Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC OT Z STOCKINGS CUSTOM EA $60

Facility

$60.00

Service Code	HCPCS A6549
Hospital Charge Code	98300111
Hospital Revenue Code	270
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna Commercial	$51.00
Rate for Payer: Aetna New Business (MI Preferred)	$39.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cofinity Commercial	$42.00
Rate for Payer: Cofinity Commercial	$51.60
Rate for Payer: Healthscope Commercial	$54.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.00
Rate for Payer: PHP Commercial	$51.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: Priority Health SBD	$37.80

HC OT Z STOCKINGS CUSTOM EA $70

Facility

$70.00

Service Code	HCPCS A6549
Hospital Charge Code	98300112
Hospital Revenue Code	270
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna Commercial	$59.50
Rate for Payer: Aetna New Business (MI Preferred)	$45.50
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cofinity Commercial	$49.00
Rate for Payer: Cofinity Commercial	$60.20
Rate for Payer: Healthscope Commercial	$63.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.50
Rate for Payer: PHP Commercial	$59.50
Rate for Payer: Priority Health Cigna Priority Health	$49.00
Rate for Payer: Priority Health SBD	$44.10

HC OT Z STOCKINGS CUSTOM EA $70

Facility

$70.00

Service Code	HCPCS A6549
Hospital Charge Code	98300112
Hospital Revenue Code	270
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$59.50
Rate for Payer: Aetna New Business (MI Preferred)	$45.50
Rate for Payer: BCBS Complete	$28.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cofinity Commercial	$60.20
Rate for Payer: Cofinity Commercial	$49.00
Rate for Payer: Healthscope Commercial	$63.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.50
Rate for Payer: PHP Commercial	$59.50
Rate for Payer: Priority Health Cigna Priority Health	$49.00
Rate for Payer: Priority Health SBD	$44.10

HC OT Z STOCKINGS CUSTOM EA $80

Facility

$80.00

Service Code	HCPCS A6549
Hospital Charge Code	98300113
Hospital Revenue Code	270
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna Commercial	$68.00
Rate for Payer: Aetna New Business (MI Preferred)	$52.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cofinity Commercial	$56.00
Rate for Payer: Cofinity Commercial	$68.80
Rate for Payer: Healthscope Commercial	$72.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$68.00
Rate for Payer: PHP Commercial	$68.00
Rate for Payer: Priority Health Cigna Priority Health	$56.00
Rate for Payer: Priority Health SBD	$50.40

HC OT Z STOCKINGS CUSTOM EA $80

Facility

$80.00

Service Code	HCPCS A6549
Hospital Charge Code	98300113
Hospital Revenue Code	270
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$68.00
Rate for Payer: Aetna New Business (MI Preferred)	$52.00
Rate for Payer: BCBS Complete	$32.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cofinity Commercial	$56.00
Rate for Payer: Cofinity Commercial	$68.80
Rate for Payer: Healthscope Commercial	$72.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$68.00
Rate for Payer: PHP Commercial	$68.00
Rate for Payer: Priority Health Cigna Priority Health	$56.00
Rate for Payer: Priority Health SBD	$50.40

HC OT Z STOCKINGS CUSTOM EA $90

Facility

$90.00

Service Code	HCPCS A6549
Hospital Charge Code	98300114
Hospital Revenue Code	270
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: Aetna New Business (MI Preferred)	$58.50
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cofinity Commercial	$63.00
Rate for Payer: Cofinity Commercial	$77.40
Rate for Payer: Healthscope Commercial	$81.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.50
Rate for Payer: PHP Commercial	$76.50
Rate for Payer: Priority Health Cigna Priority Health	$63.00
Rate for Payer: Priority Health SBD	$56.70

