Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

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	$46.68
Max. Negotiated Rate	$71.81
Rate for Payer: Aetna Commercial	$64.63
Rate for Payer: ASR ASR	$69.66
Rate for Payer: ASR Commercial	$69.66
Rate for Payer: BCBS Trust/PPO	$58.52
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: UHC All Payor (Choice/PPO) + Core	$63.19

HC COMP BURN GARM STKNG TO THI NO

Facility

$79.56

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

Facility

$79.56

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

Facility

$12.48

Service Code	HCPCS A4649
Hospital Charge Code	98300052
Hospital Revenue Code	270
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$12.48
Rate for Payer: Aetna Commercial	$11.23
Rate for Payer: ASR ASR	$12.11
Rate for Payer: ASR Commercial	$12.11
Rate for Payer: BCBS Trust/PPO	$10.17
Rate for Payer: BCN Commercial	$9.68
Rate for Payer: Cash Price	$9.98
Rate for Payer: Cofinity Commercial	$11.73
Rate for Payer: Encore Health Key Benefits Commercial	$9.98
Rate for Payer: Healthscope Commercial	$12.48
Rate for Payer: Healthscope Whirlpool	$12.11
Rate for Payer: Mclaren Commercial	$11.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.61
Rate for Payer: Nomi Health Commercial	$10.23
Rate for Payer: Priority Health Cigna Priority Health	$8.11
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$10.98

HC COMP BURN GARM STMP CLS ORNG P

Facility

$12.48

Service Code	HCPCS A4649
Hospital Charge Code	98300052
Hospital Revenue Code	270
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$12.48
Rate for Payer: Aetna Commercial	$11.23
Rate for Payer: Aetna Medicare	$6.24
Rate for Payer: ASR ASR	$12.11
Rate for Payer: ASR Commercial	$12.11
Rate for Payer: BCBS Complete	$4.99
Rate for Payer: BCBS Trust/PPO	$10.22
Rate for Payer: BCN Commercial	$9.68
Rate for Payer: Cash Price	$9.98
Rate for Payer: Cofinity Commercial	$11.73
Rate for Payer: Encore Health Key Benefits Commercial	$9.98
Rate for Payer: Healthscope Commercial	$12.48
Rate for Payer: Healthscope Whirlpool	$12.11
Rate for Payer: Mclaren Commercial	$11.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.61
Rate for Payer: Nomi Health Commercial	$10.23
Rate for Payer: Priority Health Cigna Priority Health	$8.11
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10.93
Rate for Payer: Priority Health Narrow Network	$8.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$10.98

HC COMP BURN GARM STMP CLS STRCH

Facility

$12.48

Service Code	HCPCS A4649
Hospital Charge Code	98300053
Hospital Revenue Code	270
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$12.48
Rate for Payer: Aetna Commercial	$11.23
Rate for Payer: ASR ASR	$12.11
Rate for Payer: ASR Commercial	$12.11
Rate for Payer: BCBS Trust/PPO	$10.17
Rate for Payer: BCN Commercial	$9.68
Rate for Payer: Cash Price	$9.98
Rate for Payer: Cofinity Commercial	$11.73
Rate for Payer: Encore Health Key Benefits Commercial	$9.98
Rate for Payer: Healthscope Commercial	$12.48
Rate for Payer: Healthscope Whirlpool	$12.11
Rate for Payer: Mclaren Commercial	$11.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.61
Rate for Payer: Nomi Health Commercial	$10.23
Rate for Payer: Priority Health Cigna Priority Health	$8.11
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$10.98

HC COMP BURN GARM STMP CLS STRCH

Facility

$12.48

Service Code	HCPCS A4649
Hospital Charge Code	98300053
Hospital Revenue Code	270
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$12.48
Rate for Payer: Aetna Commercial	$11.23
Rate for Payer: Aetna Medicare	$6.24
Rate for Payer: ASR ASR	$12.11
Rate for Payer: ASR Commercial	$12.11
Rate for Payer: BCBS Complete	$4.99
Rate for Payer: BCBS Trust/PPO	$10.22
Rate for Payer: BCN Commercial	$9.68
Rate for Payer: Cash Price	$9.98
Rate for Payer: Cofinity Commercial	$11.73
Rate for Payer: Encore Health Key Benefits Commercial	$9.98
Rate for Payer: Healthscope Commercial	$12.48
Rate for Payer: Healthscope Whirlpool	$12.11
Rate for Payer: Mclaren Commercial	$11.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.61
Rate for Payer: Nomi Health Commercial	$10.23
Rate for Payer: Priority Health Cigna Priority Health	$8.11
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10.93
Rate for Payer: Priority Health Narrow Network	$8.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$10.98

