Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC COMP BURN GARM SLV WRST-ELB/EL

Facility

$62.42

Service Code	HCPCS A6512
Hospital Charge Code	98300048
Hospital Revenue Code	270
Min. Negotiated Rate	$46.81
Max. Negotiated Rate	$62.42
Rate for Payer: Aetna Commercial	$56.18
Rate for Payer: ASR ASR	$60.55
Rate for Payer: BCBS Trust/PPO	$51.26
Rate for Payer: BCN Commercial	$51.26
Rate for Payer: Cash Price	$49.94
Rate for Payer: Cofinity Commercial	$58.67
Rate for Payer: Encore Health Key Benefits Commercial	$49.94
Rate for Payer: Healthscope Commercial	$60.55
Rate for Payer: Healthscope Whirlpool	$62.42
Rate for Payer: Mclaren Commercial	$56.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.06
Rate for Payer: Nomi Health Commercial	$51.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$46.81
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$54.93

HC COMP BURN GARM STERNAL STRAP

Facility

$70.75

Service Code	HCPCS A6512
Hospital Charge Code	98300049
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 STERNAL STRAP

Facility

$70.75

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

Facility

$73.25

Service Code	HCPCS A6512
Hospital Charge Code	98300050
Hospital Revenue Code	270
Min. Negotiated Rate	$54.94
Max. Negotiated Rate	$73.25
Rate for Payer: Aetna Commercial	$65.92
Rate for Payer: ASR ASR	$71.05
Rate for Payer: BCBS Trust/PPO	$60.15
Rate for Payer: BCN Commercial	$60.15
Rate for Payer: Cash Price	$58.60
Rate for Payer: Cofinity Commercial	$68.86
Rate for Payer: Encore Health Key Benefits Commercial	$58.60
Rate for Payer: Healthscope Commercial	$71.05
Rate for Payer: Healthscope Whirlpool	$73.25
Rate for Payer: Mclaren Commercial	$65.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.26
Rate for Payer: Nomi Health Commercial	$60.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$54.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$64.46

HC COMP BURN GARM STKNG KNEE TO T

Facility

$73.25

Service Code	HCPCS A6512
Hospital Charge Code	98300050
Hospital Revenue Code	270
Min. Negotiated Rate	$27.10
Max. Negotiated Rate	$73.25
Rate for Payer: Aetna Commercial	$65.92
Rate for Payer: Aetna Medicare	$27.10
Rate for Payer: ASR ASR	$71.05
Rate for Payer: BCBS Complete	$29.30
Rate for Payer: BCBS Trust/PPO	$60.39
Rate for Payer: BCN Commercial	$60.39
Rate for Payer: Cash Price	$58.60
Rate for Payer: Cofinity Commercial	$68.86
Rate for Payer: Encore Health Key Benefits Commercial	$58.60
Rate for Payer: Healthscope Commercial	$71.05
Rate for Payer: Healthscope Whirlpool	$73.25
Rate for Payer: Mclaren Commercial	$65.92
Rate for Payer: MI Amish Medical Board Commercial	$58.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.26
Rate for Payer: Nomi Health Commercial	$60.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$54.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$64.18
Rate for Payer: Priority Health Narrow Network	$51.35
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$64.46

HC COMP BURN GARM STKNG TO THI NO

Facility

$81.15

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

Facility

$81.15

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

Facility

$12.73

Service Code	HCPCS A4649
Hospital Charge Code	98300052
Hospital Revenue Code	270
Min. Negotiated Rate	$9.55
Max. Negotiated Rate	$12.73
Rate for Payer: Aetna Commercial	$11.46
Rate for Payer: ASR ASR	$12.35
Rate for Payer: BCBS Trust/PPO	$10.45
Rate for Payer: BCN Commercial	$10.45
Rate for Payer: Cash Price	$10.18
Rate for Payer: Cofinity Commercial	$11.97
Rate for Payer: Encore Health Key Benefits Commercial	$10.18
Rate for Payer: Healthscope Commercial	$12.35
Rate for Payer: Healthscope Whirlpool	$12.73
Rate for Payer: Mclaren Commercial	$11.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.82
Rate for Payer: Nomi Health Commercial	$10.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.55
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$11.20

