Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC OT Z GAUNTLET EA $350

Facility

$364.14

Service Code	HCPCS A6549
Hospital Charge Code	98300085
Hospital Revenue Code	270
Min. Negotiated Rate	$229.41
Max. Negotiated Rate	$327.73
Rate for Payer: Aetna Commercial	$309.52
Rate for Payer: Aetna New Business (MI Preferred)	$236.69
Rate for Payer: Cash Price	$291.31
Rate for Payer: Cofinity Advantage	$254.90
Rate for Payer: Cofinity Commercial	$313.16
Rate for Payer: Encore Health Key Benefits Commercial	$291.31
Rate for Payer: Healthscope Commercial	$327.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$309.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$273.11
Rate for Payer: PHP Commercial	$309.52
Rate for Payer: Priority Health SBD	$229.41

HC OT Z GAUNTLET EA $375

Facility

$390.15

Service Code	HCPCS A6549
Hospital Charge Code	98300086
Hospital Revenue Code	270
Min. Negotiated Rate	$153.33
Max. Negotiated Rate	$365.03
Rate for Payer: Aetna Commercial	$331.63
Rate for Payer: Aetna Medicare	$195.07
Rate for Payer: Aetna New Business (MI Preferred)	$253.60
Rate for Payer: BCBS Complete	$156.06
Rate for Payer: BCBS Trust/PPO	$365.03
Rate for Payer: BCN Commercial	$365.03
Rate for Payer: Cash Price	$312.12
Rate for Payer: Cash Price	$312.12
Rate for Payer: Cofinity Advantage	$273.11
Rate for Payer: Cofinity Commercial	$335.53
Rate for Payer: Encore Health Key Benefits Commercial	$312.12
Rate for Payer: Healthscope Commercial	$351.13
Rate for Payer: MI Amish Medical Board Commercial	$312.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$331.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$292.61
Rate for Payer: PHP Commercial	$331.63
Rate for Payer: Priority Health SBD	$245.79
Rate for Payer: UHC All Payor (Choice/PPO)	$253.60
Rate for Payer: UHC Core	$203.27
Rate for Payer: UHC Exchange	$153.33

HC OT Z GAUNTLET EA $375

Facility

$390.15

Service Code	HCPCS A6549
Hospital Charge Code	98300086
Hospital Revenue Code	270
Min. Negotiated Rate	$245.79
Max. Negotiated Rate	$351.13
Rate for Payer: Aetna Commercial	$331.63
Rate for Payer: Aetna New Business (MI Preferred)	$253.60
Rate for Payer: Cash Price	$312.12
Rate for Payer: Cofinity Advantage	$273.11
Rate for Payer: Cofinity Commercial	$335.53
Rate for Payer: Encore Health Key Benefits Commercial	$312.12
Rate for Payer: Healthscope Commercial	$351.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$331.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$292.61
Rate for Payer: PHP Commercial	$331.63
Rate for Payer: Priority Health SBD	$245.79

HC OT Z GAUNTLET EA $400

Facility

$416.16

Service Code	HCPCS A6549
Hospital Charge Code	98300087
Hospital Revenue Code	270
Min. Negotiated Rate	$163.55
Max. Negotiated Rate	$374.54
Rate for Payer: Aetna Commercial	$353.74
Rate for Payer: Aetna Medicare	$208.08
Rate for Payer: Aetna New Business (MI Preferred)	$270.50
Rate for Payer: BCBS Complete	$166.46
Rate for Payer: BCBS Trust/PPO	$365.03
Rate for Payer: BCN Commercial	$365.03
Rate for Payer: Cash Price	$332.93
Rate for Payer: Cash Price	$332.93
Rate for Payer: Cofinity Advantage	$291.31
Rate for Payer: Cofinity Commercial	$357.90
Rate for Payer: Encore Health Key Benefits Commercial	$332.93
Rate for Payer: Healthscope Commercial	$374.54
Rate for Payer: MI Amish Medical Board Commercial	$332.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$353.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$312.12
Rate for Payer: PHP Commercial	$353.74
Rate for Payer: Priority Health SBD	$262.18
Rate for Payer: UHC All Payor (Choice/PPO)	$270.50
Rate for Payer: UHC Core	$216.82
Rate for Payer: UHC Exchange	$163.55

