Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC COMP BURN GARM BRF 2 LEGS ABV

Facility

$153.00

Service Code	HCPCS A6512
Hospital Charge Code	98300149
Hospital Revenue Code	270
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna Commercial	$137.70
Rate for Payer: Aetna Medicare	$76.50
Rate for Payer: ASR ASR	$148.41
Rate for Payer: ASR Commercial	$148.41
Rate for Payer: BCBS Complete	$61.20
Rate for Payer: BCBS Trust/PPO	$125.29
Rate for Payer: BCN Commercial	$118.62
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cofinity Commercial	$143.82
Rate for Payer: Encore Health Key Benefits Commercial	$122.40
Rate for Payer: Healthscope Commercial	$153.00
Rate for Payer: Healthscope Whirlpool	$148.41
Rate for Payer: Mclaren Commercial	$137.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.05
Rate for Payer: Nomi Health Commercial	$125.46
Rate for Payer: Priority Health Cigna Priority Health	$99.45
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$134.06
Rate for Payer: Priority Health Narrow Network	$107.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$134.64

HC COMP BURN GARM BRF 2 LEGS ABV

Facility

$153.00

Service Code	HCPCS A6512
Hospital Charge Code	98300149
Hospital Revenue Code	270
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna Commercial	$137.70
Rate for Payer: ASR ASR	$148.41
Rate for Payer: ASR Commercial	$148.41
Rate for Payer: BCBS Trust/PPO	$124.68
Rate for Payer: BCN Commercial	$118.62
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cofinity Commercial	$143.82
Rate for Payer: Encore Health Key Benefits Commercial	$122.40
Rate for Payer: Healthscope Commercial	$153.00
Rate for Payer: Healthscope Whirlpool	$148.41
Rate for Payer: Mclaren Commercial	$137.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.05
Rate for Payer: Nomi Health Commercial	$125.46
Rate for Payer: Priority Health Cigna Priority Health	$99.45
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$134.64

HC COMP BURN GARM BRF&CHAP,LG-MID

Facility

$134.64

Service Code	HCPCS A6512
Hospital Charge Code	98300150
Hospital Revenue Code	270
Min. Negotiated Rate	$53.86
Max. Negotiated Rate	$134.64
Rate for Payer: Aetna Commercial	$121.18
Rate for Payer: Aetna Medicare	$67.32
Rate for Payer: ASR ASR	$130.60
Rate for Payer: ASR Commercial	$130.60
Rate for Payer: BCBS Complete	$53.86
Rate for Payer: BCBS Trust/PPO	$110.26
Rate for Payer: BCN Commercial	$104.39
Rate for Payer: Cash Price	$107.71
Rate for Payer: Cofinity Commercial	$126.56
Rate for Payer: Encore Health Key Benefits Commercial	$107.71
Rate for Payer: Healthscope Commercial	$134.64
Rate for Payer: Healthscope Whirlpool	$130.60
Rate for Payer: Mclaren Commercial	$121.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$114.44
Rate for Payer: Nomi Health Commercial	$110.40
Rate for Payer: Priority Health Cigna Priority Health	$87.52
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$117.97
Rate for Payer: Priority Health Narrow Network	$94.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$118.48

HC COMP BURN GARM BRF&CHAP,LG-MID

Facility

$134.64

Service Code	HCPCS A6512
Hospital Charge Code	98300150
Hospital Revenue Code	270
Min. Negotiated Rate	$87.52
Max. Negotiated Rate	$134.64
Rate for Payer: Aetna Commercial	$121.18
Rate for Payer: ASR ASR	$130.60
Rate for Payer: ASR Commercial	$130.60
Rate for Payer: BCBS Trust/PPO	$109.72
Rate for Payer: BCN Commercial	$104.39
Rate for Payer: Cash Price	$107.71
Rate for Payer: Cofinity Commercial	$126.56
Rate for Payer: Encore Health Key Benefits Commercial	$107.71
Rate for Payer: Healthscope Commercial	$134.64
Rate for Payer: Healthscope Whirlpool	$130.60
Rate for Payer: Mclaren Commercial	$121.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$114.44
Rate for Payer: Nomi Health Commercial	$110.40
Rate for Payer: Priority Health Cigna Priority Health	$87.52
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$118.48