HC COMP BURN GARM STMP CLS ORNG P

Facility

$12.73

Service Code	HCPCS A4649
Hospital Charge Code	98300052
Hospital Revenue Code	270
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$12.73
Rate for Payer: Aetna Commercial	$11.46
Rate for Payer: Aetna Medicare	$4.71
Rate for Payer: ASR ASR	$12.35
Rate for Payer: BCBS Complete	$5.09
Rate for Payer: BCBS Trust/PPO	$10.50
Rate for Payer: BCN Commercial	$10.50
Rate for Payer: Cash Price	$10.18
Rate for Payer: Cofinity Commercial	$11.97
Rate for Payer: Encore Health Key Benefits Commercial	$10.18
Rate for Payer: Healthscope Commercial	$12.35
Rate for Payer: Healthscope Whirlpool	$12.73
Rate for Payer: Mclaren Commercial	$11.46
Rate for Payer: MI Amish Medical Board Commercial	$10.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.82
Rate for Payer: Nomi Health Commercial	$10.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$11.15
Rate for Payer: Priority Health Narrow Network	$8.92
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$11.20

HC COMP BURN GARM STMP CLS STRCH

Facility

$12.73

Service Code	HCPCS A4649
Hospital Charge Code	98300053
Hospital Revenue Code	270
Min. Negotiated Rate	$9.55
Max. Negotiated Rate	$12.73
Rate for Payer: Aetna Commercial	$11.46
Rate for Payer: ASR ASR	$12.35
Rate for Payer: BCBS Trust/PPO	$10.45
Rate for Payer: BCN Commercial	$10.45
Rate for Payer: Cash Price	$10.18
Rate for Payer: Cofinity Commercial	$11.97
Rate for Payer: Encore Health Key Benefits Commercial	$10.18
Rate for Payer: Healthscope Commercial	$12.35
Rate for Payer: Healthscope Whirlpool	$12.73
Rate for Payer: Mclaren Commercial	$11.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.82
Rate for Payer: Nomi Health Commercial	$10.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.55
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$11.20

HC COMP BURN GARM STMP CLS STRCH

Facility

$12.73

Service Code	HCPCS A4649
Hospital Charge Code	98300053
Hospital Revenue Code	270
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$12.73
Rate for Payer: Aetna Commercial	$11.46
Rate for Payer: Aetna Medicare	$4.71
Rate for Payer: ASR ASR	$12.35
Rate for Payer: BCBS Complete	$5.09
Rate for Payer: BCBS Trust/PPO	$10.50
Rate for Payer: BCN Commercial	$10.50
Rate for Payer: Cash Price	$10.18
Rate for Payer: Cofinity Commercial	$11.97
Rate for Payer: Encore Health Key Benefits Commercial	$10.18
Rate for Payer: Healthscope Commercial	$12.35
Rate for Payer: Healthscope Whirlpool	$12.73
Rate for Payer: Mclaren Commercial	$11.46
Rate for Payer: MI Amish Medical Board Commercial	$10.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.82
Rate for Payer: Nomi Health Commercial	$10.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$11.15
Rate for Payer: Priority Health Narrow Network	$8.92
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$11.20

HC COMP BURN GARM STOCKING TO KNE

Facility

$72.83

Service Code	HCPCS A6507
Hospital Charge Code	98300054
Hospital Revenue Code	270
Min. Negotiated Rate	$54.62
Max. Negotiated Rate	$72.83
Rate for Payer: Aetna Commercial	$65.55
Rate for Payer: ASR ASR	$70.65
Rate for Payer: BCBS Trust/PPO	$59.81
Rate for Payer: BCN Commercial	$59.81
Rate for Payer: Cash Price	$58.26
Rate for Payer: Cofinity Commercial	$68.46
Rate for Payer: Encore Health Key Benefits Commercial	$58.26
Rate for Payer: Healthscope Commercial	$70.65
Rate for Payer: Healthscope Whirlpool	$72.83
Rate for Payer: Mclaren Commercial	$65.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.91
Rate for Payer: Nomi Health Commercial	$59.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$54.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$64.09

HC COMP BURN GARM STOCKING TO KNE

Facility

$72.83

Service Code	HCPCS A6507
Hospital Charge Code	98300054
Hospital Revenue Code	270
Min. Negotiated Rate	$26.95
Max. Negotiated Rate	$72.83
Rate for Payer: Aetna Commercial	$65.55
Rate for Payer: Aetna Medicare	$26.95
Rate for Payer: ASR ASR	$70.65
Rate for Payer: BCBS Complete	$29.13
Rate for Payer: BCBS Trust/PPO	$60.05
Rate for Payer: BCN Commercial	$60.05
Rate for Payer: Cash Price	$58.26
Rate for Payer: Cofinity Commercial	$68.46
Rate for Payer: Encore Health Key Benefits Commercial	$58.26
Rate for Payer: Healthscope Commercial	$70.65
Rate for Payer: Healthscope Whirlpool	$72.83
Rate for Payer: Mclaren Commercial	$65.55
Rate for Payer: MI Amish Medical Board Commercial	$58.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.91
Rate for Payer: Nomi Health Commercial	$59.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$54.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$63.81
Rate for Payer: Priority Health Narrow Network	$51.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$64.09