HC OT Z GAUNTLET EA $400

Facility

$416.16

Service Code	HCPCS A6549
Hospital Charge Code	98300087
Hospital Revenue Code	270
Min. Negotiated Rate	$262.18
Max. Negotiated Rate	$374.54
Rate for Payer: Aetna Commercial	$353.74
Rate for Payer: Aetna New Business (MI Preferred)	$270.50
Rate for Payer: Cash Price	$332.93
Rate for Payer: Cofinity Advantage	$291.31
Rate for Payer: Cofinity Commercial	$357.90
Rate for Payer: Encore Health Key Benefits Commercial	$332.93
Rate for Payer: Healthscope Commercial	$374.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$353.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$312.12
Rate for Payer: PHP Commercial	$353.74
Rate for Payer: Priority Health SBD	$262.18

HC OT Z GAUNTLET EA $425

Facility

$442.17

Service Code	HCPCS A6549
Hospital Charge Code	98300088
Hospital Revenue Code	270
Min. Negotiated Rate	$278.57
Max. Negotiated Rate	$397.95
Rate for Payer: Aetna Commercial	$375.84
Rate for Payer: Aetna New Business (MI Preferred)	$287.41
Rate for Payer: Cash Price	$353.74
Rate for Payer: Cofinity Advantage	$309.52
Rate for Payer: Cofinity Commercial	$380.27
Rate for Payer: Encore Health Key Benefits Commercial	$353.74
Rate for Payer: Healthscope Commercial	$397.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$375.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$331.63
Rate for Payer: PHP Commercial	$375.84
Rate for Payer: Priority Health SBD	$278.57

HC OT Z GAUNTLET EA $425

Facility

$442.17

Service Code	HCPCS A6549
Hospital Charge Code	98300088
Hospital Revenue Code	270
Min. Negotiated Rate	$173.77
Max. Negotiated Rate	$397.95
Rate for Payer: Aetna Commercial	$375.84
Rate for Payer: Aetna Medicare	$221.09
Rate for Payer: Aetna New Business (MI Preferred)	$287.41
Rate for Payer: BCBS Complete	$176.87
Rate for Payer: BCBS Trust/PPO	$365.03
Rate for Payer: BCN Commercial	$365.03
Rate for Payer: Cash Price	$353.74
Rate for Payer: Cash Price	$353.74
Rate for Payer: Cofinity Advantage	$309.52
Rate for Payer: Cofinity Commercial	$380.27
Rate for Payer: Encore Health Key Benefits Commercial	$353.74
Rate for Payer: Healthscope Commercial	$397.95
Rate for Payer: MI Amish Medical Board Commercial	$353.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$375.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$331.63
Rate for Payer: PHP Commercial	$375.84
Rate for Payer: Priority Health SBD	$278.57
Rate for Payer: UHC All Payor (Choice/PPO)	$287.41
Rate for Payer: UHC Core	$230.37
Rate for Payer: UHC Exchange	$173.77

HC OT Z GAUNTLET EA $450

Facility

$468.18

Service Code	HCPCS A6549
Hospital Charge Code	98300089
Hospital Revenue Code	270
Min. Negotiated Rate	$183.99
Max. Negotiated Rate	$421.36
Rate for Payer: Aetna Commercial	$397.95
Rate for Payer: Aetna Medicare	$234.09
Rate for Payer: Aetna New Business (MI Preferred)	$304.32
Rate for Payer: BCBS Complete	$187.27
Rate for Payer: BCBS Trust/PPO	$365.03
Rate for Payer: BCN Commercial	$365.03
Rate for Payer: Cash Price	$374.54
Rate for Payer: Cash Price	$374.54
Rate for Payer: Cofinity Advantage	$327.73
Rate for Payer: Cofinity Commercial	$402.63
Rate for Payer: Encore Health Key Benefits Commercial	$374.54
Rate for Payer: Healthscope Commercial	$421.36
Rate for Payer: MI Amish Medical Board Commercial	$374.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$397.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$351.13
Rate for Payer: PHP Commercial	$397.95
Rate for Payer: Priority Health SBD	$294.95
Rate for Payer: UHC All Payor (Choice/PPO)	$304.32
Rate for Payer: UHC Core	$243.92
Rate for Payer: UHC Exchange	$183.99