HC COMP BURN GARM STOCKING TO KNE

Facility

$71.40

Service Code	HCPCS A6507
Hospital Charge Code	98300054
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 STOCKING TO KNE

Facility

$71.40

Service Code	HCPCS A6507
Hospital Charge Code	98300054
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 STOCKING TO THI

Facility

$93.84

Service Code	HCPCS A6508
Hospital Charge Code	98300055
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 STOCKING TO THI

Facility

$93.84

Service Code	HCPCS A6508
Hospital Charge Code	98300055
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 STOCK-KNEE/NO F

Facility

$63.24

Service Code	HCPCS A6512
Hospital Charge Code	98300056
Hospital Revenue Code	270
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$63.24
Rate for Payer: Aetna Commercial	$56.92
Rate for Payer: Aetna Medicare	$31.62
Rate for Payer: ASR ASR	$61.34
Rate for Payer: ASR Commercial	$61.34
Rate for Payer: BCBS Complete	$25.30
Rate for Payer: BCBS Trust/PPO	$51.79
Rate for Payer: BCN Commercial	$49.03
Rate for Payer: Cash Price	$50.59
Rate for Payer: Cofinity Commercial	$59.45
Rate for Payer: Encore Health Key Benefits Commercial	$50.59
Rate for Payer: Healthscope Commercial	$63.24
Rate for Payer: Healthscope Whirlpool	$61.34
Rate for Payer: Mclaren Commercial	$56.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.75
Rate for Payer: Nomi Health Commercial	$51.86
Rate for Payer: Priority Health Cigna Priority Health	$41.11
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$55.41
Rate for Payer: Priority Health Narrow Network	$44.33
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$55.65

HC COMP BURN GARM STOCK-KNEE/NO F

Facility

$63.24

Service Code	HCPCS A6512
Hospital Charge Code	98300056
Hospital Revenue Code	270
Min. Negotiated Rate	$41.11
Max. Negotiated Rate	$63.24
Rate for Payer: Aetna Commercial	$56.92
Rate for Payer: ASR ASR	$61.34
Rate for Payer: ASR Commercial	$61.34
Rate for Payer: BCBS Trust/PPO	$51.53
Rate for Payer: BCN Commercial	$49.03
Rate for Payer: Cash Price	$50.59
Rate for Payer: Cofinity Commercial	$59.45
Rate for Payer: Encore Health Key Benefits Commercial	$50.59
Rate for Payer: Healthscope Commercial	$63.24
Rate for Payer: Healthscope Whirlpool	$61.34
Rate for Payer: Mclaren Commercial	$56.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.75
Rate for Payer: Nomi Health Commercial	$51.86
Rate for Payer: Priority Health Cigna Priority Health	$41.11
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$55.65

HC COMP BURN GARM STRETCH INSERT

Facility

$12.48

Service Code	HCPCS A4649
Hospital Charge Code	98300057
Hospital Revenue Code	270
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$12.48
Rate for Payer: Aetna Commercial	$11.23
Rate for Payer: ASR ASR	$12.11
Rate for Payer: ASR Commercial	$12.11
Rate for Payer: BCBS Trust/PPO	$10.17
Rate for Payer: BCN Commercial	$9.68
Rate for Payer: Cash Price	$9.98
Rate for Payer: Cofinity Commercial	$11.73
Rate for Payer: Encore Health Key Benefits Commercial	$9.98
Rate for Payer: Healthscope Commercial	$12.48
Rate for Payer: Healthscope Whirlpool	$12.11
Rate for Payer: Mclaren Commercial	$11.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.61
Rate for Payer: Nomi Health Commercial	$10.23
Rate for Payer: Priority Health Cigna Priority Health	$8.11
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$10.98