HC COMP BURN GARM STOCKING TO THI

Facility

$95.72

Service Code	HCPCS A6508
Hospital Charge Code	98300055
Hospital Revenue Code	270
Min. Negotiated Rate	$71.79
Max. Negotiated Rate	$95.72
Rate for Payer: Aetna Commercial	$86.15
Rate for Payer: ASR ASR	$92.85
Rate for Payer: BCBS Trust/PPO	$78.61
Rate for Payer: BCN Commercial	$78.61
Rate for Payer: Cash Price	$76.58
Rate for Payer: Cofinity Commercial	$89.98
Rate for Payer: Encore Health Key Benefits Commercial	$76.58
Rate for Payer: Healthscope Commercial	$92.85
Rate for Payer: Healthscope Whirlpool	$95.72
Rate for Payer: Mclaren Commercial	$86.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.36
Rate for Payer: Nomi Health Commercial	$78.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$71.79
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$84.23

HC COMP BURN GARM STOCKING TO THI

Facility

$95.72

Service Code	HCPCS A6508
Hospital Charge Code	98300055
Hospital Revenue Code	270
Min. Negotiated Rate	$35.42
Max. Negotiated Rate	$95.72
Rate for Payer: Aetna Commercial	$86.15
Rate for Payer: Aetna Medicare	$35.42
Rate for Payer: ASR ASR	$92.85
Rate for Payer: BCBS Complete	$38.29
Rate for Payer: BCBS Trust/PPO	$78.92
Rate for Payer: BCN Commercial	$78.92
Rate for Payer: Cash Price	$76.58
Rate for Payer: Cofinity Commercial	$89.98
Rate for Payer: Encore Health Key Benefits Commercial	$76.58
Rate for Payer: Healthscope Commercial	$92.85
Rate for Payer: Healthscope Whirlpool	$95.72
Rate for Payer: Mclaren Commercial	$86.15
Rate for Payer: MI Amish Medical Board Commercial	$76.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.36
Rate for Payer: Nomi Health Commercial	$78.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$71.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$83.87
Rate for Payer: Priority Health Narrow Network	$67.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$84.23

HC COMP BURN GARM STOCK-KNEE/NO F

Facility

$64.50

Service Code	HCPCS A6512
Hospital Charge Code	98300056
Hospital Revenue Code	270
Min. Negotiated Rate	$23.86
Max. Negotiated Rate	$64.50
Rate for Payer: Aetna Commercial	$58.05
Rate for Payer: Aetna Medicare	$23.86
Rate for Payer: ASR ASR	$62.56
Rate for Payer: BCBS Complete	$25.80
Rate for Payer: BCBS Trust/PPO	$53.18
Rate for Payer: BCN Commercial	$53.18
Rate for Payer: Cash Price	$51.60
Rate for Payer: Cofinity Commercial	$60.63
Rate for Payer: Encore Health Key Benefits Commercial	$51.60
Rate for Payer: Healthscope Commercial	$62.56
Rate for Payer: Healthscope Whirlpool	$64.50
Rate for Payer: Mclaren Commercial	$58.05
Rate for Payer: MI Amish Medical Board Commercial	$51.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.83
Rate for Payer: Nomi Health Commercial	$52.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$48.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$56.51
Rate for Payer: Priority Health Narrow Network	$45.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$56.76

HC COMP BURN GARM STOCK-KNEE/NO F

Facility

$64.50

Service Code	HCPCS A6512
Hospital Charge Code	98300056
Hospital Revenue Code	270
Min. Negotiated Rate	$48.38
Max. Negotiated Rate	$64.50
Rate for Payer: Aetna Commercial	$58.05
Rate for Payer: ASR ASR	$62.56
Rate for Payer: BCBS Trust/PPO	$52.97
Rate for Payer: BCN Commercial	$52.97
Rate for Payer: Cash Price	$51.60
Rate for Payer: Cofinity Commercial	$60.63
Rate for Payer: Encore Health Key Benefits Commercial	$51.60
Rate for Payer: Healthscope Commercial	$62.56
Rate for Payer: Healthscope Whirlpool	$64.50
Rate for Payer: Mclaren Commercial	$58.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.83
Rate for Payer: Nomi Health Commercial	$52.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$48.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$56.76

