Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC COMP BURN GARM FOOT GLOVE

Facility

$112.20

Service Code	HCPCS A6512
Hospital Charge Code	98300161
Hospital Revenue Code	270
Min. Negotiated Rate	$44.88
Max. Negotiated Rate	$112.20
Rate for Payer: Aetna Commercial	$100.98
Rate for Payer: Aetna Medicare	$56.10
Rate for Payer: ASR ASR	$108.83
Rate for Payer: ASR Commercial	$108.83
Rate for Payer: BCBS Complete	$44.88
Rate for Payer: BCBS Trust/PPO	$91.88
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: Priority Health HMO/PPO/Tiered Network	$98.31
Rate for Payer: Priority Health Narrow Network	$78.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$98.74

HC COMP BURN GARM FOOT MITTEN

Facility

$91.80

Service Code	HCPCS A6512
Hospital Charge Code	98300025
Hospital Revenue Code	270
Min. Negotiated Rate	$36.72
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna Commercial	$82.62
Rate for Payer: Aetna Medicare	$45.90
Rate for Payer: ASR ASR	$89.05
Rate for Payer: ASR Commercial	$89.05
Rate for Payer: BCBS Complete	$36.72
Rate for Payer: BCBS Trust/PPO	$75.18
Rate for Payer: BCN Commercial	$71.17
Rate for Payer: Cash Price	$73.44
Rate for Payer: Cofinity Commercial	$86.29
Rate for Payer: Encore Health Key Benefits Commercial	$73.44
Rate for Payer: Healthscope Commercial	$91.80
Rate for Payer: Healthscope Whirlpool	$89.05
Rate for Payer: Mclaren Commercial	$82.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.03
Rate for Payer: Nomi Health Commercial	$75.28
Rate for Payer: Priority Health Cigna Priority Health	$59.67
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$80.44
Rate for Payer: Priority Health Narrow Network	$64.35
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$80.78

HC COMP BURN GARM FOOT MITTEN

Facility

$91.80

Service Code	HCPCS A6512
Hospital Charge Code	98300025
Hospital Revenue Code	270
Min. Negotiated Rate	$59.67
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna Commercial	$82.62
Rate for Payer: ASR ASR	$89.05
Rate for Payer: ASR Commercial	$89.05
Rate for Payer: BCBS Trust/PPO	$74.81
Rate for Payer: BCN Commercial	$71.17
Rate for Payer: Cash Price	$73.44
Rate for Payer: Cofinity Commercial	$86.29
Rate for Payer: Encore Health Key Benefits Commercial	$73.44
Rate for Payer: Healthscope Commercial	$91.80
Rate for Payer: Healthscope Whirlpool	$89.05
Rate for Payer: Mclaren Commercial	$82.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.03
Rate for Payer: Nomi Health Commercial	$75.28
Rate for Payer: Priority Health Cigna Priority Health	$59.67
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$80.78

HC COMP BURN GARM FULLY LINED GAR

Facility

$1.02

Service Code	HCPCS A6512
Hospital Charge Code	98300026
Hospital Revenue Code	270
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$1.02
Rate for Payer: Aetna Commercial	$0.92
Rate for Payer: ASR ASR	$0.99
Rate for Payer: ASR Commercial	$0.99
Rate for Payer: BCBS Trust/PPO	$0.83
Rate for Payer: BCN Commercial	$0.79
Rate for Payer: Cash Price	$0.82
Rate for Payer: Cofinity Commercial	$0.96
Rate for Payer: Encore Health Key Benefits Commercial	$0.82
Rate for Payer: Healthscope Commercial	$1.02
Rate for Payer: Healthscope Whirlpool	$0.99
Rate for Payer: Mclaren Commercial	$0.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.87
Rate for Payer: Nomi Health Commercial	$0.84
Rate for Payer: Priority Health Cigna Priority Health	$0.66
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$0.90