HC COMP BURN GARM STRETCH INSERT

Facility

$12.48

Service Code	HCPCS A4649
Hospital Charge Code	98300057
Hospital Revenue Code	270
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$12.48
Rate for Payer: Aetna Commercial	$11.23
Rate for Payer: Aetna Medicare	$6.24
Rate for Payer: ASR ASR	$12.11
Rate for Payer: ASR Commercial	$12.11
Rate for Payer: BCBS Complete	$4.99
Rate for Payer: BCBS Trust/PPO	$10.22
Rate for Payer: BCN Commercial	$9.68
Rate for Payer: Cash Price	$9.98
Rate for Payer: Cofinity Commercial	$11.73
Rate for Payer: Encore Health Key Benefits Commercial	$9.98
Rate for Payer: Healthscope Commercial	$12.48
Rate for Payer: Healthscope Whirlpool	$12.11
Rate for Payer: Mclaren Commercial	$11.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.61
Rate for Payer: Nomi Health Commercial	$10.23
Rate for Payer: Priority Health Cigna Priority Health	$8.11
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10.93
Rate for Payer: Priority Health Narrow Network	$8.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$10.98

HC COMP BURN GARM SUEDE/LEATHER G

Facility

$45.90

Service Code	HCPCS A9900
Hospital Charge Code	98300058
Hospital Revenue Code	270
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna Commercial	$41.31
Rate for Payer: Aetna Medicare	$22.95
Rate for Payer: ASR ASR	$44.52
Rate for Payer: ASR Commercial	$44.52
Rate for Payer: BCBS Complete	$18.36
Rate for Payer: BCBS Trust/PPO	$37.59
Rate for Payer: BCN Commercial	$35.59
Rate for Payer: Cash Price	$36.72
Rate for Payer: Cofinity Commercial	$43.15
Rate for Payer: Encore Health Key Benefits Commercial	$36.72
Rate for Payer: Healthscope Commercial	$45.90
Rate for Payer: Healthscope Whirlpool	$44.52
Rate for Payer: Mclaren Commercial	$41.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.02
Rate for Payer: Nomi Health Commercial	$37.64
Rate for Payer: Priority Health Cigna Priority Health	$29.84
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$40.22
Rate for Payer: Priority Health Narrow Network	$32.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$40.39

HC COMP BURN GARM SUEDE/LEATHER G

Facility

$45.90

Service Code	HCPCS A9900
Hospital Charge Code	98300058
Hospital Revenue Code	270
Min. Negotiated Rate	$29.84
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna Commercial	$41.31
Rate for Payer: ASR ASR	$44.52
Rate for Payer: ASR Commercial	$44.52
Rate for Payer: BCBS Trust/PPO	$37.40
Rate for Payer: BCN Commercial	$35.59
Rate for Payer: Cash Price	$36.72
Rate for Payer: Cofinity Commercial	$43.15
Rate for Payer: Encore Health Key Benefits Commercial	$36.72
Rate for Payer: Healthscope Commercial	$45.90
Rate for Payer: Healthscope Whirlpool	$44.52
Rate for Payer: Mclaren Commercial	$41.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.02
Rate for Payer: Nomi Health Commercial	$37.64
Rate for Payer: Priority Health Cigna Priority Health	$29.84
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$40.39

HC COMP BURN GARM SUIT SLVD ABV K

Facility

$387.60

Service Code	HCPCS A6512
Hospital Charge Code	98300059
Hospital Revenue Code	270
Min. Negotiated Rate	$155.04
Max. Negotiated Rate	$387.60
Rate for Payer: Aetna Commercial	$348.84
Rate for Payer: Aetna Medicare	$193.80
Rate for Payer: ASR ASR	$375.97
Rate for Payer: ASR Commercial	$375.97
Rate for Payer: BCBS Complete	$155.04
Rate for Payer: BCBS Trust/PPO	$317.41
Rate for Payer: BCN Commercial	$300.51
Rate for Payer: Cash Price	$310.08
Rate for Payer: Cofinity Commercial	$364.34
Rate for Payer: Encore Health Key Benefits Commercial	$310.08
Rate for Payer: Healthscope Commercial	$387.60
Rate for Payer: Healthscope Whirlpool	$375.97
Rate for Payer: Mclaren Commercial	$348.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$329.46
Rate for Payer: Nomi Health Commercial	$317.83
Rate for Payer: Priority Health Cigna Priority Health	$251.94
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$339.62
Rate for Payer: Priority Health Narrow Network	$271.71
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$341.09

