Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC COMP BURN GARM BELLY BAND

Facility

$41.62

Service Code	HCPCS A6512
Hospital Charge Code	98300147
Hospital Revenue Code	270
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$41.62
Rate for Payer: Aetna Commercial	$37.46
Rate for Payer: Aetna Medicare	$15.40
Rate for Payer: ASR ASR	$40.37
Rate for Payer: BCBS Complete	$16.65
Rate for Payer: BCBS Trust/PPO	$34.32
Rate for Payer: BCN Commercial	$34.32
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cofinity Commercial	$39.12
Rate for Payer: Encore Health Key Benefits Commercial	$33.30
Rate for Payer: Healthscope Commercial	$40.37
Rate for Payer: Healthscope Whirlpool	$41.62
Rate for Payer: Mclaren Commercial	$37.46
Rate for Payer: MI Amish Medical Board Commercial	$33.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.38
Rate for Payer: Nomi Health Commercial	$34.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$36.47
Rate for Payer: Priority Health Narrow Network	$29.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$36.63

HC COMP BURN GARM BELLY BAND

Facility

$41.62

Service Code	HCPCS A6512
Hospital Charge Code	98300147
Hospital Revenue Code	270
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$41.62
Rate for Payer: Aetna Commercial	$37.46
Rate for Payer: ASR ASR	$40.37
Rate for Payer: BCBS Trust/PPO	$34.18
Rate for Payer: BCN Commercial	$34.18
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cofinity Commercial	$39.12
Rate for Payer: Encore Health Key Benefits Commercial	$33.30
Rate for Payer: Healthscope Commercial	$40.37
Rate for Payer: Healthscope Whirlpool	$41.62
Rate for Payer: Mclaren Commercial	$37.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.38
Rate for Payer: Nomi Health Commercial	$34.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$36.63

HC COMP BURN GARM BODY BRF SLEEVE

Facility

$245.53

Service Code	HCPCS A6512
Hospital Charge Code	98300148
Hospital Revenue Code	270
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$245.53
Rate for Payer: Aetna Commercial	$220.98
Rate for Payer: Aetna Medicare	$90.85
Rate for Payer: ASR ASR	$238.16
Rate for Payer: BCBS Complete	$98.21
Rate for Payer: BCBS Trust/PPO	$202.44
Rate for Payer: BCN Commercial	$202.44
Rate for Payer: Cash Price	$196.42
Rate for Payer: Cofinity Commercial	$230.80
Rate for Payer: Encore Health Key Benefits Commercial	$196.42
Rate for Payer: Healthscope Commercial	$238.16
Rate for Payer: Healthscope Whirlpool	$245.53
Rate for Payer: Mclaren Commercial	$220.98
Rate for Payer: MI Amish Medical Board Commercial	$196.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$208.70
Rate for Payer: Nomi Health Commercial	$201.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$184.15
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$215.13
Rate for Payer: Priority Health Narrow Network	$172.12
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$216.07

HC COMP BURN GARM BODY BRF SLEEVE

Facility

$245.53

Service Code	HCPCS A6512
Hospital Charge Code	98300148
Hospital Revenue Code	270
Min. Negotiated Rate	$184.15
Max. Negotiated Rate	$245.53
Rate for Payer: Aetna Commercial	$220.98
Rate for Payer: ASR ASR	$238.16
Rate for Payer: BCBS Trust/PPO	$201.63
Rate for Payer: BCN Commercial	$201.63
Rate for Payer: Cash Price	$196.42
Rate for Payer: Cofinity Commercial	$230.80
Rate for Payer: Encore Health Key Benefits Commercial	$196.42
Rate for Payer: Healthscope Commercial	$238.16
Rate for Payer: Healthscope Whirlpool	$245.53
Rate for Payer: Mclaren Commercial	$220.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$208.70
Rate for Payer: Nomi Health Commercial	$201.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$184.15
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$216.07

