Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

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	$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 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 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&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 & 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

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 LINING,POCKET,F

Facility

$12.24

Service Code	HCPCS A6512
Hospital Charge Code	98300037
Hospital Revenue Code	270
Min. Negotiated Rate	$7.96
Max. Negotiated Rate	$12.24
Rate for Payer: Aetna Commercial	$11.02
Rate for Payer: ASR ASR	$11.87
Rate for Payer: ASR Commercial	$11.87
Rate for Payer: BCBS Trust/PPO	$9.97
Rate for Payer: BCN Commercial	$9.49
Rate for Payer: Cash Price	$9.79
Rate for Payer: Cofinity Commercial	$11.51
Rate for Payer: Encore Health Key Benefits Commercial	$9.79
Rate for Payer: Healthscope Commercial	$12.24
Rate for Payer: Healthscope Whirlpool	$11.87
Rate for Payer: Mclaren Commercial	$11.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.40
Rate for Payer: Nomi Health Commercial	$10.04
Rate for Payer: Priority Health Cigna Priority Health	$7.96
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$10.77

HC COMP BURN GARM LINING,POCKET,F

Facility

$12.24

Service Code	HCPCS A6512
Hospital Charge Code	98300037
Hospital Revenue Code	270
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$12.24
Rate for Payer: Aetna Commercial	$11.02
Rate for Payer: Aetna Medicare	$6.12
Rate for Payer: ASR ASR	$11.87
Rate for Payer: ASR Commercial	$11.87
Rate for Payer: BCBS Complete	$4.90
Rate for Payer: BCBS Trust/PPO	$10.02
Rate for Payer: BCN Commercial	$9.49
Rate for Payer: Cash Price	$9.79
Rate for Payer: Cofinity Commercial	$11.51
Rate for Payer: Encore Health Key Benefits Commercial	$9.79
Rate for Payer: Healthscope Commercial	$12.24
Rate for Payer: Healthscope Whirlpool	$11.87
Rate for Payer: Mclaren Commercial	$11.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.40
Rate for Payer: Nomi Health Commercial	$10.04
Rate for Payer: Priority Health Cigna Priority Health	$7.96
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10.72
Rate for Payer: Priority Health Narrow Network	$8.58
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$10.77

HC COMP BURN GARM MITTEN TO WRIST

Facility

$69.36

Service Code	HCPCS A6512
Hospital Charge Code	98300038
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 MITTEN TO WRIST

Facility

$69.36

Service Code	HCPCS A6512
Hospital Charge Code	98300038
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 POCKET & PAD CO

Facility

$14.28

Service Code	HCPCS A6512
Hospital Charge Code	98300039
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 POCKET & PAD CO

Facility

$14.28

Service Code	HCPCS A6512
Hospital Charge Code	98300039
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 REINFORCEMENTS

Facility

$12.24

Service Code	HCPCS A6512
Hospital Charge Code	98300041
Hospital Revenue Code	270
Min. Negotiated Rate	$7.96
Max. Negotiated Rate	$12.24
Rate for Payer: Aetna Commercial	$11.02
Rate for Payer: ASR ASR	$11.87
Rate for Payer: ASR Commercial	$11.87
Rate for Payer: BCBS Trust/PPO	$9.97
Rate for Payer: BCN Commercial	$9.49
Rate for Payer: Cash Price	$9.79
Rate for Payer: Cofinity Commercial	$11.51
Rate for Payer: Encore Health Key Benefits Commercial	$9.79
Rate for Payer: Healthscope Commercial	$12.24
Rate for Payer: Healthscope Whirlpool	$11.87
Rate for Payer: Mclaren Commercial	$11.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.40
Rate for Payer: Nomi Health Commercial	$10.04
Rate for Payer: Priority Health Cigna Priority Health	$7.96
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$10.77

HC COMP BURN GARM REINFORCEMENTS

Facility

$12.24

Service Code	HCPCS A6512
Hospital Charge Code	98300041
Hospital Revenue Code	270
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$12.24
Rate for Payer: Aetna Commercial	$11.02
Rate for Payer: Aetna Medicare	$6.12
Rate for Payer: ASR ASR	$11.87
Rate for Payer: ASR Commercial	$11.87
Rate for Payer: BCBS Complete	$4.90
Rate for Payer: BCBS Trust/PPO	$10.02
Rate for Payer: BCN Commercial	$9.49
Rate for Payer: Cash Price	$9.79
Rate for Payer: Cofinity Commercial	$11.51
Rate for Payer: Encore Health Key Benefits Commercial	$9.79
Rate for Payer: Healthscope Commercial	$12.24
Rate for Payer: Healthscope Whirlpool	$11.87
Rate for Payer: Mclaren Commercial	$11.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.40
Rate for Payer: Nomi Health Commercial	$10.04
Rate for Payer: Priority Health Cigna Priority Health	$7.96
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10.72
Rate for Payer: Priority Health Narrow Network	$8.58
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$10.77