HC COMP BURN GARM FULLY LINED GAR

Facility

$1.02

Service Code	HCPCS A6512
Hospital Charge Code	98300026
Hospital Revenue Code	270
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$1.02
Rate for Payer: Aetna Commercial	$0.92
Rate for Payer: Aetna Medicare	$0.51
Rate for Payer: ASR ASR	$0.99
Rate for Payer: ASR Commercial	$0.99
Rate for Payer: BCBS Complete	$0.41
Rate for Payer: BCBS Trust/PPO	$0.84
Rate for Payer: BCN Commercial	$0.79
Rate for Payer: Cash Price	$0.82
Rate for Payer: Cofinity Commercial	$0.96
Rate for Payer: Encore Health Key Benefits Commercial	$0.82
Rate for Payer: Healthscope Commercial	$1.02
Rate for Payer: Healthscope Whirlpool	$0.99
Rate for Payer: Mclaren Commercial	$0.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.87
Rate for Payer: Nomi Health Commercial	$0.84
Rate for Payer: Priority Health Cigna Priority Health	$0.66
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$0.89
Rate for Payer: Priority Health Narrow Network	$0.72
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$0.90

HC COMP BURN GARM GAUNTLET TO AXI

Facility

$93.84

Service Code	HCPCS A6512
Hospital Charge Code	98300027
Hospital Revenue Code	270
Min. Negotiated Rate	$61.00
Max. Negotiated Rate	$93.84
Rate for Payer: Aetna Commercial	$84.46
Rate for Payer: ASR ASR	$91.02
Rate for Payer: ASR Commercial	$91.02
Rate for Payer: BCBS Trust/PPO	$76.47
Rate for Payer: BCN Commercial	$72.75
Rate for Payer: Cash Price	$75.07
Rate for Payer: Cofinity Commercial	$88.21
Rate for Payer: Encore Health Key Benefits Commercial	$75.07
Rate for Payer: Healthscope Commercial	$93.84
Rate for Payer: Healthscope Whirlpool	$91.02
Rate for Payer: Mclaren Commercial	$84.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.76
Rate for Payer: Nomi Health Commercial	$76.95
Rate for Payer: Priority Health Cigna Priority Health	$61.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$82.58

HC COMP BURN GARM GAUNTLET TO AXI

Facility

$93.84

Service Code	HCPCS A6512
Hospital Charge Code	98300027
Hospital Revenue Code	270
Min. Negotiated Rate	$37.54
Max. Negotiated Rate	$93.84
Rate for Payer: Aetna Commercial	$84.46
Rate for Payer: Aetna Medicare	$46.92
Rate for Payer: ASR ASR	$91.02
Rate for Payer: ASR Commercial	$91.02
Rate for Payer: BCBS Complete	$37.54
Rate for Payer: BCBS Trust/PPO	$76.85
Rate for Payer: BCN Commercial	$72.75
Rate for Payer: Cash Price	$75.07
Rate for Payer: Cofinity Commercial	$88.21
Rate for Payer: Encore Health Key Benefits Commercial	$75.07
Rate for Payer: Healthscope Commercial	$93.84
Rate for Payer: Healthscope Whirlpool	$91.02
Rate for Payer: Mclaren Commercial	$84.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.76
Rate for Payer: Nomi Health Commercial	$76.95
Rate for Payer: Priority Health Cigna Priority Health	$61.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$82.22
Rate for Payer: Priority Health Narrow Network	$65.78
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$82.58

HC COMP BURN GARM GAUNTLET TO WRI

Facility

$35.70

Service Code	HCPCS A6512
Hospital Charge Code	98300028
Hospital Revenue Code	270
Min. Negotiated Rate	$14.28
Max. Negotiated Rate	$35.70
Rate for Payer: Aetna Commercial	$32.13
Rate for Payer: Aetna Medicare	$17.85
Rate for Payer: ASR ASR	$34.63
Rate for Payer: ASR Commercial	$34.63
Rate for Payer: BCBS Complete	$14.28
Rate for Payer: BCBS Trust/PPO	$29.23
Rate for Payer: BCN Commercial	$27.68
Rate for Payer: Cash Price	$28.56
Rate for Payer: Cofinity Commercial	$33.56
Rate for Payer: Encore Health Key Benefits Commercial	$28.56
Rate for Payer: Healthscope Commercial	$35.70
Rate for Payer: Healthscope Whirlpool	$34.63
Rate for Payer: Mclaren Commercial	$32.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.34
Rate for Payer: Nomi Health Commercial	$29.27
Rate for Payer: Priority Health Cigna Priority Health	$23.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$31.28
Rate for Payer: Priority Health Narrow Network	$25.03
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$31.42