HC COMP BURN GARM BRIEF

Facility

$134.64

Service Code	HCPCS A6511
Hospital Charge Code	98300151
Hospital Revenue Code	270
Min. Negotiated Rate	$87.52
Max. Negotiated Rate	$134.64
Rate for Payer: Aetna Commercial	$121.18
Rate for Payer: ASR ASR	$130.60
Rate for Payer: ASR Commercial	$130.60
Rate for Payer: BCBS Trust/PPO	$109.72
Rate for Payer: BCN Commercial	$104.39
Rate for Payer: Cash Price	$107.71
Rate for Payer: Cofinity Commercial	$126.56
Rate for Payer: Encore Health Key Benefits Commercial	$107.71
Rate for Payer: Healthscope Commercial	$134.64
Rate for Payer: Healthscope Whirlpool	$130.60
Rate for Payer: Mclaren Commercial	$121.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$114.44
Rate for Payer: Nomi Health Commercial	$110.40
Rate for Payer: Priority Health Cigna Priority Health	$87.52
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$118.48

HC COMP BURN GARM BRIEF

Facility

$134.64

Service Code	HCPCS A6511
Hospital Charge Code	98300151
Hospital Revenue Code	270
Min. Negotiated Rate	$53.86
Max. Negotiated Rate	$134.64
Rate for Payer: Aetna Commercial	$121.18
Rate for Payer: Aetna Medicare	$67.32
Rate for Payer: ASR ASR	$130.60
Rate for Payer: ASR Commercial	$130.60
Rate for Payer: BCBS Complete	$53.86
Rate for Payer: BCBS Trust/PPO	$110.26
Rate for Payer: BCN Commercial	$104.39
Rate for Payer: Cash Price	$107.71
Rate for Payer: Cofinity Commercial	$126.56
Rate for Payer: Encore Health Key Benefits Commercial	$107.71
Rate for Payer: Healthscope Commercial	$134.64
Rate for Payer: Healthscope Whirlpool	$130.60
Rate for Payer: Mclaren Commercial	$121.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$114.44
Rate for Payer: Nomi Health Commercial	$110.40
Rate for Payer: Priority Health Cigna Priority Health	$87.52
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$117.97
Rate for Payer: Priority Health Narrow Network	$94.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$118.48

HC COMP BURN GARM CHIN STRAP REGU

Facility

$79.56

Service Code	HCPCS A6502
Hospital Charge Code	98300152
Hospital Revenue Code	270
Min. Negotiated Rate	$51.71
Max. Negotiated Rate	$79.56
Rate for Payer: Aetna Commercial	$71.60
Rate for Payer: ASR ASR	$77.17
Rate for Payer: ASR Commercial	$77.17
Rate for Payer: BCBS Trust/PPO	$64.83
Rate for Payer: BCN Commercial	$61.68
Rate for Payer: Cash Price	$63.65
Rate for Payer: Cofinity Commercial	$74.79
Rate for Payer: Encore Health Key Benefits Commercial	$63.65
Rate for Payer: Healthscope Commercial	$79.56
Rate for Payer: Healthscope Whirlpool	$77.17
Rate for Payer: Mclaren Commercial	$71.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.63
Rate for Payer: Nomi Health Commercial	$65.24
Rate for Payer: Priority Health Cigna Priority Health	$51.71
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$70.01