HC COMP BURN GARM SUIT SLVD ABV K

Facility

$387.60

Service Code	HCPCS A6512
Hospital Charge Code	98300059
Hospital Revenue Code	270
Min. Negotiated Rate	$251.94
Max. Negotiated Rate	$387.60
Rate for Payer: Aetna Commercial	$348.84
Rate for Payer: ASR ASR	$375.97
Rate for Payer: ASR Commercial	$375.97
Rate for Payer: BCBS Trust/PPO	$315.86
Rate for Payer: BCN Commercial	$300.51
Rate for Payer: Cash Price	$310.08
Rate for Payer: Cofinity Commercial	$364.34
Rate for Payer: Encore Health Key Benefits Commercial	$310.08
Rate for Payer: Healthscope Commercial	$387.60
Rate for Payer: Healthscope Whirlpool	$375.97
Rate for Payer: Mclaren Commercial	$348.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$329.46
Rate for Payer: Nomi Health Commercial	$317.83
Rate for Payer: Priority Health Cigna Priority Health	$251.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$341.09

HC COMP BURN GARM SUIT SLVD TWO LEGS

Facility

$491.64

Service Code	HCPCS A6501
Hospital Charge Code	98300060
Hospital Revenue Code	270
Min. Negotiated Rate	$319.57
Max. Negotiated Rate	$491.64
Rate for Payer: Aetna Commercial	$442.48
Rate for Payer: ASR ASR	$476.89
Rate for Payer: ASR Commercial	$476.89
Rate for Payer: BCBS Trust/PPO	$400.64
Rate for Payer: BCN Commercial	$381.17
Rate for Payer: Cash Price	$393.31
Rate for Payer: Cofinity Commercial	$462.14
Rate for Payer: Encore Health Key Benefits Commercial	$393.31
Rate for Payer: Healthscope Commercial	$491.64
Rate for Payer: Healthscope Whirlpool	$476.89
Rate for Payer: Mclaren Commercial	$442.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$417.89
Rate for Payer: Nomi Health Commercial	$403.14
Rate for Payer: Priority Health Cigna Priority Health	$319.57
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$432.64

HC COMP BURN GARM SUIT SLVD TWO LEGS

Facility

$491.64

Service Code	HCPCS A6501
Hospital Charge Code	98300060
Hospital Revenue Code	270
Min. Negotiated Rate	$196.66
Max. Negotiated Rate	$491.64
Rate for Payer: Aetna Commercial	$442.48
Rate for Payer: Aetna Medicare	$245.82
Rate for Payer: ASR ASR	$476.89
Rate for Payer: ASR Commercial	$476.89
Rate for Payer: BCBS Complete	$196.66
Rate for Payer: BCBS Trust/PPO	$402.60
Rate for Payer: BCN Commercial	$381.17
Rate for Payer: Cash Price	$393.31
Rate for Payer: Cofinity Commercial	$462.14
Rate for Payer: Encore Health Key Benefits Commercial	$393.31
Rate for Payer: Healthscope Commercial	$491.64
Rate for Payer: Healthscope Whirlpool	$476.89
Rate for Payer: Mclaren Commercial	$442.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$417.89
Rate for Payer: Nomi Health Commercial	$403.14
Rate for Payer: Priority Health Cigna Priority Health	$319.57
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$430.77
Rate for Payer: Priority Health Narrow Network	$344.64
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$432.64