HC COMP BURN GARM BRF 2 LEGS ABV

Facility

$156.06

Service Code	HCPCS A6512
Hospital Charge Code	98300149
Hospital Revenue Code	270
Min. Negotiated Rate	$57.74
Max. Negotiated Rate	$156.06
Rate for Payer: Aetna Commercial	$140.45
Rate for Payer: Aetna Medicare	$57.74
Rate for Payer: ASR ASR	$151.38
Rate for Payer: BCBS Complete	$62.42
Rate for Payer: BCBS Trust/PPO	$128.67
Rate for Payer: BCN Commercial	$128.67
Rate for Payer: Cash Price	$124.85
Rate for Payer: Cofinity Commercial	$146.70
Rate for Payer: Encore Health Key Benefits Commercial	$124.85
Rate for Payer: Healthscope Commercial	$151.38
Rate for Payer: Healthscope Whirlpool	$156.06
Rate for Payer: Mclaren Commercial	$140.45
Rate for Payer: MI Amish Medical Board Commercial	$124.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$132.65
Rate for Payer: Nomi Health Commercial	$127.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$117.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$136.74
Rate for Payer: Priority Health Narrow Network	$109.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$137.33

HC COMP BURN GARM BRF 2 LEGS ABV

Facility

$156.06

Service Code	HCPCS A6512
Hospital Charge Code	98300149
Hospital Revenue Code	270
Min. Negotiated Rate	$117.05
Max. Negotiated Rate	$156.06
Rate for Payer: Aetna Commercial	$140.45
Rate for Payer: ASR ASR	$151.38
Rate for Payer: BCBS Trust/PPO	$128.16
Rate for Payer: BCN Commercial	$128.16
Rate for Payer: Cash Price	$124.85
Rate for Payer: Cofinity Commercial	$146.70
Rate for Payer: Encore Health Key Benefits Commercial	$124.85
Rate for Payer: Healthscope Commercial	$151.38
Rate for Payer: Healthscope Whirlpool	$156.06
Rate for Payer: Mclaren Commercial	$140.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$132.65
Rate for Payer: Nomi Health Commercial	$127.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$117.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$137.33

HC COMP BURN GARM BRF&CHAP,LG-MID

Facility

$137.33

Service Code	HCPCS A6512
Hospital Charge Code	98300150
Hospital Revenue Code	270
Min. Negotiated Rate	$103.00
Max. Negotiated Rate	$137.33
Rate for Payer: Aetna Commercial	$123.60
Rate for Payer: ASR ASR	$133.21
Rate for Payer: BCBS Trust/PPO	$112.78
Rate for Payer: BCN Commercial	$112.78
Rate for Payer: Cash Price	$109.86
Rate for Payer: Cofinity Commercial	$129.09
Rate for Payer: Encore Health Key Benefits Commercial	$109.86
Rate for Payer: Healthscope Commercial	$133.21
Rate for Payer: Healthscope Whirlpool	$137.33
Rate for Payer: Mclaren Commercial	$123.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.73
Rate for Payer: Nomi Health Commercial	$112.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$103.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$120.85

HC COMP BURN GARM BRF&CHAP,LG-MID

Facility

$137.33

Service Code	HCPCS A6512
Hospital Charge Code	98300150
Hospital Revenue Code	270
Min. Negotiated Rate	$50.81
Max. Negotiated Rate	$137.33
Rate for Payer: Aetna Commercial	$123.60
Rate for Payer: Aetna Medicare	$50.81
Rate for Payer: ASR ASR	$133.21
Rate for Payer: BCBS Complete	$54.93
Rate for Payer: BCBS Trust/PPO	$113.23
Rate for Payer: BCN Commercial	$113.23
Rate for Payer: Cash Price	$109.86
Rate for Payer: Cofinity Commercial	$129.09
Rate for Payer: Encore Health Key Benefits Commercial	$109.86
Rate for Payer: Healthscope Commercial	$133.21
Rate for Payer: Healthscope Whirlpool	$137.33
Rate for Payer: Mclaren Commercial	$123.60
Rate for Payer: MI Amish Medical Board Commercial	$109.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.73
Rate for Payer: Nomi Health Commercial	$112.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$103.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$120.33
Rate for Payer: Priority Health Narrow Network	$96.27
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$120.85