HC COMP BURN GARM CHIN STRAP REGU

Facility

$79.56

Service Code	HCPCS A6502
Hospital Charge Code	98300152
Hospital Revenue Code	270
Min. Negotiated Rate	$31.82
Max. Negotiated Rate	$79.56
Rate for Payer: Aetna Commercial	$71.60
Rate for Payer: Aetna Medicare	$39.78
Rate for Payer: ASR ASR	$77.17
Rate for Payer: ASR Commercial	$77.17
Rate for Payer: BCBS Complete	$31.82
Rate for Payer: BCBS Trust/PPO	$65.15
Rate for Payer: BCN Commercial	$61.68
Rate for Payer: Cash Price	$63.65
Rate for Payer: Cofinity Commercial	$74.79
Rate for Payer: Encore Health Key Benefits Commercial	$63.65
Rate for Payer: Healthscope Commercial	$79.56
Rate for Payer: Healthscope Whirlpool	$77.17
Rate for Payer: Mclaren Commercial	$71.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.63
Rate for Payer: Nomi Health Commercial	$65.24
Rate for Payer: Priority Health Cigna Priority Health	$51.71
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$69.71
Rate for Payer: Priority Health Narrow Network	$55.77
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$70.01

HC COMP BURN GARM CHIN STRP W LIP

Facility

$79.56

Service Code	HCPCS A6502
Hospital Charge Code	98300153
Hospital Revenue Code	270
Min. Negotiated Rate	$51.71
Max. Negotiated Rate	$79.56
Rate for Payer: Aetna Commercial	$71.60
Rate for Payer: ASR ASR	$77.17
Rate for Payer: ASR Commercial	$77.17
Rate for Payer: BCBS Trust/PPO	$64.83
Rate for Payer: BCN Commercial	$61.68
Rate for Payer: Cash Price	$63.65
Rate for Payer: Cofinity Commercial	$74.79
Rate for Payer: Encore Health Key Benefits Commercial	$63.65
Rate for Payer: Healthscope Commercial	$79.56
Rate for Payer: Healthscope Whirlpool	$77.17
Rate for Payer: Mclaren Commercial	$71.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.63
Rate for Payer: Nomi Health Commercial	$65.24
Rate for Payer: Priority Health Cigna Priority Health	$51.71
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$70.01

HC COMP BURN GARM CHIN STRP W LIP

Facility

$79.56

Service Code	HCPCS A6502
Hospital Charge Code	98300153
Hospital Revenue Code	270
Min. Negotiated Rate	$31.82
Max. Negotiated Rate	$79.56
Rate for Payer: Aetna Commercial	$71.60
Rate for Payer: Aetna Medicare	$39.78
Rate for Payer: ASR ASR	$77.17
Rate for Payer: ASR Commercial	$77.17
Rate for Payer: BCBS Complete	$31.82
Rate for Payer: BCBS Trust/PPO	$65.15
Rate for Payer: BCN Commercial	$61.68
Rate for Payer: Cash Price	$63.65
Rate for Payer: Cofinity Commercial	$74.79
Rate for Payer: Encore Health Key Benefits Commercial	$63.65
Rate for Payer: Healthscope Commercial	$79.56
Rate for Payer: Healthscope Whirlpool	$77.17
Rate for Payer: Mclaren Commercial	$71.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.63
Rate for Payer: Nomi Health Commercial	$65.24
Rate for Payer: Priority Health Cigna Priority Health	$51.71
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$69.71
Rate for Payer: Priority Health Narrow Network	$55.77
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$70.01

HC COMP BURN GARM COLLAR FOAM

Facility

$40.80

Service Code	HCPCS A6512
Hospital Charge Code	98300154
Hospital Revenue Code	270
Min. Negotiated Rate	$16.32
Max. Negotiated Rate	$40.80
Rate for Payer: Aetna Commercial	$36.72
Rate for Payer: Aetna Medicare	$20.40
Rate for Payer: ASR ASR	$39.58
Rate for Payer: ASR Commercial	$39.58
Rate for Payer: BCBS Complete	$16.32
Rate for Payer: BCBS Trust/PPO	$33.41
Rate for Payer: BCN Commercial	$31.63
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cofinity Commercial	$38.35
Rate for Payer: Encore Health Key Benefits Commercial	$32.64
Rate for Payer: Healthscope Commercial	$40.80
Rate for Payer: Healthscope Whirlpool	$39.58
Rate for Payer: Mclaren Commercial	$36.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.68
Rate for Payer: Nomi Health Commercial	$33.46
Rate for Payer: Priority Health Cigna Priority Health	$26.52
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.75
Rate for Payer: Priority Health Narrow Network	$28.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$35.90