HC COMP BURN GARM GAUNTLET TO WRI

Facility

$35.70

Service Code	HCPCS A6512
Hospital Charge Code	98300028
Hospital Revenue Code	270
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$35.70
Rate for Payer: Aetna Commercial	$32.13
Rate for Payer: ASR ASR	$34.63
Rate for Payer: ASR Commercial	$34.63
Rate for Payer: BCBS Trust/PPO	$29.09
Rate for Payer: BCN Commercial	$27.68
Rate for Payer: Cash Price	$28.56
Rate for Payer: Cofinity Commercial	$33.56
Rate for Payer: Encore Health Key Benefits Commercial	$28.56
Rate for Payer: Healthscope Commercial	$35.70
Rate for Payer: Healthscope Whirlpool	$34.63
Rate for Payer: Mclaren Commercial	$32.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.34
Rate for Payer: Nomi Health Commercial	$29.27
Rate for Payer: Priority Health Cigna Priority Health	$23.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$31.42

HC COMP BURN GARM GLOVE-ELBOW

Facility

$163.20

Service Code	HCPCS A6505
Hospital Charge Code	98300030
Hospital Revenue Code	270
Min. Negotiated Rate	$65.28
Max. Negotiated Rate	$163.20
Rate for Payer: Aetna Commercial	$146.88
Rate for Payer: Aetna Medicare	$81.60
Rate for Payer: ASR ASR	$158.30
Rate for Payer: ASR Commercial	$158.30
Rate for Payer: BCBS Complete	$65.28
Rate for Payer: BCBS Trust/PPO	$133.64
Rate for Payer: BCN Commercial	$126.53
Rate for Payer: Cash Price	$130.56
Rate for Payer: Cofinity Commercial	$153.41
Rate for Payer: Encore Health Key Benefits Commercial	$130.56
Rate for Payer: Healthscope Commercial	$163.20
Rate for Payer: Healthscope Whirlpool	$158.30
Rate for Payer: Mclaren Commercial	$146.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$138.72
Rate for Payer: Nomi Health Commercial	$133.82
Rate for Payer: Priority Health Cigna Priority Health	$106.08
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$143.00
Rate for Payer: Priority Health Narrow Network	$114.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$143.62

HC COMP BURN GARM GLOVE-ELBOW

Facility

$163.20

Service Code	HCPCS A6505
Hospital Charge Code	98300030
Hospital Revenue Code	270
Min. Negotiated Rate	$106.08
Max. Negotiated Rate	$163.20
Rate for Payer: Aetna Commercial	$146.88
Rate for Payer: ASR ASR	$158.30
Rate for Payer: ASR Commercial	$158.30
Rate for Payer: BCBS Trust/PPO	$132.99
Rate for Payer: BCN Commercial	$126.53
Rate for Payer: Cash Price	$130.56
Rate for Payer: Cofinity Commercial	$153.41
Rate for Payer: Encore Health Key Benefits Commercial	$130.56
Rate for Payer: Healthscope Commercial	$163.20
Rate for Payer: Healthscope Whirlpool	$158.30
Rate for Payer: Mclaren Commercial	$146.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$138.72
Rate for Payer: Nomi Health Commercial	$133.82
Rate for Payer: Priority Health Cigna Priority Health	$106.08
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$143.62