HC COMP BURN GARM BRIEF

Facility

$137.33

Service Code	HCPCS A6511
Hospital Charge Code	98300151
Hospital Revenue Code	270
Min. Negotiated Rate	$50.81
Max. Negotiated Rate	$137.33
Rate for Payer: Aetna Commercial	$123.60
Rate for Payer: Aetna Medicare	$50.81
Rate for Payer: ASR ASR	$133.21
Rate for Payer: BCBS Complete	$54.93
Rate for Payer: BCBS Trust/PPO	$113.23
Rate for Payer: BCN Commercial	$113.23
Rate for Payer: Cash Price	$109.86
Rate for Payer: Cofinity Commercial	$129.09
Rate for Payer: Encore Health Key Benefits Commercial	$109.86
Rate for Payer: Healthscope Commercial	$133.21
Rate for Payer: Healthscope Whirlpool	$137.33
Rate for Payer: Mclaren Commercial	$123.60
Rate for Payer: MI Amish Medical Board Commercial	$109.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.73
Rate for Payer: Nomi Health Commercial	$112.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$103.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$120.33
Rate for Payer: Priority Health Narrow Network	$96.27
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$120.85

HC COMP BURN GARM BRIEF

Facility

$137.33

Service Code	HCPCS A6511
Hospital Charge Code	98300151
Hospital Revenue Code	270
Min. Negotiated Rate	$103.00
Max. Negotiated Rate	$137.33
Rate for Payer: Aetna Commercial	$123.60
Rate for Payer: ASR ASR	$133.21
Rate for Payer: BCBS Trust/PPO	$112.78
Rate for Payer: BCN Commercial	$112.78
Rate for Payer: Cash Price	$109.86
Rate for Payer: Cofinity Commercial	$129.09
Rate for Payer: Encore Health Key Benefits Commercial	$109.86
Rate for Payer: Healthscope Commercial	$133.21
Rate for Payer: Healthscope Whirlpool	$137.33
Rate for Payer: Mclaren Commercial	$123.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.73
Rate for Payer: Nomi Health Commercial	$112.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$103.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$120.85

HC COMP BURN GARM CHIN STRAP REGU

Facility

$81.15

Service Code	HCPCS A6502
Hospital Charge Code	98300152
Hospital Revenue Code	270
Min. Negotiated Rate	$60.86
Max. Negotiated Rate	$81.15
Rate for Payer: Aetna Commercial	$73.03
Rate for Payer: ASR ASR	$78.72
Rate for Payer: BCBS Trust/PPO	$66.64
Rate for Payer: BCN Commercial	$66.64
Rate for Payer: Cash Price	$64.92
Rate for Payer: Cofinity Commercial	$76.28
Rate for Payer: Encore Health Key Benefits Commercial	$64.92
Rate for Payer: Healthscope Commercial	$78.72
Rate for Payer: Healthscope Whirlpool	$81.15
Rate for Payer: Mclaren Commercial	$73.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.98
Rate for Payer: Nomi Health Commercial	$66.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$60.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$71.41

HC COMP BURN GARM CHIN STRAP REGU

Facility

$81.15

Service Code	HCPCS A6502
Hospital Charge Code	98300152
Hospital Revenue Code	270
Min. Negotiated Rate	$30.03
Max. Negotiated Rate	$81.15
Rate for Payer: Aetna Commercial	$73.03
Rate for Payer: Aetna Medicare	$30.03
Rate for Payer: ASR ASR	$78.72
Rate for Payer: BCBS Complete	$32.46
Rate for Payer: BCBS Trust/PPO	$66.91
Rate for Payer: BCN Commercial	$66.91
Rate for Payer: Cash Price	$64.92
Rate for Payer: Cofinity Commercial	$76.28
Rate for Payer: Encore Health Key Benefits Commercial	$64.92
Rate for Payer: Healthscope Commercial	$78.72
Rate for Payer: Healthscope Whirlpool	$81.15
Rate for Payer: Mclaren Commercial	$73.03
Rate for Payer: MI Amish Medical Board Commercial	$64.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.98
Rate for Payer: Nomi Health Commercial	$66.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$60.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$71.10
Rate for Payer: Priority Health Narrow Network	$56.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$71.41