HC COMP BURN GARM COLLAR FOAM

Facility

$40.80

Service Code	HCPCS A6512
Hospital Charge Code	98300154
Hospital Revenue Code	270
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$40.80
Rate for Payer: Aetna Commercial	$36.72
Rate for Payer: ASR ASR	$39.58
Rate for Payer: ASR Commercial	$39.58
Rate for Payer: BCBS Trust/PPO	$33.25
Rate for Payer: BCN Commercial	$31.63
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cofinity Commercial	$38.35
Rate for Payer: Encore Health Key Benefits Commercial	$32.64
Rate for Payer: Healthscope Commercial	$40.80
Rate for Payer: Healthscope Whirlpool	$39.58
Rate for Payer: Mclaren Commercial	$36.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.68
Rate for Payer: Nomi Health Commercial	$33.46
Rate for Payer: Priority Health Cigna Priority Health	$26.52
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$35.90

HC COMP BURN GARM COLLAR PILLOW

Facility

$69.36

Service Code	HCPCS A6512
Hospital Charge Code	98300155
Hospital Revenue Code	270
Min. Negotiated Rate	$27.74
Max. Negotiated Rate	$69.36
Rate for Payer: Aetna Commercial	$62.42
Rate for Payer: Aetna Medicare	$34.68
Rate for Payer: ASR ASR	$67.28
Rate for Payer: ASR Commercial	$67.28
Rate for Payer: BCBS Complete	$27.74
Rate for Payer: BCBS Trust/PPO	$56.80
Rate for Payer: BCN Commercial	$53.77
Rate for Payer: Cash Price	$55.49
Rate for Payer: Cofinity Commercial	$65.20
Rate for Payer: Encore Health Key Benefits Commercial	$55.49
Rate for Payer: Healthscope Commercial	$69.36
Rate for Payer: Healthscope Whirlpool	$67.28
Rate for Payer: Mclaren Commercial	$62.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.96
Rate for Payer: Nomi Health Commercial	$56.88
Rate for Payer: Priority Health Cigna Priority Health	$45.08
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$60.77
Rate for Payer: Priority Health Narrow Network	$48.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.04

HC COMP BURN GARM COLLAR PILLOW

Facility

$69.36

Service Code	HCPCS A6512
Hospital Charge Code	98300155
Hospital Revenue Code	270
Min. Negotiated Rate	$45.08
Max. Negotiated Rate	$69.36
Rate for Payer: Aetna Commercial	$62.42
Rate for Payer: ASR ASR	$67.28
Rate for Payer: ASR Commercial	$67.28
Rate for Payer: BCBS Trust/PPO	$56.52
Rate for Payer: BCN Commercial	$53.77
Rate for Payer: Cash Price	$55.49
Rate for Payer: Cofinity Commercial	$65.20
Rate for Payer: Encore Health Key Benefits Commercial	$55.49
Rate for Payer: Healthscope Commercial	$69.36
Rate for Payer: Healthscope Whirlpool	$67.28
Rate for Payer: Mclaren Commercial	$62.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.96
Rate for Payer: Nomi Health Commercial	$56.88
Rate for Payer: Priority Health Cigna Priority Health	$45.08
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.04