HC COMP BURN GARM STRETCH INSERT

Facility

$12.73

Service Code	HCPCS A4649
Hospital Charge Code	98300057
Hospital Revenue Code	270
Min. Negotiated Rate	$9.55
Max. Negotiated Rate	$12.73
Rate for Payer: Aetna Commercial	$11.46
Rate for Payer: ASR ASR	$12.35
Rate for Payer: BCBS Trust/PPO	$10.45
Rate for Payer: BCN Commercial	$10.45
Rate for Payer: Cash Price	$10.18
Rate for Payer: Cofinity Commercial	$11.97
Rate for Payer: Encore Health Key Benefits Commercial	$10.18
Rate for Payer: Healthscope Commercial	$12.35
Rate for Payer: Healthscope Whirlpool	$12.73
Rate for Payer: Mclaren Commercial	$11.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.82
Rate for Payer: Nomi Health Commercial	$10.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.55
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$11.20

HC COMP BURN GARM STRETCH INSERT

Facility

$12.73

Service Code	HCPCS A4649
Hospital Charge Code	98300057
Hospital Revenue Code	270
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$12.73
Rate for Payer: Aetna Commercial	$11.46
Rate for Payer: Aetna Medicare	$4.71
Rate for Payer: ASR ASR	$12.35
Rate for Payer: BCBS Complete	$5.09
Rate for Payer: BCBS Trust/PPO	$10.50
Rate for Payer: BCN Commercial	$10.50
Rate for Payer: Cash Price	$10.18
Rate for Payer: Cofinity Commercial	$11.97
Rate for Payer: Encore Health Key Benefits Commercial	$10.18
Rate for Payer: Healthscope Commercial	$12.35
Rate for Payer: Healthscope Whirlpool	$12.73
Rate for Payer: Mclaren Commercial	$11.46
Rate for Payer: MI Amish Medical Board Commercial	$10.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.82
Rate for Payer: Nomi Health Commercial	$10.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$11.15
Rate for Payer: Priority Health Narrow Network	$8.92
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$11.20

HC COMP BURN GARM SUEDE/LEATHER G

Facility

$46.82

Service Code	HCPCS A9900
Hospital Charge Code	98300058
Hospital Revenue Code	270
Min. Negotiated Rate	$35.12
Max. Negotiated Rate	$46.82
Rate for Payer: Aetna Commercial	$42.14
Rate for Payer: ASR ASR	$45.42
Rate for Payer: BCBS Trust/PPO	$38.45
Rate for Payer: BCN Commercial	$38.45
Rate for Payer: Cash Price	$37.46
Rate for Payer: Cofinity Commercial	$44.01
Rate for Payer: Encore Health Key Benefits Commercial	$37.46
Rate for Payer: Healthscope Commercial	$45.42
Rate for Payer: Healthscope Whirlpool	$46.82
Rate for Payer: Mclaren Commercial	$42.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.80
Rate for Payer: Nomi Health Commercial	$38.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$35.12
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$41.20

HC COMP BURN GARM SUEDE/LEATHER G

Facility

$46.82

Service Code	HCPCS A9900
Hospital Charge Code	98300058
Hospital Revenue Code	270
Min. Negotiated Rate	$17.32
Max. Negotiated Rate	$46.82
Rate for Payer: Aetna Commercial	$42.14
Rate for Payer: Aetna Medicare	$17.32
Rate for Payer: ASR ASR	$45.42
Rate for Payer: BCBS Complete	$18.73
Rate for Payer: BCBS Trust/PPO	$38.60
Rate for Payer: BCN Commercial	$38.60
Rate for Payer: Cash Price	$37.46
Rate for Payer: Cofinity Commercial	$44.01
Rate for Payer: Encore Health Key Benefits Commercial	$37.46
Rate for Payer: Healthscope Commercial	$45.42
Rate for Payer: Healthscope Whirlpool	$46.82
Rate for Payer: Mclaren Commercial	$42.14
Rate for Payer: MI Amish Medical Board Commercial	$37.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.80
Rate for Payer: Nomi Health Commercial	$38.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$35.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$41.02
Rate for Payer: Priority Health Narrow Network	$32.82
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$41.20

