Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

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 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 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 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 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 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 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	$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 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 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 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 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 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 UP TO

Facility

$36.72

Service Code	HCPCS A6512
Hospital Charge Code	98300045
Hospital Revenue Code	270
Min. Negotiated Rate	$14.69
Max. Negotiated Rate	$36.72
Rate for Payer: Aetna Commercial	$33.05
Rate for Payer: Aetna Medicare	$18.36
Rate for Payer: ASR ASR	$35.62
Rate for Payer: ASR Commercial	$35.62
Rate for Payer: BCBS Complete	$14.69
Rate for Payer: BCBS Trust/PPO	$30.07
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: Priority Health HMO/PPO/Tiered Network	$32.17
Rate for Payer: Priority Health Narrow Network	$25.74
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$32.31

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

HC COMP BURN GARM SILON-TEX WHOL

Facility

$85.68

Service Code	HCPCS A6512
Hospital Charge Code	98300046
Hospital Revenue Code	270
Min. Negotiated Rate	$55.69
Max. Negotiated Rate	$85.68
Rate for Payer: Aetna Commercial	$77.11
Rate for Payer: ASR ASR	$83.11
Rate for Payer: ASR Commercial	$83.11
Rate for Payer: BCBS Trust/PPO	$69.82
Rate for Payer: BCN Commercial	$66.43
Rate for Payer: Cash Price	$68.54
Rate for Payer: Cofinity Commercial	$80.54
Rate for Payer: Encore Health Key Benefits Commercial	$68.54
Rate for Payer: Healthscope Commercial	$85.68
Rate for Payer: Healthscope Whirlpool	$83.11
Rate for Payer: Mclaren Commercial	$77.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$72.83
Rate for Payer: Nomi Health Commercial	$70.26
Rate for Payer: Priority Health Cigna Priority Health	$55.69
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$75.40

HC COMP BURN GARM SILON-TEX WHOL

Facility

$85.68

Service Code	HCPCS A6512
Hospital Charge Code	98300046
Hospital Revenue Code	270
Min. Negotiated Rate	$34.27
Max. Negotiated Rate	$85.68
Rate for Payer: Aetna Commercial	$77.11
Rate for Payer: Aetna Medicare	$42.84
Rate for Payer: ASR ASR	$83.11
Rate for Payer: ASR Commercial	$83.11
Rate for Payer: BCBS Complete	$34.27
Rate for Payer: BCBS Trust/PPO	$70.16
Rate for Payer: BCN Commercial	$66.43
Rate for Payer: Cash Price	$68.54
Rate for Payer: Cofinity Commercial	$80.54
Rate for Payer: Encore Health Key Benefits Commercial	$68.54
Rate for Payer: Healthscope Commercial	$85.68
Rate for Payer: Healthscope Whirlpool	$83.11
Rate for Payer: Mclaren Commercial	$77.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$72.83
Rate for Payer: Nomi Health Commercial	$70.26
Rate for Payer: Priority Health Cigna Priority Health	$55.69
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.07
Rate for Payer: Priority Health Narrow Network	$60.06
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$75.40

HC COMP BURN GARM SLEEVE WRIST/AX

Facility

$71.40

Service Code	HCPCS A6512
Hospital Charge Code	98300047
Hospital Revenue Code	270
Min. Negotiated Rate	$28.56
Max. Negotiated Rate	$71.40
Rate for Payer: Aetna Commercial	$64.26
Rate for Payer: Aetna Medicare	$35.70
Rate for Payer: ASR ASR	$69.26
Rate for Payer: ASR Commercial	$69.26
Rate for Payer: BCBS Complete	$28.56
Rate for Payer: BCBS Trust/PPO	$58.47
Rate for Payer: BCN Commercial	$55.36
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cofinity Commercial	$67.12
Rate for Payer: Encore Health Key Benefits Commercial	$57.12
Rate for Payer: Healthscope Commercial	$71.40
Rate for Payer: Healthscope Whirlpool	$69.26
Rate for Payer: Mclaren Commercial	$64.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.69
Rate for Payer: Nomi Health Commercial	$58.55
Rate for Payer: Priority Health Cigna Priority Health	$46.41
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$62.56
Rate for Payer: Priority Health Narrow Network	$50.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$62.83

HC COMP BURN GARM SLEEVE WRIST/AX

Facility

$71.40

Service Code	HCPCS A6512
Hospital Charge Code	98300047
Hospital Revenue Code	270
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$71.40
Rate for Payer: Aetna Commercial	$64.26
Rate for Payer: ASR ASR	$69.26
Rate for Payer: ASR Commercial	$69.26
Rate for Payer: BCBS Trust/PPO	$58.18
Rate for Payer: BCN Commercial	$55.36
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cofinity Commercial	$67.12
Rate for Payer: Encore Health Key Benefits Commercial	$57.12
Rate for Payer: Healthscope Commercial	$71.40
Rate for Payer: Healthscope Whirlpool	$69.26
Rate for Payer: Mclaren Commercial	$64.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.69
Rate for Payer: Nomi Health Commercial	$58.55
Rate for Payer: Priority Health Cigna Priority Health	$46.41
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$62.83

HC COMP BURN GARM SLV WRST-ELB/EL

Facility

$61.20

Service Code	HCPCS A6512
Hospital Charge Code	98300048
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 SLV WRST-ELB/EL

Facility

$61.20

Service Code	HCPCS A6512
Hospital Charge Code	98300048
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 STERNAL STRAP

Facility

$69.36

Service Code	HCPCS A6512
Hospital Charge Code	98300049
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 STERNAL STRAP

Facility

$69.36

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

Facility

$71.81

Service Code	HCPCS A6512
Hospital Charge Code	98300050
Hospital Revenue Code	270
Min. Negotiated Rate	$28.72
Max. Negotiated Rate	$71.81
Rate for Payer: Aetna Commercial	$64.63
Rate for Payer: Aetna Medicare	$35.91
Rate for Payer: ASR ASR	$69.66
Rate for Payer: ASR Commercial	$69.66
Rate for Payer: BCBS Complete	$28.72
Rate for Payer: BCBS Trust/PPO	$58.81
Rate for Payer: BCN Commercial	$55.67
Rate for Payer: Cash Price	$57.45
Rate for Payer: Cofinity Commercial	$67.50
Rate for Payer: Encore Health Key Benefits Commercial	$57.45
Rate for Payer: Healthscope Commercial	$71.81
Rate for Payer: Healthscope Whirlpool	$69.66
Rate for Payer: Mclaren Commercial	$64.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.04
Rate for Payer: Nomi Health Commercial	$58.88
Rate for Payer: Priority Health Cigna Priority Health	$46.68
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$62.92
Rate for Payer: Priority Health Narrow Network	$50.34
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$63.19

Know your out-of-pocket cost for care.

All Charges