HC COMP BURN GARM COLLAR TRACH

Facility

$40.80

Service Code	HCPCS A6512
Hospital Charge Code	98300156
Hospital Revenue Code	270
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$40.80
Rate for Payer: Aetna Commercial	$36.72
Rate for Payer: ASR ASR	$39.58
Rate for Payer: ASR Commercial	$39.58
Rate for Payer: BCBS Trust/PPO	$33.25
Rate for Payer: BCN Commercial	$31.63
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cofinity Commercial	$38.35
Rate for Payer: Encore Health Key Benefits Commercial	$32.64
Rate for Payer: Healthscope Commercial	$40.80
Rate for Payer: Healthscope Whirlpool	$39.58
Rate for Payer: Mclaren Commercial	$36.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.68
Rate for Payer: Nomi Health Commercial	$33.46
Rate for Payer: Priority Health Cigna Priority Health	$26.52
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$35.90

HC COMP BURN GARM COLLAR TRACH

Facility

$40.80

Service Code	HCPCS A6512
Hospital Charge Code	98300156
Hospital Revenue Code	270
Min. Negotiated Rate	$16.32
Max. Negotiated Rate	$40.80
Rate for Payer: Aetna Commercial	$36.72
Rate for Payer: Aetna Medicare	$20.40
Rate for Payer: ASR ASR	$39.58
Rate for Payer: ASR Commercial	$39.58
Rate for Payer: BCBS Complete	$16.32
Rate for Payer: BCBS Trust/PPO	$33.41
Rate for Payer: BCN Commercial	$31.63
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cofinity Commercial	$38.35
Rate for Payer: Encore Health Key Benefits Commercial	$32.64
Rate for Payer: Healthscope Commercial	$40.80
Rate for Payer: Healthscope Whirlpool	$39.58
Rate for Payer: Mclaren Commercial	$36.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.68
Rate for Payer: Nomi Health Commercial	$33.46
Rate for Payer: Priority Health Cigna Priority Health	$26.52
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.75
Rate for Payer: Priority Health Narrow Network	$28.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$35.90

HC COMP BURN GARM ELECTIVE ALTERA

Facility

$20.40

Service Code	HCPCS A6512
Hospital Charge Code	98300157
Hospital Revenue Code	270
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$20.40
Rate for Payer: Aetna Commercial	$18.36
Rate for Payer: ASR ASR	$19.79
Rate for Payer: ASR Commercial	$19.79
Rate for Payer: BCBS Trust/PPO	$16.62
Rate for Payer: BCN Commercial	$15.82
Rate for Payer: Cash Price	$16.32
Rate for Payer: Cofinity Commercial	$19.18
Rate for Payer: Encore Health Key Benefits Commercial	$16.32
Rate for Payer: Healthscope Commercial	$20.40
Rate for Payer: Healthscope Whirlpool	$19.79
Rate for Payer: Mclaren Commercial	$18.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.34
Rate for Payer: Nomi Health Commercial	$16.73
Rate for Payer: Priority Health Cigna Priority Health	$13.26
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$17.95

HC COMP BURN GARM ELECTIVE ALTERA

Facility

$20.40

Service Code	HCPCS A6512
Hospital Charge Code	98300157
Hospital Revenue Code	270
Min. Negotiated Rate	$8.16
Max. Negotiated Rate	$20.40
Rate for Payer: Aetna Commercial	$18.36
Rate for Payer: Aetna Medicare	$10.20
Rate for Payer: ASR ASR	$19.79
Rate for Payer: ASR Commercial	$19.79
Rate for Payer: BCBS Complete	$8.16
Rate for Payer: BCBS Trust/PPO	$16.71
Rate for Payer: BCN Commercial	$15.82
Rate for Payer: Cash Price	$16.32
Rate for Payer: Cofinity Commercial	$19.18
Rate for Payer: Encore Health Key Benefits Commercial	$16.32
Rate for Payer: Healthscope Commercial	$20.40
Rate for Payer: Healthscope Whirlpool	$19.79
Rate for Payer: Mclaren Commercial	$18.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.34
Rate for Payer: Nomi Health Commercial	$16.73
Rate for Payer: Priority Health Cigna Priority Health	$13.26
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17.87
Rate for Payer: Priority Health Narrow Network	$14.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$17.95