HC COMP BURN GARM REINF SET HK&LO

Facility

$10.20

Service Code	HCPCS A6512
Hospital Charge Code	98300040
Hospital Revenue Code	270
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$10.20
Rate for Payer: Aetna Commercial	$9.18
Rate for Payer: ASR ASR	$9.89
Rate for Payer: ASR Commercial	$9.89
Rate for Payer: BCBS Trust/PPO	$8.31
Rate for Payer: BCN Commercial	$7.91
Rate for Payer: Cash Price	$8.16
Rate for Payer: Cofinity Commercial	$9.59
Rate for Payer: Encore Health Key Benefits Commercial	$8.16
Rate for Payer: Healthscope Commercial	$10.20
Rate for Payer: Healthscope Whirlpool	$9.89
Rate for Payer: Mclaren Commercial	$9.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.67
Rate for Payer: Nomi Health Commercial	$8.36
Rate for Payer: Priority Health Cigna Priority Health	$6.63
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$8.98

HC COMP BURN GARM REINF SET HK&LO

Facility

$10.20

Service Code	HCPCS A6512
Hospital Charge Code	98300040
Hospital Revenue Code	270
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$10.20
Rate for Payer: Aetna Commercial	$9.18
Rate for Payer: Aetna Medicare	$5.10
Rate for Payer: ASR ASR	$9.89
Rate for Payer: ASR Commercial	$9.89
Rate for Payer: BCBS Complete	$4.08
Rate for Payer: BCBS Trust/PPO	$8.35
Rate for Payer: BCN Commercial	$7.91
Rate for Payer: Cash Price	$8.16
Rate for Payer: Cofinity Commercial	$9.59
Rate for Payer: Encore Health Key Benefits Commercial	$8.16
Rate for Payer: Healthscope Commercial	$10.20
Rate for Payer: Healthscope Whirlpool	$9.89
Rate for Payer: Mclaren Commercial	$9.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.67
Rate for Payer: Nomi Health Commercial	$8.36
Rate for Payer: Priority Health Cigna Priority Health	$6.63
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8.94
Rate for Payer: Priority Health Narrow Network	$7.15
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$8.98

HC COMP BURN GARM SHOULD FLAP REG

Facility

$34.68

Service Code	HCPCS A6512
Hospital Charge Code	98300042
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 SHOULD FLAP REG

Facility

$34.68

Service Code	HCPCS A6512
Hospital Charge Code	98300042
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 SILON-TEX P/D-G

Facility

$61.20

Service Code	HCPCS A6512
Hospital Charge Code	98300044
Hospital Revenue Code	270
Min. Negotiated Rate	$24.48
Max. Negotiated Rate	$61.20
Rate for Payer: Aetna Commercial	$55.08
Rate for Payer: Aetna Medicare	$30.60
Rate for Payer: ASR ASR	$59.36
Rate for Payer: ASR Commercial	$59.36
Rate for Payer: BCBS Complete	$24.48
Rate for Payer: BCBS Trust/PPO	$50.12
Rate for Payer: BCN Commercial	$47.45
Rate for Payer: Cash Price	$48.96
Rate for Payer: Cofinity Commercial	$57.53
Rate for Payer: Encore Health Key Benefits Commercial	$48.96
Rate for Payer: Healthscope Commercial	$61.20
Rate for Payer: Healthscope Whirlpool	$59.36
Rate for Payer: Mclaren Commercial	$55.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.02
Rate for Payer: Nomi Health Commercial	$50.18
Rate for Payer: Priority Health Cigna Priority Health	$39.78
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$53.62
Rate for Payer: Priority Health Narrow Network	$42.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$53.86

HC COMP BURN GARM SILON-TEX P/D-G

Facility

$61.20

Service Code	HCPCS A6512
Hospital Charge Code	98300044
Hospital Revenue Code	270
Min. Negotiated Rate	$39.78
Max. Negotiated Rate	$61.20
Rate for Payer: Aetna Commercial	$55.08
Rate for Payer: ASR ASR	$59.36
Rate for Payer: ASR Commercial	$59.36
Rate for Payer: BCBS Trust/PPO	$49.87
Rate for Payer: BCN Commercial	$47.45
Rate for Payer: Cash Price	$48.96
Rate for Payer: Cofinity Commercial	$57.53
Rate for Payer: Encore Health Key Benefits Commercial	$48.96
Rate for Payer: Healthscope Commercial	$61.20
Rate for Payer: Healthscope Whirlpool	$59.36
Rate for Payer: Mclaren Commercial	$55.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.02
Rate for Payer: Nomi Health Commercial	$50.18
Rate for Payer: Priority Health Cigna Priority Health	$39.78
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$53.86

HC COMP BURN GARM SILON-TEX UP TO

Facility

$36.72

Service Code	HCPCS A6512
Hospital Charge Code	98300045
Hospital Revenue Code	270
Min. Negotiated Rate	$23.87
Max. Negotiated Rate	$36.72
Rate for Payer: Aetna Commercial	$33.05
Rate for Payer: ASR ASR	$35.62
Rate for Payer: ASR Commercial	$35.62
Rate for Payer: BCBS Trust/PPO	$29.92
Rate for Payer: BCN Commercial	$28.47
Rate for Payer: Cash Price	$29.38
Rate for Payer: Cofinity Commercial	$34.52
Rate for Payer: Encore Health Key Benefits Commercial	$29.38
Rate for Payer: Healthscope Commercial	$36.72
Rate for Payer: Healthscope Whirlpool	$35.62
Rate for Payer: Mclaren Commercial	$33.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.21
Rate for Payer: Nomi Health Commercial	$30.11
Rate for Payer: Priority Health Cigna Priority Health	$23.87
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$32.31

Know your out-of-pocket cost for care.

All Charges