HC OT Z STOCKINGS CUSTOM EA $90

Facility

$90.00

Service Code	HCPCS A6549
Hospital Charge Code	98300114
Hospital Revenue Code	270
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: Aetna New Business (MI Preferred)	$58.50
Rate for Payer: BCBS Complete	$36.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cofinity Commercial	$63.00
Rate for Payer: Cofinity Commercial	$77.40
Rate for Payer: Healthscope Commercial	$81.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.50
Rate for Payer: PHP Commercial	$76.50
Rate for Payer: Priority Health Cigna Priority Health	$63.00
Rate for Payer: Priority Health SBD	$56.70

HC OT Z STOCKINGS NON CUSTOM $100

Facility

$100.00

Service Code	HCPCS A6549
Hospital Charge Code	98300115
Hospital Revenue Code	270
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$85.00
Rate for Payer: Aetna New Business (MI Preferred)	$65.00
Rate for Payer: BCBS Complete	$40.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cofinity Commercial	$70.00
Rate for Payer: Cofinity Commercial	$86.00
Rate for Payer: Healthscope Commercial	$90.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$85.00
Rate for Payer: PHP Commercial	$85.00
Rate for Payer: Priority Health Cigna Priority Health	$70.00
Rate for Payer: Priority Health SBD	$63.00

HC OT Z STOCKINGS NON CUSTOM $100

Facility

$100.00

Service Code	HCPCS A6549
Hospital Charge Code	98300115
Hospital Revenue Code	270
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna Commercial	$85.00
Rate for Payer: Aetna New Business (MI Preferred)	$65.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cofinity Commercial	$70.00
Rate for Payer: Cofinity Commercial	$86.00
Rate for Payer: Healthscope Commercial	$90.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$85.00
Rate for Payer: PHP Commercial	$85.00
Rate for Payer: Priority Health Cigna Priority Health	$70.00
Rate for Payer: Priority Health SBD	$63.00

HC OT Z STOCKINGS NON CUSTOM $125

Facility

$125.00

Service Code	HCPCS A6549
Hospital Charge Code	98300116
Hospital Revenue Code	270
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$106.25
Rate for Payer: Aetna New Business (MI Preferred)	$81.25
Rate for Payer: BCBS Complete	$50.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cofinity Commercial	$107.50
Rate for Payer: Cofinity Commercial	$87.50
Rate for Payer: Healthscope Commercial	$112.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$106.25
Rate for Payer: PHP Commercial	$106.25
Rate for Payer: Priority Health Cigna Priority Health	$87.50
Rate for Payer: Priority Health SBD	$78.75

HC OT Z STOCKINGS NON CUSTOM $125

Facility

$125.00

Service Code	HCPCS A6549
Hospital Charge Code	98300116
Hospital Revenue Code	270
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$106.25
Rate for Payer: Aetna New Business (MI Preferred)	$81.25
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cofinity Commercial	$107.50
Rate for Payer: Cofinity Commercial	$87.50
Rate for Payer: Healthscope Commercial	$112.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$106.25
Rate for Payer: PHP Commercial	$106.25
Rate for Payer: Priority Health Cigna Priority Health	$87.50
Rate for Payer: Priority Health SBD	$78.75

HC OT Z STOCKINGS NON CUSTOM $150

Facility

$150.00

Service Code	HCPCS A6549
Hospital Charge Code	98300117
Hospital Revenue Code	270
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna New Business (MI Preferred)	$97.50
Rate for Payer: BCBS Complete	$60.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cofinity Commercial	$105.00
Rate for Payer: Cofinity Commercial	$129.00
Rate for Payer: Healthscope Commercial	$135.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$127.50
Rate for Payer: PHP Commercial	$127.50
Rate for Payer: Priority Health Cigna Priority Health	$105.00
Rate for Payer: Priority Health SBD	$94.50

HC OT Z STOCKINGS NON CUSTOM $150

Facility

$150.00

Service Code	HCPCS A6549
Hospital Charge Code	98300117
Hospital Revenue Code	270
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna New Business (MI Preferred)	$97.50
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cofinity Commercial	$105.00
Rate for Payer: Cofinity Commercial	$129.00
Rate for Payer: Healthscope Commercial	$135.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$127.50
Rate for Payer: PHP Commercial	$127.50
Rate for Payer: Priority Health Cigna Priority Health	$105.00
Rate for Payer: Priority Health SBD	$94.50

