority Health	$92.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$116.16

HC COMP BURN GARM BRF&CHAP,LG-MID

Facility

$132.00

Service Code	HCPCS A6512
Hospital Charge Code	98300150
Hospital Revenue Code	270
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$132.00
Rate for Payer: Aetna Commercial	$118.80
Rate for Payer: ASR ASR	$128.04
Rate for Payer: BCBS Complete	$52.80
Rate for Payer: BCBS Trust/PPO	$102.34
Rate for Payer: BCN Commercial	$102.34
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cofinity Commercial	$124.08
Rate for Payer: Encore Health Key Benefits Commercial	$105.60
Rate for Payer: Healthscope Commercial	$132.00
Rate for Payer: Healthscope Whirlpool	$128.04
Rate for Payer: Mclaren Commercial	$118.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$112.20
Rate for Payer: Priority Health Cigna Priority Health	$92.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$120.12
Rate for Payer: Priority Health Narrow Network	$93.72
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$116.16

HC COMP BURN GARM BRIEF

Facility

$132.00

Service Code	HCPCS A6511
Hospital Charge Code	98300151
Hospital Revenue Code	270
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$132.00
Rate for Payer: Aetna Commercial	$118.80
Rate for Payer: ASR ASR	$128.04
Rate for Payer: BCBS Complete	$52.80
Rate for Payer: BCBS Trust/PPO	$102.34
Rate for Payer: BCN Commercial	$102.34
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cofinity Commercial	$124.08
Rate for Payer: Encore Health Key Benefits Commercial	$105.60
Rate for Payer: Healthscope Commercial	$132.00
Rate for Payer: Healthscope Whirlpool	$128.04
Rate for Payer: Mclaren Commercial	$118.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$112.20
Rate for Payer: Priority Health Cigna Priority Health	$92.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$120.12
Rate for Payer: Priority Health Narrow Network	$93.72
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$116.16

HC COMP BURN GARM BRIEF

Facility

$132.00

Service Code	HCPCS A6511
Hospital Charge Code	98300151
Hospital Revenue Code	270
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$132.00
Rate for Payer: Aetna Commercial	$118.80
Rate for Payer: ASR ASR	$128.04
Rate for Payer: BCBS Trust/PPO	$102.34
Rate for Payer: BCN Commercial	$102.34
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cofinity Commercial	$124.08
Rate for Payer: Encore Health Key Benefits Commercial	$105.60
Rate for Payer: Healthscope Commercial	$132.00
Rate for Payer: Healthscope Whirlpool	$128.04
Rate for Payer: Mclaren Commercial	$118.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$112.20
Rate for Payer: Priority Health Cigna Priority Health	$92.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$116.16

HC COMP BURN GARM CHIN STRAP REGU

Facility

$78.00

Service Code	HCPCS A6502
Hospital Charge Code	98300152
Hospital Revenue Code	270
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$78.00
Rate for Payer: Aetna Commercial	$70.20
Rate for Payer: ASR ASR	$75.66
Rate for Payer: BCBS Complete	$31.20
Rate for Payer: BCBS Trust/PPO	$60.47
Rate for Payer: BCN Commercial	$60.47
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cofinity Commercial	$73.32
Rate for Payer: Encore Health Key Benefits Commercial	$62.40
Rate for Payer: Healthscope Commercial	$78.00
Rate for Payer: Healthscope Whirlpool	$75.66
Rate for Payer: Mclaren Commercial	$70.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$66.30
Rate for Payer: Priority Health Cigna Priority Health	$54.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$70.98
Rate for Payer: Priority Health Narrow Network	$55.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$68.64

HC COMP BURN GARM CHIN STRAP REGU

Facility

$78.00

Service Code	HCPCS A6502
Hospital Charge Code	98300152
Hospital Revenue Code	270
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$78.00
Rate for Payer: Aetna Commercial	$70.20
Rate for Payer: ASR ASR	$75.66
Rate for Payer: BCBS Trust/PPO	$60.47
Rate for Payer: BCN Commercial	$60.47
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cofinity Commercial	$73.32
Rate for Payer: Encore Health Key Benefits Commercial	$62.40
Rate for Payer: Healthscope Commercial	$78.00
Rate for Payer: Healthscope Whirlpool	$75.66
Rate for Payer: Mclaren Commercial	$70.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$66.30
Rate for Payer: Priority Health Cigna Priority Health	$54.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$68.64

HC COMP BURN GARM CHIN STRP W LIP

Facility

$78.00

Service Code	HCPCS A6502
Hospital Charge Code	98300153
Hospital Revenue Code	270
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$78.00
Rate for Payer: Aetna Commercial	$70.20
Rate for Payer: ASR ASR	$75.66
Rate for Payer: BCBS Trust/PPO	$60.47
Rate for Payer: BCN Commercial	$60.47
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cofinity Commercial	$73.32
Rate for Payer: Encore Health Key Benefits Commercial	$62.40
Rate for Payer: Healthscope Commercial	$78.00
Rate for Payer: Healthscope Whirlpool	$75.66
Rate for Payer: Mclaren Commercial	$70.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$66.30
Rate for Payer: Priority Health Cigna Priority Health	$54.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$68.64

Know your out-of-pocket cost for care.

All Charges