HC COMP BURN GARM EXPANSION PANEL

Facility

$28.56

Service Code	HCPCS A6512
Hospital Charge Code	98300158
Hospital Revenue Code	270
Min. Negotiated Rate	$11.42
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna Commercial	$25.70
Rate for Payer: Aetna Medicare	$14.28
Rate for Payer: ASR ASR	$27.70
Rate for Payer: ASR Commercial	$27.70
Rate for Payer: BCBS Complete	$11.42
Rate for Payer: BCBS Trust/PPO	$23.39
Rate for Payer: BCN Commercial	$22.14
Rate for Payer: Cash Price	$22.85
Rate for Payer: Cofinity Commercial	$26.85
Rate for Payer: Encore Health Key Benefits Commercial	$22.85
Rate for Payer: Healthscope Commercial	$28.56
Rate for Payer: Healthscope Whirlpool	$27.70
Rate for Payer: Mclaren Commercial	$25.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.28
Rate for Payer: Nomi Health Commercial	$23.42
Rate for Payer: Priority Health Cigna Priority Health	$18.56
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$25.02
Rate for Payer: Priority Health Narrow Network	$20.02
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$25.13

HC COMP BURN GARM EXPANSION PANEL

Facility

$28.56

Service Code	HCPCS A6512
Hospital Charge Code	98300158
Hospital Revenue Code	270
Min. Negotiated Rate	$18.56
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna Commercial	$25.70
Rate for Payer: ASR ASR	$27.70
Rate for Payer: ASR Commercial	$27.70
Rate for Payer: BCBS Trust/PPO	$23.27
Rate for Payer: BCN Commercial	$22.14
Rate for Payer: Cash Price	$22.85
Rate for Payer: Cofinity Commercial	$26.85
Rate for Payer: Encore Health Key Benefits Commercial	$22.85
Rate for Payer: Healthscope Commercial	$28.56
Rate for Payer: Healthscope Whirlpool	$27.70
Rate for Payer: Mclaren Commercial	$25.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.28
Rate for Payer: Nomi Health Commercial	$23.42
Rate for Payer: Priority Health Cigna Priority Health	$18.56
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$25.13

HC COMP BURN GARM FACE MASK

Facility

$136.68

Service Code	HCPCS A6503
Hospital Charge Code	98300159
Hospital Revenue Code	270
Min. Negotiated Rate	$54.67
Max. Negotiated Rate	$136.68
Rate for Payer: Aetna Commercial	$123.01
Rate for Payer: Aetna Medicare	$68.34
Rate for Payer: ASR ASR	$132.58
Rate for Payer: ASR Commercial	$132.58
Rate for Payer: BCBS Complete	$54.67
Rate for Payer: BCBS Trust/PPO	$111.93
Rate for Payer: BCN Commercial	$105.97
Rate for Payer: Cash Price	$109.34
Rate for Payer: Cofinity Commercial	$128.48
Rate for Payer: Encore Health Key Benefits Commercial	$109.34
Rate for Payer: Healthscope Commercial	$136.68
Rate for Payer: Healthscope Whirlpool	$132.58
Rate for Payer: Mclaren Commercial	$123.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.18
Rate for Payer: Nomi Health Commercial	$112.08
Rate for Payer: Priority Health Cigna Priority Health	$88.84
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$119.76
Rate for Payer: Priority Health Narrow Network	$95.81
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$120.28