HC COMP BURN GARM CHIN STRP W LIP

Facility

$81.15

Service Code	HCPCS A6502
Hospital Charge Code	98300153
Hospital Revenue Code	270
Min. Negotiated Rate	$30.03
Max. Negotiated Rate	$81.15
Rate for Payer: Aetna Commercial	$73.03
Rate for Payer: Aetna Medicare	$30.03
Rate for Payer: ASR ASR	$78.72
Rate for Payer: BCBS Complete	$32.46
Rate for Payer: BCBS Trust/PPO	$66.91
Rate for Payer: BCN Commercial	$66.91
Rate for Payer: Cash Price	$64.92
Rate for Payer: Cofinity Commercial	$76.28
Rate for Payer: Encore Health Key Benefits Commercial	$64.92
Rate for Payer: Healthscope Commercial	$78.72
Rate for Payer: Healthscope Whirlpool	$81.15
Rate for Payer: Mclaren Commercial	$73.03
Rate for Payer: MI Amish Medical Board Commercial	$64.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.98
Rate for Payer: Nomi Health Commercial	$66.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$60.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$71.10
Rate for Payer: Priority Health Narrow Network	$56.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$71.41

HC COMP BURN GARM CHIN STRP W LIP

Facility

$81.15

Service Code	HCPCS A6502
Hospital Charge Code	98300153
Hospital Revenue Code	270
Min. Negotiated Rate	$60.86
Max. Negotiated Rate	$81.15
Rate for Payer: Aetna Commercial	$73.03
Rate for Payer: ASR ASR	$78.72
Rate for Payer: BCBS Trust/PPO	$66.64
Rate for Payer: BCN Commercial	$66.64
Rate for Payer: Cash Price	$64.92
Rate for Payer: Cofinity Commercial	$76.28
Rate for Payer: Encore Health Key Benefits Commercial	$64.92
Rate for Payer: Healthscope Commercial	$78.72
Rate for Payer: Healthscope Whirlpool	$81.15
Rate for Payer: Mclaren Commercial	$73.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.98
Rate for Payer: Nomi Health Commercial	$66.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$60.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$71.41

HC COMP BURN GARM COLLAR FOAM

Facility

$41.62

Service Code	HCPCS A6512
Hospital Charge Code	98300154
Hospital Revenue Code	270
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$41.62
Rate for Payer: Aetna Commercial	$37.46
Rate for Payer: Aetna Medicare	$15.40
Rate for Payer: ASR ASR	$40.37
Rate for Payer: BCBS Complete	$16.65
Rate for Payer: BCBS Trust/PPO	$34.32
Rate for Payer: BCN Commercial	$34.32
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cofinity Commercial	$39.12
Rate for Payer: Encore Health Key Benefits Commercial	$33.30
Rate for Payer: Healthscope Commercial	$40.37
Rate for Payer: Healthscope Whirlpool	$41.62
Rate for Payer: Mclaren Commercial	$37.46
Rate for Payer: MI Amish Medical Board Commercial	$33.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.38
Rate for Payer: Nomi Health Commercial	$34.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$36.47
Rate for Payer: Priority Health Narrow Network	$29.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$36.63

HC COMP BURN GARM COLLAR FOAM

Facility

$41.62

Service Code	HCPCS A6512
Hospital Charge Code	98300154
Hospital Revenue Code	270
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$41.62
Rate for Payer: Aetna Commercial	$37.46
Rate for Payer: ASR ASR	$40.37
Rate for Payer: BCBS Trust/PPO	$34.18
Rate for Payer: BCN Commercial	$34.18
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cofinity Commercial	$39.12
Rate for Payer: Encore Health Key Benefits Commercial	$33.30
Rate for Payer: Healthscope Commercial	$40.37
Rate for Payer: Healthscope Whirlpool	$41.62
Rate for Payer: Mclaren Commercial	$37.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.38
Rate for Payer: Nomi Health Commercial	$34.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$36.63

HC COMP BURN GARM COLLAR PILLOW

Facility

$70.75

Service Code	HCPCS A6512
Hospital Charge Code	98300155
Hospital Revenue Code	270
Min. Negotiated Rate	$53.06
Max. Negotiated Rate	$70.75
Rate for Payer: Aetna Commercial	$63.67
Rate for Payer: ASR ASR	$68.63
Rate for Payer: BCBS Trust/PPO	$58.10
Rate for Payer: BCN Commercial	$58.10
Rate for Payer: Cash Price	$56.60
Rate for Payer: Cofinity Commercial	$66.50
Rate for Payer: Encore Health Key Benefits Commercial	$56.60
Rate for Payer: Healthscope Commercial	$68.63
Rate for Payer: Healthscope Whirlpool	$70.75
Rate for Payer: Mclaren Commercial	$63.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.14
Rate for Payer: Nomi Health Commercial	$58.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$53.06
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$62.26