HC OT Z STOCKINGS NON CUSTOM $175

Facility

$175.00

Service Code	HCPCS A6549
Hospital Charge Code	98300118
Hospital Revenue Code	270
Min. Negotiated Rate	$110.25
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna Commercial	$148.75
Rate for Payer: Aetna New Business (MI Preferred)	$113.75
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cofinity Commercial	$122.50
Rate for Payer: Cofinity Commercial	$150.50
Rate for Payer: Healthscope Commercial	$157.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$148.75
Rate for Payer: PHP Commercial	$148.75
Rate for Payer: Priority Health Cigna Priority Health	$122.50
Rate for Payer: Priority Health SBD	$110.25

HC OT Z STOCKINGS NON CUSTOM $175

Facility

$175.00

Service Code	HCPCS A6549
Hospital Charge Code	98300118
Hospital Revenue Code	270
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$148.75
Rate for Payer: Aetna New Business (MI Preferred)	$113.75
Rate for Payer: BCBS Complete	$70.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cofinity Commercial	$122.50
Rate for Payer: Cofinity Commercial	$150.50
Rate for Payer: Healthscope Commercial	$157.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$148.75
Rate for Payer: PHP Commercial	$148.75
Rate for Payer: Priority Health Cigna Priority Health	$122.50
Rate for Payer: Priority Health SBD	$110.25

HC OT Z STOCKINGS NON CUSTOM $200

Facility

$200.00

Service Code	HCPCS A6549
Hospital Charge Code	98300119
Hospital Revenue Code	270
Min. Negotiated Rate	$80.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$170.00
Rate for Payer: Aetna New Business (MI Preferred)	$130.00
Rate for Payer: BCBS Complete	$80.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cofinity Commercial	$140.00
Rate for Payer: Cofinity Commercial	$172.00
Rate for Payer: Healthscope Commercial	$180.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$170.00
Rate for Payer: PHP Commercial	$170.00
Rate for Payer: Priority Health Cigna Priority Health	$140.00
Rate for Payer: Priority Health SBD	$126.00

HC OT Z STOCKINGS NON CUSTOM $200

Facility

$200.00

Service Code	HCPCS A6549
Hospital Charge Code	98300119
Hospital Revenue Code	270
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna Commercial	$170.00
Rate for Payer: Aetna New Business (MI Preferred)	$130.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cofinity Commercial	$140.00
Rate for Payer: Cofinity Commercial	$172.00
Rate for Payer: Healthscope Commercial	$180.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$170.00
Rate for Payer: PHP Commercial	$170.00
Rate for Payer: Priority Health Cigna Priority Health	$140.00
Rate for Payer: Priority Health SBD	$126.00

HC OT Z STOCKINGS NON CUSTOM $225

Facility

$225.00

Service Code	HCPCS A6549
Hospital Charge Code	98300120
Hospital Revenue Code	270
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$191.25
Rate for Payer: Aetna New Business (MI Preferred)	$146.25
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cofinity Commercial	$157.50
Rate for Payer: Cofinity Commercial	$193.50
Rate for Payer: Healthscope Commercial	$202.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$191.25
Rate for Payer: PHP Commercial	$191.25
Rate for Payer: Priority Health Cigna Priority Health	$157.50
Rate for Payer: Priority Health SBD	$141.75

HC OT Z STOCKINGS NON CUSTOM $225

Facility

$225.00

Service Code	HCPCS A6549
Hospital Charge Code	98300120
Hospital Revenue Code	270
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$191.25
Rate for Payer: Aetna New Business (MI Preferred)	$146.25
Rate for Payer: BCBS Complete	$90.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cofinity Commercial	$157.50
Rate for Payer: Cofinity Commercial	$193.50
Rate for Payer: Healthscope Commercial	$202.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$191.25
Rate for Payer: PHP Commercial	$191.25
Rate for Payer: Priority Health Cigna Priority Health	$157.50
Rate for Payer: Priority Health SBD	$141.75