HC COMP BURN GARM FACE MASK

Facility

$136.68

Service Code	HCPCS A6503
Hospital Charge Code	98300159
Hospital Revenue Code	270
Min. Negotiated Rate	$88.84
Max. Negotiated Rate	$136.68
Rate for Payer: Aetna Commercial	$123.01
Rate for Payer: ASR ASR	$132.58
Rate for Payer: ASR Commercial	$132.58
Rate for Payer: BCBS Trust/PPO	$111.38
Rate for Payer: BCN Commercial	$105.97
Rate for Payer: Cash Price	$109.34
Rate for Payer: Cofinity Commercial	$128.48
Rate for Payer: Encore Health Key Benefits Commercial	$109.34
Rate for Payer: Healthscope Commercial	$136.68
Rate for Payer: Healthscope Whirlpool	$132.58
Rate for Payer: Mclaren Commercial	$123.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.18
Rate for Payer: Nomi Health Commercial	$112.08
Rate for Payer: Priority Health Cigna Priority Health	$88.84
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$120.28

HC COMP BURN GARM FOOT GAUNTLET

Facility

$34.68

Service Code	HCPCS A6512
Hospital Charge Code	98300160
Hospital Revenue Code	270
Min. Negotiated Rate	$13.87
Max. Negotiated Rate	$34.68
Rate for Payer: Aetna Commercial	$31.21
Rate for Payer: Aetna Medicare	$17.34
Rate for Payer: ASR ASR	$33.64
Rate for Payer: ASR Commercial	$33.64
Rate for Payer: BCBS Complete	$13.87
Rate for Payer: BCBS Trust/PPO	$28.40
Rate for Payer: BCN Commercial	$26.89
Rate for Payer: Cash Price	$27.74
Rate for Payer: Cofinity Commercial	$32.60
Rate for Payer: Encore Health Key Benefits Commercial	$27.74
Rate for Payer: Healthscope Commercial	$34.68
Rate for Payer: Healthscope Whirlpool	$33.64
Rate for Payer: Mclaren Commercial	$31.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.48
Rate for Payer: Nomi Health Commercial	$28.44
Rate for Payer: Priority Health Cigna Priority Health	$22.54
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$30.39
Rate for Payer: Priority Health Narrow Network	$24.31
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$30.52

HC COMP BURN GARM FOOT GAUNTLET

Facility

$34.68

Service Code	HCPCS A6512
Hospital Charge Code	98300160
Hospital Revenue Code	270
Min. Negotiated Rate	$22.54
Max. Negotiated Rate	$34.68
Rate for Payer: Aetna Commercial	$31.21
Rate for Payer: ASR ASR	$33.64
Rate for Payer: ASR Commercial	$33.64
Rate for Payer: BCBS Trust/PPO	$28.26
Rate for Payer: BCN Commercial	$26.89
Rate for Payer: Cash Price	$27.74
Rate for Payer: Cofinity Commercial	$32.60
Rate for Payer: Encore Health Key Benefits Commercial	$27.74
Rate for Payer: Healthscope Commercial	$34.68
Rate for Payer: Healthscope Whirlpool	$33.64
Rate for Payer: Mclaren Commercial	$31.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.48
Rate for Payer: Nomi Health Commercial	$28.44
Rate for Payer: Priority Health Cigna Priority Health	$22.54
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$30.52

HC COMP BURN GARM FOOT GLOVE

Facility

$112.20

Service Code	HCPCS A6512
Hospital Charge Code	98300161
Hospital Revenue Code	270
Min. Negotiated Rate	$72.93
Max. Negotiated Rate	$112.20
Rate for Payer: Aetna Commercial	$100.98
Rate for Payer: ASR ASR	$108.83
Rate for Payer: ASR Commercial	$108.83
Rate for Payer: BCBS Trust/PPO	$91.43
Rate for Payer: BCN Commercial	$86.99
Rate for Payer: Cash Price	$89.76
Rate for Payer: Cofinity Commercial	$105.47
Rate for Payer: Encore Health Key Benefits Commercial	$89.76
Rate for Payer: Healthscope Commercial	$112.20
Rate for Payer: Healthscope Whirlpool	$108.83
Rate for Payer: Mclaren Commercial	$100.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$95.37
Rate for Payer: Nomi Health Commercial	$92.00
Rate for Payer: Priority Health Cigna Priority Health	$72.93
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$98.74

Know your out-of-pocket cost for care.

All Charges