HC COMP BURN GARM GLOVE TO AXILLA

Facility

$179.52

Service Code	HCPCS A6506
Hospital Charge Code	98300029
Hospital Revenue Code	270
Min. Negotiated Rate	$71.81
Max. Negotiated Rate	$179.52
Rate for Payer: Aetna Commercial	$161.57
Rate for Payer: Aetna Medicare	$89.76
Rate for Payer: ASR ASR	$174.13
Rate for Payer: ASR Commercial	$174.13
Rate for Payer: BCBS Complete	$71.81
Rate for Payer: BCBS Trust/PPO	$147.01
Rate for Payer: BCN Commercial	$139.18
Rate for Payer: Cash Price	$143.62
Rate for Payer: Cofinity Commercial	$168.75
Rate for Payer: Encore Health Key Benefits Commercial	$143.62
Rate for Payer: Healthscope Commercial	$179.52
Rate for Payer: Healthscope Whirlpool	$174.13
Rate for Payer: Mclaren Commercial	$161.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$152.59
Rate for Payer: Nomi Health Commercial	$147.21
Rate for Payer: Priority Health Cigna Priority Health	$116.69
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$157.30
Rate for Payer: Priority Health Narrow Network	$125.84
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$157.98

HC COMP BURN GARM GLOVE TO AXILLA

Facility

$179.52

Service Code	HCPCS A6506
Hospital Charge Code	98300029
Hospital Revenue Code	270
Min. Negotiated Rate	$116.69
Max. Negotiated Rate	$179.52
Rate for Payer: Aetna Commercial	$161.57
Rate for Payer: ASR ASR	$174.13
Rate for Payer: ASR Commercial	$174.13
Rate for Payer: BCBS Trust/PPO	$146.29
Rate for Payer: BCN Commercial	$139.18
Rate for Payer: Cash Price	$143.62
Rate for Payer: Cofinity Commercial	$168.75
Rate for Payer: Encore Health Key Benefits Commercial	$143.62
Rate for Payer: Healthscope Commercial	$179.52
Rate for Payer: Healthscope Whirlpool	$174.13
Rate for Payer: Mclaren Commercial	$161.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$152.59
Rate for Payer: Nomi Health Commercial	$147.21
Rate for Payer: Priority Health Cigna Priority Health	$116.69
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$157.98

HC COMP BURN GARM GLOVE-WRIST

Facility

$112.20

Service Code	HCPCS A6504
Hospital Charge Code	98300031
Hospital Revenue Code	270
Min. Negotiated Rate	$44.88
Max. Negotiated Rate	$112.20
Rate for Payer: Aetna Commercial	$100.98
Rate for Payer: Aetna Medicare	$56.10
Rate for Payer: ASR ASR	$108.83
Rate for Payer: ASR Commercial	$108.83
Rate for Payer: BCBS Complete	$44.88
Rate for Payer: BCBS Trust/PPO	$91.88
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: Priority Health HMO/PPO/Tiered Network	$98.31
Rate for Payer: Priority Health Narrow Network	$78.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$98.74

HC COMP BURN GARM GLOVE-WRIST

Facility

$112.20

Service Code	HCPCS A6504
Hospital Charge Code	98300031
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

HC COMP BURN GARM HEAD BAND

Facility

$40.80

Service Code	HCPCS A6512
Hospital Charge Code	98300032
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 HEAD BAND

Facility

$40.80

Service Code	HCPCS A6512
Hospital Charge Code	98300032
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 HOOK&LOOP SNAP

Facility

$14.28

Service Code	HCPCS A6512
Hospital Charge Code	98300033
Hospital Revenue Code	270
Min. Negotiated Rate	$9.28
Max. Negotiated Rate	$14.28
Rate for Payer: Aetna Commercial	$12.85
Rate for Payer: ASR ASR	$13.85
Rate for Payer: ASR Commercial	$13.85
Rate for Payer: BCBS Trust/PPO	$11.64
Rate for Payer: BCN Commercial	$11.07
Rate for Payer: Cash Price	$11.42
Rate for Payer: Cofinity Commercial	$13.42
Rate for Payer: Encore Health Key Benefits Commercial	$11.42
Rate for Payer: Healthscope Commercial	$14.28
Rate for Payer: Healthscope Whirlpool	$13.85
Rate for Payer: Mclaren Commercial	$12.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.14
Rate for Payer: Nomi Health Commercial	$11.71
Rate for Payer: Priority Health Cigna Priority Health	$9.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$12.57