HC COMP BURN GARM SUIT SLVD ABV K

Facility

$395.35

Service Code	HCPCS A6512
Hospital Charge Code	98300059
Hospital Revenue Code	270
Min. Negotiated Rate	$146.28
Max. Negotiated Rate	$395.35
Rate for Payer: Aetna Commercial	$355.81
Rate for Payer: Aetna Medicare	$146.28
Rate for Payer: ASR ASR	$383.49
Rate for Payer: BCBS Complete	$158.14
Rate for Payer: BCBS Trust/PPO	$325.97
Rate for Payer: BCN Commercial	$325.97
Rate for Payer: Cash Price	$316.28
Rate for Payer: Cofinity Commercial	$371.63
Rate for Payer: Encore Health Key Benefits Commercial	$316.28
Rate for Payer: Healthscope Commercial	$383.49
Rate for Payer: Healthscope Whirlpool	$395.35
Rate for Payer: Mclaren Commercial	$355.81
Rate for Payer: MI Amish Medical Board Commercial	$316.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$336.05
Rate for Payer: Nomi Health Commercial	$324.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$296.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$346.41
Rate for Payer: Priority Health Narrow Network	$277.14
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$347.91

HC COMP BURN GARM SUIT SLVD ABV K

Facility

$395.35

Service Code	HCPCS A6512
Hospital Charge Code	98300059
Hospital Revenue Code	270
Min. Negotiated Rate	$296.51
Max. Negotiated Rate	$395.35
Rate for Payer: Aetna Commercial	$355.81
Rate for Payer: ASR ASR	$383.49
Rate for Payer: BCBS Trust/PPO	$324.66
Rate for Payer: BCN Commercial	$324.66
Rate for Payer: Cash Price	$316.28
Rate for Payer: Cofinity Commercial	$371.63
Rate for Payer: Encore Health Key Benefits Commercial	$316.28
Rate for Payer: Healthscope Commercial	$383.49
Rate for Payer: Healthscope Whirlpool	$395.35
Rate for Payer: Mclaren Commercial	$355.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$336.05
Rate for Payer: Nomi Health Commercial	$324.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$296.51
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$347.91

HC COMP BURN GARM SUIT SLVD TWO LEGS

Facility

$501.47

Service Code	HCPCS A6501
Hospital Charge Code	98300060
Hospital Revenue Code	270
Min. Negotiated Rate	$185.54
Max. Negotiated Rate	$501.47
Rate for Payer: Aetna Commercial	$451.32
Rate for Payer: Aetna Medicare	$185.54
Rate for Payer: ASR ASR	$486.43
Rate for Payer: BCBS Complete	$200.59
Rate for Payer: BCBS Trust/PPO	$413.46
Rate for Payer: BCN Commercial	$413.46
Rate for Payer: Cash Price	$401.18
Rate for Payer: Cofinity Commercial	$471.38
Rate for Payer: Encore Health Key Benefits Commercial	$401.18
Rate for Payer: Healthscope Commercial	$486.43
Rate for Payer: Healthscope Whirlpool	$501.47
Rate for Payer: Mclaren Commercial	$451.32
Rate for Payer: MI Amish Medical Board Commercial	$401.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$426.25
Rate for Payer: Nomi Health Commercial	$411.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$376.10
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$439.39
Rate for Payer: Priority Health Narrow Network	$351.53
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$441.29

HC COMP BURN GARM SUIT SLVD TWO LEGS

Facility

$501.47

Service Code	HCPCS A6501
Hospital Charge Code	98300060
Hospital Revenue Code	270
Min. Negotiated Rate	$376.10
Max. Negotiated Rate	$501.47
Rate for Payer: Aetna Commercial	$451.32
Rate for Payer: ASR ASR	$486.43
Rate for Payer: BCBS Trust/PPO	$411.81
Rate for Payer: BCN Commercial	$411.81
Rate for Payer: Cash Price	$401.18
Rate for Payer: Cofinity Commercial	$471.38
Rate for Payer: Encore Health Key Benefits Commercial	$401.18
Rate for Payer: Healthscope Commercial	$486.43
Rate for Payer: Healthscope Whirlpool	$501.47
Rate for Payer: Mclaren Commercial	$451.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$426.25
Rate for Payer: Nomi Health Commercial	$411.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$376.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$441.29

Know your out-of-pocket cost for care.

All Charges