HC COMP BURN GARM SUIT SLVLS ABV

Facility

$320.28

Service Code	HCPCS A6512
Hospital Charge Code	98300061
Hospital Revenue Code	270
Min. Negotiated Rate	$208.18
Max. Negotiated Rate	$320.28
Rate for Payer: Aetna Commercial	$288.25
Rate for Payer: ASR ASR	$310.67
Rate for Payer: ASR Commercial	$310.67
Rate for Payer: BCBS Trust/PPO	$261.00
Rate for Payer: BCN Commercial	$248.31
Rate for Payer: Cash Price	$256.22
Rate for Payer: Cofinity Commercial	$301.06
Rate for Payer: Encore Health Key Benefits Commercial	$256.22
Rate for Payer: Healthscope Commercial	$320.28
Rate for Payer: Healthscope Whirlpool	$310.67
Rate for Payer: Mclaren Commercial	$288.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$272.24
Rate for Payer: Nomi Health Commercial	$262.63
Rate for Payer: Priority Health Cigna Priority Health	$208.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$281.85

HC COMP BURN GARM SUIT SLVLS ABV

Facility

$320.28

Service Code	HCPCS A6512
Hospital Charge Code	98300061
Hospital Revenue Code	270
Min. Negotiated Rate	$128.11
Max. Negotiated Rate	$320.28
Rate for Payer: Aetna Commercial	$288.25
Rate for Payer: Aetna Medicare	$160.14
Rate for Payer: ASR ASR	$310.67
Rate for Payer: ASR Commercial	$310.67
Rate for Payer: BCBS Complete	$128.11
Rate for Payer: BCBS Trust/PPO	$262.28
Rate for Payer: BCN Commercial	$248.31
Rate for Payer: Cash Price	$256.22
Rate for Payer: Cofinity Commercial	$301.06
Rate for Payer: Encore Health Key Benefits Commercial	$256.22
Rate for Payer: Healthscope Commercial	$320.28
Rate for Payer: Healthscope Whirlpool	$310.67
Rate for Payer: Mclaren Commercial	$288.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$272.24
Rate for Payer: Nomi Health Commercial	$262.63
Rate for Payer: Priority Health Cigna Priority Health	$208.18
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$280.63
Rate for Payer: Priority Health Narrow Network	$224.52
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$281.85

HC COMP BURN GARM SUIT SLVLS-TWO LEGS

Facility

$375.36

Service Code	HCPCS A6512
Hospital Charge Code	98300062
Hospital Revenue Code	270
Min. Negotiated Rate	$150.14
Max. Negotiated Rate	$375.36
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare	$187.68
Rate for Payer: ASR ASR	$364.10
Rate for Payer: ASR Commercial	$364.10
Rate for Payer: BCBS Complete	$150.14
Rate for Payer: BCBS Trust/PPO	$307.38
Rate for Payer: BCN Commercial	$291.02
Rate for Payer: Cash Price	$300.29
Rate for Payer: Cofinity Commercial	$352.84
Rate for Payer: Encore Health Key Benefits Commercial	$300.29
Rate for Payer: Healthscope Commercial	$375.36
Rate for Payer: Healthscope Whirlpool	$364.10
Rate for Payer: Mclaren Commercial	$337.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$319.06
Rate for Payer: Nomi Health Commercial	$307.80
Rate for Payer: Priority Health Cigna Priority Health	$243.98
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$328.89
Rate for Payer: Priority Health Narrow Network	$263.13
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$330.32

HC COMP BURN GARM SUIT SLVLS-TWO LEGS

Facility

$375.36

Service Code	HCPCS A6512
Hospital Charge Code	98300062
Hospital Revenue Code	270
Min. Negotiated Rate	$243.98
Max. Negotiated Rate	$375.36
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: ASR ASR	$364.10
Rate for Payer: ASR Commercial	$364.10
Rate for Payer: BCBS Trust/PPO	$305.88
Rate for Payer: BCN Commercial	$291.02
Rate for Payer: Cash Price	$300.29
Rate for Payer: Cofinity Commercial	$352.84
Rate for Payer: Encore Health Key Benefits Commercial	$300.29
Rate for Payer: Healthscope Commercial	$375.36
Rate for Payer: Healthscope Whirlpool	$364.10
Rate for Payer: Mclaren Commercial	$337.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$319.06
Rate for Payer: Nomi Health Commercial	$307.80
Rate for Payer: Priority Health Cigna Priority Health	$243.98
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$330.32

Know your out-of-pocket cost for care.

All Charges