HC COMP BURN GARM HOOK&LOOP SNAP

Facility

$14.28

Service Code	HCPCS A6512
Hospital Charge Code	98300033
Hospital Revenue Code	270
Min. Negotiated Rate	$5.71
Max. Negotiated Rate	$14.28
Rate for Payer: Aetna Commercial	$12.85
Rate for Payer: Aetna Medicare	$7.14
Rate for Payer: ASR ASR	$13.85
Rate for Payer: ASR Commercial	$13.85
Rate for Payer: BCBS Complete	$5.71
Rate for Payer: BCBS Trust/PPO	$11.69
Rate for Payer: BCN Commercial	$11.07
Rate for Payer: Cash Price	$11.42
Rate for Payer: Cofinity Commercial	$13.42
Rate for Payer: Encore Health Key Benefits Commercial	$11.42
Rate for Payer: Healthscope Commercial	$14.28
Rate for Payer: Healthscope Whirlpool	$13.85
Rate for Payer: Mclaren Commercial	$12.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.14
Rate for Payer: Nomi Health Commercial	$11.71
Rate for Payer: Priority Health Cigna Priority Health	$9.28
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$12.51
Rate for Payer: Priority Health Narrow Network	$10.01
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$12.57

HC COMP BURN GARM HOOK&LOOP TAB S

Facility

$8.16

Service Code	HCPCS A6512
Hospital Charge Code	98300034
Hospital Revenue Code	270
Min. Negotiated Rate	$3.26
Max. Negotiated Rate	$8.16
Rate for Payer: Aetna Commercial	$7.34
Rate for Payer: Aetna Medicare	$4.08
Rate for Payer: ASR ASR	$7.92
Rate for Payer: ASR Commercial	$7.92
Rate for Payer: BCBS Complete	$3.26
Rate for Payer: BCBS Trust/PPO	$6.68
Rate for Payer: BCN Commercial	$6.33
Rate for Payer: Cash Price	$6.53
Rate for Payer: Cofinity Commercial	$7.67
Rate for Payer: Encore Health Key Benefits Commercial	$6.53
Rate for Payer: Healthscope Commercial	$8.16
Rate for Payer: Healthscope Whirlpool	$7.92
Rate for Payer: Mclaren Commercial	$7.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.94
Rate for Payer: Nomi Health Commercial	$6.69
Rate for Payer: Priority Health Cigna Priority Health	$5.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7.15
Rate for Payer: Priority Health Narrow Network	$5.72
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$7.18

HC COMP BURN GARM HOOK&LOOP TAB S

Facility

$8.16

Service Code	HCPCS A6512
Hospital Charge Code	98300034
Hospital Revenue Code	270
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$8.16
Rate for Payer: Aetna Commercial	$7.34
Rate for Payer: ASR ASR	$7.92
Rate for Payer: ASR Commercial	$7.92
Rate for Payer: BCBS Trust/PPO	$6.65
Rate for Payer: BCN Commercial	$6.33
Rate for Payer: Cash Price	$6.53
Rate for Payer: Cofinity Commercial	$7.67
Rate for Payer: Encore Health Key Benefits Commercial	$6.53
Rate for Payer: Healthscope Commercial	$8.16
Rate for Payer: Healthscope Whirlpool	$7.92
Rate for Payer: Mclaren Commercial	$7.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.94
Rate for Payer: Nomi Health Commercial	$6.69
Rate for Payer: Priority Health Cigna Priority Health	$5.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$7.18

HC COMP BURN GARM LEG&CHAP TO WAI

Facility

$212.16

Service Code	HCPCS A6512
Hospital Charge Code	98300036
Hospital Revenue Code	270
Min. Negotiated Rate	$137.90
Max. Negotiated Rate	$212.16
Rate for Payer: Aetna Commercial	$190.94
Rate for Payer: ASR ASR	$205.80
Rate for Payer: ASR Commercial	$205.80
Rate for Payer: BCBS Trust/PPO	$172.89
Rate for Payer: BCN Commercial	$164.49
Rate for Payer: Cash Price	$169.73
Rate for Payer: Cofinity Commercial	$199.43
Rate for Payer: Encore Health Key Benefits Commercial	$169.73
Rate for Payer: Healthscope Commercial	$212.16
Rate for Payer: Healthscope Whirlpool	$205.80
Rate for Payer: Mclaren Commercial	$190.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$180.34
Rate for Payer: Nomi Health Commercial	$173.97
Rate for Payer: Priority Health Cigna Priority Health	$137.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$186.70