HC OT Z GAUNTLET EA $450

Facility

$468.18

Service Code	HCPCS A6549
Hospital Charge Code	98300089
Hospital Revenue Code	270
Min. Negotiated Rate	$294.95
Max. Negotiated Rate	$421.36
Rate for Payer: Aetna Commercial	$397.95
Rate for Payer: Aetna New Business (MI Preferred)	$304.32
Rate for Payer: Cash Price	$374.54
Rate for Payer: Cofinity Advantage	$327.73
Rate for Payer: Cofinity Commercial	$402.63
Rate for Payer: Encore Health Key Benefits Commercial	$374.54
Rate for Payer: Healthscope Commercial	$421.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$397.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$351.13
Rate for Payer: PHP Commercial	$397.95
Rate for Payer: Priority Health SBD	$294.95

HC OT Z GAUNTLET EA $60

Facility

$62.42

Service Code	HCPCS A6549
Hospital Charge Code	98300090
Hospital Revenue Code	270
Min. Negotiated Rate	$39.32
Max. Negotiated Rate	$56.18
Rate for Payer: Aetna Commercial	$53.06
Rate for Payer: Aetna New Business (MI Preferred)	$40.57
Rate for Payer: Cash Price	$49.94
Rate for Payer: Cofinity Advantage	$43.69
Rate for Payer: Cofinity Commercial	$53.68
Rate for Payer: Encore Health Key Benefits Commercial	$49.94
Rate for Payer: Healthscope Commercial	$56.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$46.81
Rate for Payer: PHP Commercial	$53.06
Rate for Payer: Priority Health SBD	$39.32

HC OT Z GAUNTLET EA $60

Facility

$62.42

Service Code	HCPCS A6549
Hospital Charge Code	98300090
Hospital Revenue Code	270
Min. Negotiated Rate	$24.53
Max. Negotiated Rate	$365.03
Rate for Payer: Cofinity Advantage	$43.69
Rate for Payer: Aetna Commercial	$53.06
Rate for Payer: Aetna Medicare	$31.21
Rate for Payer: Aetna New Business (MI Preferred)	$40.57
Rate for Payer: BCBS Complete	$24.97
Rate for Payer: BCBS Trust/PPO	$365.03
Rate for Payer: BCN Commercial	$365.03
Rate for Payer: Cash Price	$49.94
Rate for Payer: Cash Price	$49.94
Rate for Payer: Cofinity Commercial	$53.68
Rate for Payer: Encore Health Key Benefits Commercial	$49.94
Rate for Payer: Healthscope Commercial	$56.18
Rate for Payer: MI Amish Medical Board Commercial	$49.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$46.81
Rate for Payer: PHP Commercial	$53.06
Rate for Payer: Priority Health SBD	$39.32
Rate for Payer: UHC All Payor (Choice/PPO)	$40.57
Rate for Payer: UHC Core	$32.52
Rate for Payer: UHC Exchange	$24.53

HC OT Z GAUNTLET EA $70

Facility

$72.83

Service Code	HCPCS A6549
Hospital Charge Code	98300091
Hospital Revenue Code	270
Min. Negotiated Rate	$28.62
Max. Negotiated Rate	$365.03
Rate for Payer: Aetna Commercial	$61.91
Rate for Payer: Aetna Medicare	$36.41
Rate for Payer: Aetna New Business (MI Preferred)	$47.34
Rate for Payer: BCBS Complete	$29.13
Rate for Payer: BCBS Trust/PPO	$365.03
Rate for Payer: BCN Commercial	$365.03
Rate for Payer: Cash Price	$58.26
Rate for Payer: Cash Price	$58.26
Rate for Payer: Cofinity Advantage	$50.98
Rate for Payer: Cofinity Commercial	$62.63
Rate for Payer: Encore Health Key Benefits Commercial	$58.26
Rate for Payer: Healthscope Commercial	$65.55
Rate for Payer: MI Amish Medical Board Commercial	$58.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$54.62
Rate for Payer: PHP Commercial	$61.91
Rate for Payer: Priority Health SBD	$45.88
Rate for Payer: UHC All Payor (Choice/PPO)	$47.34
Rate for Payer: UHC Core	$37.94
Rate for Payer: UHC Exchange	$28.62

HC OT Z GAUNTLET EA $70

Facility

$72.83

Service Code	HCPCS A6549
Hospital Charge Code	98300091
Hospital Revenue Code	270
Min. Negotiated Rate	$45.88
Max. Negotiated Rate	$65.55
Rate for Payer: Aetna Commercial	$61.91
Rate for Payer: Aetna New Business (MI Preferred)	$47.34
Rate for Payer: Cash Price	$58.26
Rate for Payer: Cofinity Advantage	$50.98
Rate for Payer: Cofinity Commercial	$62.63
Rate for Payer: Encore Health Key Benefits Commercial	$58.26
Rate for Payer: Healthscope Commercial	$65.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$54.62
Rate for Payer: PHP Commercial	$61.91
Rate for Payer: Priority Health SBD	$45.88