HC OT Z STOCKINGS NON CUSTOM $250

Facility

$250.00

Service Code	HCPCS A6549
Hospital Charge Code	98300121
Hospital Revenue Code	270
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$212.50
Rate for Payer: Aetna New Business (MI Preferred)	$162.50
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cofinity Commercial	$175.00
Rate for Payer: Cofinity Commercial	$215.00
Rate for Payer: Healthscope Commercial	$225.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$212.50
Rate for Payer: PHP Commercial	$212.50
Rate for Payer: Priority Health Cigna Priority Health	$175.00
Rate for Payer: Priority Health SBD	$157.50

HC OT Z STOCKINGS NON CUSTOM $250

Facility

$250.00

Service Code	HCPCS A6549
Hospital Charge Code	98300121
Hospital Revenue Code	270
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$212.50
Rate for Payer: Aetna New Business (MI Preferred)	$162.50
Rate for Payer: BCBS Complete	$100.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cofinity Commercial	$175.00
Rate for Payer: Cofinity Commercial	$215.00
Rate for Payer: Healthscope Commercial	$225.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$212.50
Rate for Payer: PHP Commercial	$212.50
Rate for Payer: Priority Health Cigna Priority Health	$175.00
Rate for Payer: Priority Health SBD	$157.50

HC OT Z STOCKINGS NON CUSTOM $275

Facility

$275.00

Service Code	HCPCS A6549
Hospital Charge Code	98300122
Hospital Revenue Code	270
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$233.75
Rate for Payer: Aetna New Business (MI Preferred)	$178.75
Rate for Payer: BCBS Complete	$110.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cofinity Commercial	$192.50
Rate for Payer: Cofinity Commercial	$236.50
Rate for Payer: Healthscope Commercial	$247.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$233.75
Rate for Payer: PHP Commercial	$233.75
Rate for Payer: Priority Health Cigna Priority Health	$192.50
Rate for Payer: Priority Health SBD	$173.25

HC OT Z STOCKINGS NON CUSTOM $275

Facility

$275.00

Service Code	HCPCS A6549
Hospital Charge Code	98300122
Hospital Revenue Code	270
Min. Negotiated Rate	$173.25
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$233.75
Rate for Payer: Aetna New Business (MI Preferred)	$178.75
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cofinity Commercial	$192.50
Rate for Payer: Cofinity Commercial	$236.50
Rate for Payer: Healthscope Commercial	$247.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$233.75
Rate for Payer: PHP Commercial	$233.75
Rate for Payer: Priority Health Cigna Priority Health	$192.50
Rate for Payer: Priority Health SBD	$173.25

HC OT Z STOCKINGS NON CUSTOM $300

Facility

$300.00

Service Code	HCPCS A6549
Hospital Charge Code	98300123
Hospital Revenue Code	270
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna New Business (MI Preferred)	$195.00
Rate for Payer: BCBS Complete	$120.00
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cofinity Commercial	$210.00
Rate for Payer: Cofinity Commercial	$258.00
Rate for Payer: Healthscope Commercial	$270.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$255.00
Rate for Payer: PHP Commercial	$255.00
Rate for Payer: Priority Health Cigna Priority Health	$210.00
Rate for Payer: Priority Health SBD	$189.00

HC OT Z STOCKINGS NON CUSTOM $300

Facility

$300.00

Service Code	HCPCS A6549
Hospital Charge Code	98300123
Hospital Revenue Code	270
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna New Business (MI Preferred)	$195.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cofinity Commercial	$210.00
Rate for Payer: Cofinity Commercial	$258.00
Rate for Payer: Healthscope Commercial	$270.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$255.00
Rate for Payer: PHP Commercial	$255.00
Rate for Payer: Priority Health Cigna Priority Health	$210.00
Rate for Payer: Priority Health SBD	$189.00

Know your out-of-pocket cost for care.

All Charges