HC COMP BURN GARM COLLAR PILLOW

Facility

$70.75

Service Code	HCPCS A6512
Hospital Charge Code	98300155
Hospital Revenue Code	270
Min. Negotiated Rate	$26.18
Max. Negotiated Rate	$70.75
Rate for Payer: Aetna Commercial	$63.67
Rate for Payer: Aetna Medicare	$26.18
Rate for Payer: ASR ASR	$68.63
Rate for Payer: BCBS Complete	$28.30
Rate for Payer: BCBS Trust/PPO	$58.33
Rate for Payer: BCN Commercial	$58.33
Rate for Payer: Cash Price	$56.60
Rate for Payer: Cofinity Commercial	$66.50
Rate for Payer: Encore Health Key Benefits Commercial	$56.60
Rate for Payer: Healthscope Commercial	$68.63
Rate for Payer: Healthscope Whirlpool	$70.75
Rate for Payer: Mclaren Commercial	$63.67
Rate for Payer: MI Amish Medical Board Commercial	$56.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.14
Rate for Payer: Nomi Health Commercial	$58.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$53.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$61.99
Rate for Payer: Priority Health Narrow Network	$49.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$62.26

HC COMP BURN GARM COLLAR TRACH

Facility

$41.62

Service Code	HCPCS A6512
Hospital Charge Code	98300156
Hospital Revenue Code	270
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$41.62
Rate for Payer: Aetna Commercial	$37.46
Rate for Payer: Aetna Medicare	$15.40
Rate for Payer: ASR ASR	$40.37
Rate for Payer: BCBS Complete	$16.65
Rate for Payer: BCBS Trust/PPO	$34.32
Rate for Payer: BCN Commercial	$34.32
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cofinity Commercial	$39.12
Rate for Payer: Encore Health Key Benefits Commercial	$33.30
Rate for Payer: Healthscope Commercial	$40.37
Rate for Payer: Healthscope Whirlpool	$41.62
Rate for Payer: Mclaren Commercial	$37.46
Rate for Payer: MI Amish Medical Board Commercial	$33.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.38
Rate for Payer: Nomi Health Commercial	$34.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$36.47
Rate for Payer: Priority Health Narrow Network	$29.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$36.63

HC COMP BURN GARM COLLAR TRACH

Facility

$41.62

Service Code	HCPCS A6512
Hospital Charge Code	98300156
Hospital Revenue Code	270
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$41.62
Rate for Payer: Aetna Commercial	$37.46
Rate for Payer: ASR ASR	$40.37
Rate for Payer: BCBS Trust/PPO	$34.18
Rate for Payer: BCN Commercial	$34.18
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cofinity Commercial	$39.12
Rate for Payer: Encore Health Key Benefits Commercial	$33.30
Rate for Payer: Healthscope Commercial	$40.37
Rate for Payer: Healthscope Whirlpool	$41.62
Rate for Payer: Mclaren Commercial	$37.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.38
Rate for Payer: Nomi Health Commercial	$34.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$36.63

HC COMP BURN GARM ELECTIVE ALTERA

Facility

$20.81

Service Code	HCPCS A6512
Hospital Charge Code	98300157
Hospital Revenue Code	270
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$20.81
Rate for Payer: Aetna Commercial	$18.73
Rate for Payer: Aetna Medicare	$7.70
Rate for Payer: ASR ASR	$20.19
Rate for Payer: BCBS Complete	$8.32
Rate for Payer: BCBS Trust/PPO	$17.16
Rate for Payer: BCN Commercial	$17.16
Rate for Payer: Cash Price	$16.65
Rate for Payer: Cofinity Commercial	$19.56
Rate for Payer: Encore Health Key Benefits Commercial	$16.65
Rate for Payer: Healthscope Commercial	$20.19
Rate for Payer: Healthscope Whirlpool	$20.81
Rate for Payer: Mclaren Commercial	$18.73
Rate for Payer: MI Amish Medical Board Commercial	$16.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.69
Rate for Payer: Nomi Health Commercial	$17.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.61
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$18.23
Rate for Payer: Priority Health Narrow Network	$14.59
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$18.31