HC OT Z GAUNTLET EA $80

Facility

$83.23

Service Code	HCPCS A6549
Hospital Charge Code	98300092
Hospital Revenue Code	270
Min. Negotiated Rate	$32.71
Max. Negotiated Rate	$365.03
Rate for Payer: Aetna Commercial	$70.75
Rate for Payer: Aetna Medicare	$41.62
Rate for Payer: Aetna New Business (MI Preferred)	$54.10
Rate for Payer: BCBS Complete	$33.29
Rate for Payer: BCBS Trust/PPO	$365.03
Rate for Payer: BCN Commercial	$365.03
Rate for Payer: Cash Price	$66.58
Rate for Payer: Cash Price	$66.58
Rate for Payer: Cofinity Advantage	$58.26
Rate for Payer: Cofinity Commercial	$71.58
Rate for Payer: Encore Health Key Benefits Commercial	$66.58
Rate for Payer: Healthscope Commercial	$74.91
Rate for Payer: MI Amish Medical Board Commercial	$66.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$62.42
Rate for Payer: PHP Commercial	$70.75
Rate for Payer: Priority Health SBD	$52.43
Rate for Payer: UHC All Payor (Choice/PPO)	$54.10
Rate for Payer: UHC Core	$43.36
Rate for Payer: UHC Exchange	$32.71

HC OT Z GAUNTLET EA $80

Facility

$83.23

Service Code	HCPCS A6549
Hospital Charge Code	98300092
Hospital Revenue Code	270
Min. Negotiated Rate	$52.43
Max. Negotiated Rate	$74.91
Rate for Payer: Aetna Commercial	$70.75
Rate for Payer: Aetna New Business (MI Preferred)	$54.10
Rate for Payer: Cash Price	$66.58
Rate for Payer: Cofinity Advantage	$58.26
Rate for Payer: Cofinity Commercial	$71.58
Rate for Payer: Encore Health Key Benefits Commercial	$66.58
Rate for Payer: Healthscope Commercial	$74.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$62.42
Rate for Payer: PHP Commercial	$70.75
Rate for Payer: Priority Health SBD	$52.43

HC OT Z GAUNTLET EA $90

Facility

$93.64

Service Code	HCPCS A6549
Hospital Charge Code	98300093
Hospital Revenue Code	270
Min. Negotiated Rate	$58.99
Max. Negotiated Rate	$84.28
Rate for Payer: Aetna Commercial	$79.59
Rate for Payer: Aetna New Business (MI Preferred)	$60.87
Rate for Payer: Cash Price	$74.91
Rate for Payer: Cofinity Advantage	$65.55
Rate for Payer: Cofinity Commercial	$80.53
Rate for Payer: Encore Health Key Benefits Commercial	$74.91
Rate for Payer: Healthscope Commercial	$84.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.23
Rate for Payer: PHP Commercial	$79.59
Rate for Payer: Priority Health SBD	$58.99

HC OT Z GAUNTLET EA $90

Facility

$93.64

Service Code	HCPCS A6549
Hospital Charge Code	98300093
Hospital Revenue Code	270
Min. Negotiated Rate	$36.80
Max. Negotiated Rate	$365.03
Rate for Payer: Aetna Commercial	$79.59
Rate for Payer: Aetna Medicare	$46.82
Rate for Payer: Aetna New Business (MI Preferred)	$60.87
Rate for Payer: BCBS Complete	$37.46
Rate for Payer: BCBS Trust/PPO	$365.03
Rate for Payer: BCN Commercial	$365.03
Rate for Payer: Cash Price	$74.91
Rate for Payer: Cash Price	$74.91
Rate for Payer: Cofinity Advantage	$65.55
Rate for Payer: Cofinity Commercial	$80.53
Rate for Payer: Encore Health Key Benefits Commercial	$74.91
Rate for Payer: Healthscope Commercial	$84.28
Rate for Payer: MI Amish Medical Board Commercial	$74.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.23
Rate for Payer: PHP Commercial	$79.59
Rate for Payer: Priority Health SBD	$58.99
Rate for Payer: UHC All Payor (Choice/PPO)	$60.87
Rate for Payer: UHC Core	$48.79
Rate for Payer: UHC Exchange	$36.80