HC COMP BURN GARM LEG&CHAP TO WAI

Facility

$212.16

Service Code	HCPCS A6512
Hospital Charge Code	98300036
Hospital Revenue Code	270
Min. Negotiated Rate	$84.86
Max. Negotiated Rate	$212.16
Rate for Payer: Aetna Commercial	$190.94
Rate for Payer: Aetna Medicare	$106.08
Rate for Payer: ASR ASR	$205.80
Rate for Payer: ASR Commercial	$205.80
Rate for Payer: BCBS Complete	$84.86
Rate for Payer: BCBS Trust/PPO	$173.74
Rate for Payer: BCN Commercial	$164.49
Rate for Payer: Cash Price	$169.73
Rate for Payer: Cofinity Commercial	$199.43
Rate for Payer: Encore Health Key Benefits Commercial	$169.73
Rate for Payer: Healthscope Commercial	$212.16
Rate for Payer: Healthscope Whirlpool	$205.80
Rate for Payer: Mclaren Commercial	$190.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$180.34
Rate for Payer: Nomi Health Commercial	$173.97
Rate for Payer: Priority Health Cigna Priority Health	$137.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$185.89
Rate for Payer: Priority Health Narrow Network	$148.72
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$186.70

HC COMP BURN GARM LEG & PANTY

Facility

$226.44

Service Code	HCPCS A6511
Hospital Charge Code	98300035
Hospital Revenue Code	270
Min. Negotiated Rate	$147.19
Max. Negotiated Rate	$226.44
Rate for Payer: Aetna Commercial	$203.80
Rate for Payer: ASR ASR	$219.65
Rate for Payer: ASR Commercial	$219.65
Rate for Payer: BCBS Trust/PPO	$184.53
Rate for Payer: BCN Commercial	$175.56
Rate for Payer: Cash Price	$181.15
Rate for Payer: Cofinity Commercial	$212.85
Rate for Payer: Encore Health Key Benefits Commercial	$181.15
Rate for Payer: Healthscope Commercial	$226.44
Rate for Payer: Healthscope Whirlpool	$219.65
Rate for Payer: Mclaren Commercial	$203.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$192.47
Rate for Payer: Nomi Health Commercial	$185.68
Rate for Payer: Priority Health Cigna Priority Health	$147.19
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$199.27

HC COMP BURN GARM LEG & PANTY

Facility

$226.44

Service Code	HCPCS A6511
Hospital Charge Code	98300035
Hospital Revenue Code	270
Min. Negotiated Rate	$90.58
Max. Negotiated Rate	$226.44
Rate for Payer: Aetna Commercial	$203.80
Rate for Payer: Aetna Medicare	$113.22
Rate for Payer: ASR ASR	$219.65
Rate for Payer: ASR Commercial	$219.65
Rate for Payer: BCBS Complete	$90.58
Rate for Payer: BCBS Trust/PPO	$185.43
Rate for Payer: BCN Commercial	$175.56
Rate for Payer: Cash Price	$181.15
Rate for Payer: Cofinity Commercial	$212.85
Rate for Payer: Encore Health Key Benefits Commercial	$181.15
Rate for Payer: Healthscope Commercial	$226.44
Rate for Payer: Healthscope Whirlpool	$219.65
Rate for Payer: Mclaren Commercial	$203.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$192.47
Rate for Payer: Nomi Health Commercial	$185.68
Rate for Payer: Priority Health Cigna Priority Health	$147.19
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$198.41
Rate for Payer: Priority Health Narrow Network	$158.73
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$199.27

Know your out-of-pocket cost for care.

All Charges