HC COMP BURN GARM ELECTIVE ALTERA

Facility

$20.81

Service Code	HCPCS A6512
Hospital Charge Code	98300157
Hospital Revenue Code	270
Min. Negotiated Rate	$15.61
Max. Negotiated Rate	$20.81
Rate for Payer: Aetna Commercial	$18.73
Rate for Payer: ASR ASR	$20.19
Rate for Payer: BCBS Trust/PPO	$17.09
Rate for Payer: BCN Commercial	$17.09
Rate for Payer: Cash Price	$16.65
Rate for Payer: Cofinity Commercial	$19.56
Rate for Payer: Encore Health Key Benefits Commercial	$16.65
Rate for Payer: Healthscope Commercial	$20.19
Rate for Payer: Healthscope Whirlpool	$20.81
Rate for Payer: Mclaren Commercial	$18.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.69
Rate for Payer: Nomi Health Commercial	$17.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.61
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$18.31

HC COMP BURN GARM EXPANSION PANEL

Facility

$29.13

Service Code	HCPCS A6512
Hospital Charge Code	98300158
Hospital Revenue Code	270
Min. Negotiated Rate	$10.78
Max. Negotiated Rate	$29.13
Rate for Payer: Aetna Commercial	$26.22
Rate for Payer: Aetna Medicare	$10.78
Rate for Payer: ASR ASR	$28.26
Rate for Payer: BCBS Complete	$11.65
Rate for Payer: BCBS Trust/PPO	$24.02
Rate for Payer: BCN Commercial	$24.02
Rate for Payer: Cash Price	$23.30
Rate for Payer: Cofinity Commercial	$27.38
Rate for Payer: Encore Health Key Benefits Commercial	$23.30
Rate for Payer: Healthscope Commercial	$28.26
Rate for Payer: Healthscope Whirlpool	$29.13
Rate for Payer: Mclaren Commercial	$26.22
Rate for Payer: MI Amish Medical Board Commercial	$23.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.76
Rate for Payer: Nomi Health Commercial	$23.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$25.52
Rate for Payer: Priority Health Narrow Network	$20.42
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$25.63

HC COMP BURN GARM EXPANSION PANEL

Facility

$29.13

Service Code	HCPCS A6512
Hospital Charge Code	98300158
Hospital Revenue Code	270
Min. Negotiated Rate	$21.85
Max. Negotiated Rate	$29.13
Rate for Payer: Aetna Commercial	$26.22
Rate for Payer: ASR ASR	$28.26
Rate for Payer: BCBS Trust/PPO	$23.92
Rate for Payer: BCN Commercial	$23.92
Rate for Payer: Cash Price	$23.30
Rate for Payer: Cofinity Commercial	$27.38
Rate for Payer: Encore Health Key Benefits Commercial	$23.30
Rate for Payer: Healthscope Commercial	$28.26
Rate for Payer: Healthscope Whirlpool	$29.13
Rate for Payer: Mclaren Commercial	$26.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.76
Rate for Payer: Nomi Health Commercial	$23.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.85
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$25.63

HC COMP BURN GARM FACE MASK

Facility

$139.41

Service Code	HCPCS A6503
Hospital Charge Code	98300159
Hospital Revenue Code	270
Min. Negotiated Rate	$51.58
Max. Negotiated Rate	$139.41
Rate for Payer: Aetna Commercial	$125.47
Rate for Payer: Aetna Medicare	$51.58
Rate for Payer: ASR ASR	$135.23
Rate for Payer: BCBS Complete	$55.76
Rate for Payer: BCBS Trust/PPO	$114.94
Rate for Payer: BCN Commercial	$114.94
Rate for Payer: Cash Price	$111.53
Rate for Payer: Cofinity Commercial	$131.05
Rate for Payer: Encore Health Key Benefits Commercial	$111.53
Rate for Payer: Healthscope Commercial	$135.23
Rate for Payer: Healthscope Whirlpool	$139.41
Rate for Payer: Mclaren Commercial	$125.47
Rate for Payer: MI Amish Medical Board Commercial	$111.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$118.50
Rate for Payer: Nomi Health Commercial	$114.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$104.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$122.15
Rate for Payer: Priority Health Narrow Network	$97.73
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$122.68

Know your out-of-pocket cost for care.

All Charges