HC OT Z SLEEVE OR GLOVE EA $100

Facility

$104.04

Service Code	HCPCS L3999
Hospital Charge Code	96000026
Hospital Revenue Code	270
Min. Negotiated Rate	$65.55
Max. Negotiated Rate	$93.64
Rate for Payer: Aetna Commercial	$88.43
Rate for Payer: Aetna New Business (MI Preferred)	$67.63
Rate for Payer: Cash Price	$83.23
Rate for Payer: Cofinity Advantage	$72.83
Rate for Payer: Cofinity Commercial	$89.47
Rate for Payer: Encore Health Key Benefits Commercial	$83.23
Rate for Payer: Healthscope Commercial	$93.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$88.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$78.03
Rate for Payer: PHP Commercial	$88.43
Rate for Payer: Priority Health SBD	$65.55

HC OT Z SLEEVE OR GLOVE EA $100

Facility

$104.04

Service Code	HCPCS L3999
Hospital Charge Code	96000026
Hospital Revenue Code	270
Min. Negotiated Rate	$40.89
Max. Negotiated Rate	$684.58
Rate for Payer: Aetna Commercial	$88.43
Rate for Payer: Aetna Medicare	$52.02
Rate for Payer: Aetna New Business (MI Preferred)	$67.63
Rate for Payer: BCBS Complete	$41.62
Rate for Payer: BCBS Trust/PPO	$684.58
Rate for Payer: BCN Commercial	$684.58
Rate for Payer: Cash Price	$83.23
Rate for Payer: Cash Price	$83.23
Rate for Payer: Cofinity Advantage	$72.83
Rate for Payer: Cofinity Commercial	$89.47
Rate for Payer: Encore Health Key Benefits Commercial	$83.23
Rate for Payer: Healthscope Commercial	$93.64
Rate for Payer: MI Amish Medical Board Commercial	$83.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$88.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$78.03
Rate for Payer: PHP Commercial	$88.43
Rate for Payer: Priority Health SBD	$65.55
Rate for Payer: UHC All Payor (Choice/PPO)	$67.63
Rate for Payer: UHC Core	$54.20
Rate for Payer: UHC Exchange	$40.89

HC OT Z SLEEVE OR GLOVE EA $125

Facility

$130.05

Service Code	HCPCS L3999
Hospital Charge Code	96000027
Hospital Revenue Code	270
Min. Negotiated Rate	$81.93
Max. Negotiated Rate	$117.05
Rate for Payer: Aetna Commercial	$110.54
Rate for Payer: Aetna New Business (MI Preferred)	$84.53
Rate for Payer: Cash Price	$104.04
Rate for Payer: Cofinity Advantage	$91.03
Rate for Payer: Cofinity Commercial	$111.84
Rate for Payer: Encore Health Key Benefits Commercial	$104.04
Rate for Payer: Healthscope Commercial	$117.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$110.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$97.54
Rate for Payer: PHP Commercial	$110.54
Rate for Payer: Priority Health SBD	$81.93

HC OT Z SLEEVE OR GLOVE EA $125

Facility

$130.05

Service Code	HCPCS L3999
Hospital Charge Code	96000027
Hospital Revenue Code	270
Min. Negotiated Rate	$51.11
Max. Negotiated Rate	$684.58
Rate for Payer: Aetna Commercial	$110.54
Rate for Payer: Aetna Medicare	$65.03
Rate for Payer: Aetna New Business (MI Preferred)	$84.53
Rate for Payer: BCBS Complete	$52.02
Rate for Payer: BCBS Trust/PPO	$684.58
Rate for Payer: BCN Commercial	$684.58
Rate for Payer: Cash Price	$104.04
Rate for Payer: Cash Price	$104.04
Rate for Payer: Cofinity Advantage	$91.03
Rate for Payer: Cofinity Commercial	$111.84
Rate for Payer: Encore Health Key Benefits Commercial	$104.04
Rate for Payer: Healthscope Commercial	$117.05
Rate for Payer: MI Amish Medical Board Commercial	$104.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$110.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$97.54
Rate for Payer: PHP Commercial	$110.54
Rate for Payer: Priority Health SBD	$81.93
Rate for Payer: UHC All Payor (Choice/PPO)	$84.53
Rate for Payer: UHC Core	$67.76
Rate for Payer: UHC Exchange	$51.11

HC OT Z SLEEVE OR GLOVE EA $150

Facility

$156.06

Service Code	HCPCS L3999
Hospital Charge Code	96000028
Hospital Revenue Code	270
Min. Negotiated Rate	$61.33
Max. Negotiated Rate	$684.58
Rate for Payer: Aetna Commercial	$132.65
Rate for Payer: Aetna Medicare	$78.03
Rate for Payer: Aetna New Business (MI Preferred)	$101.44
Rate for Payer: BCBS Complete	$62.42
Rate for Payer: BCBS Trust/PPO	$684.58
Rate for Payer: BCN Commercial	$684.58
Rate for Payer: Cash Price	$124.85
Rate for Payer: Cash Price	$124.85
Rate for Payer: Cofinity Advantage	$109.24
Rate for Payer: Cofinity Commercial	$134.21
Rate for Payer: Encore Health Key Benefits Commercial	$124.85
Rate for Payer: Healthscope Commercial	$140.45
Rate for Payer: MI Amish Medical Board Commercial	$124.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$132.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$117.05
Rate for Payer: PHP Commercial	$132.65
Rate for Payer: Priority Health SBD	$98.32
Rate for Payer: UHC All Payor (Choice/PPO)	$101.44
Rate for Payer: UHC Core	$81.31
Rate for Payer: UHC Exchange	$61.33

HC OT Z SLEEVE OR GLOVE EA $150

Facility

$156.06

Service Code	HCPCS L3999
Hospital Charge Code	96000028
Hospital Revenue Code	270
Min. Negotiated Rate	$98.32
Max. Negotiated Rate	$140.45
Rate for Payer: Aetna Commercial	$132.65
Rate for Payer: Aetna New Business (MI Preferred)	$101.44
Rate for Payer: Cash Price	$124.85
Rate for Payer: Cofinity Advantage	$109.24
Rate for Payer: Cofinity Commercial	$134.21
Rate for Payer: Encore Health Key Benefits Commercial	$124.85
Rate for Payer: Healthscope Commercial	$140.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$132.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$117.05
Rate for Payer: PHP Commercial	$132.65
Rate for Payer: Priority Health SBD	$98.32

HC OT Z SLEEVE OR GLOVE EA $175

Facility

$182.07

Service Code	HCPCS L3999
Hospital Charge Code	96000029
Hospital Revenue Code	270
Min. Negotiated Rate	$71.55
Max. Negotiated Rate	$684.58
Rate for Payer: Aetna Commercial	$154.76
Rate for Payer: Aetna Medicare	$91.03
Rate for Payer: Aetna New Business (MI Preferred)	$118.35
Rate for Payer: BCBS Complete	$72.83
Rate for Payer: BCBS Trust/PPO	$684.58
Rate for Payer: BCN Commercial	$684.58
Rate for Payer: Cash Price	$145.66
Rate for Payer: Cash Price	$145.66
Rate for Payer: Cofinity Advantage	$127.45
Rate for Payer: Cofinity Commercial	$156.58
Rate for Payer: Encore Health Key Benefits Commercial	$145.66
Rate for Payer: Healthscope Commercial	$163.86
Rate for Payer: MI Amish Medical Board Commercial	$145.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$154.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$136.55
Rate for Payer: PHP Commercial	$154.76
Rate for Payer: Priority Health SBD	$114.70
Rate for Payer: UHC All Payor (Choice/PPO)	$118.35
Rate for Payer: UHC Core	$94.86
Rate for Payer: UHC Exchange	$71.55

HC OT Z SLEEVE OR GLOVE EA $175

Facility

$182.07

Service Code	HCPCS L3999
Hospital Charge Code	96000029
Hospital Revenue Code	270
Min. Negotiated Rate	$114.70
Max. Negotiated Rate	$163.86
Rate for Payer: Aetna Commercial	$154.76
Rate for Payer: Aetna New Business (MI Preferred)	$118.35
Rate for Payer: Cash Price	$145.66
Rate for Payer: Cofinity Advantage	$127.45
Rate for Payer: Cofinity Commercial	$156.58
Rate for Payer: Encore Health Key Benefits Commercial	$145.66
Rate for Payer: Healthscope Commercial	$163.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$154.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$136.55
Rate for Payer: PHP Commercial	$154.76
Rate for Payer: Priority Health SBD	$114.70

Know your out-of-pocket cost for care.

All Charges