Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC OT Z SLEEVE OR GLOVE EA $375

Facility

$382.50

Service Code	HCPCS L3999
Hospital Charge Code	96000038
Hospital Revenue Code	270
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$344.25
Rate for Payer: Aetna Commercial	$325.12
Rate for Payer: Aetna Medicare	$191.25
Rate for Payer: Aetna New Business (MI Preferred)	$248.62
Rate for Payer: BCBS Complete	$153.00
Rate for Payer: Cash Price	$306.00
Rate for Payer: Cofinity Commercial	$267.75
Rate for Payer: Cofinity Commercial	$328.95
Rate for Payer: Cofinity Medicare Advantage	$267.75
Rate for Payer: Encore Health Key Benefits Commercial	$306.00
Rate for Payer: Healthscope Commercial	$344.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$325.12
Rate for Payer: PHP Commercial	$325.12
Rate for Payer: Priority Health Cigna Priority Health	$248.62
Rate for Payer: Priority Health SBD	$240.97

HC OT Z SLEEVE OR GLOVE EA $40

Facility

$40.80

Service Code	HCPCS L3999
Hospital Charge Code	96000039
Hospital Revenue Code	270
Min. Negotiated Rate	$25.70
Max. Negotiated Rate	$36.72
Rate for Payer: Aetna Commercial	$34.68
Rate for Payer: Aetna New Business (MI Preferred)	$26.52
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cofinity Commercial	$28.56
Rate for Payer: Cofinity Commercial	$35.09
Rate for Payer: Cofinity Medicare Advantage	$28.56
Rate for Payer: Encore Health Key Benefits Commercial	$32.64
Rate for Payer: Healthscope Commercial	$36.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.68
Rate for Payer: PHP Commercial	$34.68
Rate for Payer: Priority Health Cigna Priority Health	$26.52
Rate for Payer: Priority Health SBD	$25.70

HC OT Z SLEEVE OR GLOVE EA $40

Facility

$40.80

Service Code	HCPCS L3999
Hospital Charge Code	96000039
Hospital Revenue Code	270
Min. Negotiated Rate	$16.32
Max. Negotiated Rate	$36.72
Rate for Payer: Aetna Commercial	$34.68
Rate for Payer: Aetna Medicare	$20.40
Rate for Payer: Aetna New Business (MI Preferred)	$26.52
Rate for Payer: BCBS Complete	$16.32
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cofinity Commercial	$28.56
Rate for Payer: Cofinity Commercial	$35.09
Rate for Payer: Cofinity Medicare Advantage	$28.56
Rate for Payer: Encore Health Key Benefits Commercial	$32.64
Rate for Payer: Healthscope Commercial	$36.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.68
Rate for Payer: PHP Commercial	$34.68
Rate for Payer: Priority Health Cigna Priority Health	$26.52
Rate for Payer: Priority Health SBD	$25.70

HC OT Z SLEEVE OR GLOVE EA $400

Facility

$408.00

Service Code	HCPCS L3999
Hospital Charge Code	96000040
Hospital Revenue Code	270
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$367.20
Rate for Payer: Aetna Commercial	$346.80
Rate for Payer: Aetna Medicare	$204.00
Rate for Payer: Aetna New Business (MI Preferred)	$265.20
Rate for Payer: BCBS Complete	$163.20
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cofinity Commercial	$285.60
Rate for Payer: Cofinity Commercial	$350.88
Rate for Payer: Cofinity Medicare Advantage	$285.60
Rate for Payer: Encore Health Key Benefits Commercial	$326.40
Rate for Payer: Healthscope Commercial	$367.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$346.80
Rate for Payer: PHP Commercial	$346.80
Rate for Payer: Priority Health Cigna Priority Health	$265.20
Rate for Payer: Priority Health SBD	$257.04

HC OT Z SLEEVE OR GLOVE EA $400

Facility

$408.00

Service Code	HCPCS L3999
Hospital Charge Code	96000040
Hospital Revenue Code	270
Min. Negotiated Rate	$257.04
Max. Negotiated Rate	$367.20
Rate for Payer: Aetna Commercial	$346.80
Rate for Payer: Aetna New Business (MI Preferred)	$265.20
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cofinity Commercial	$285.60
Rate for Payer: Cofinity Commercial	$350.88
Rate for Payer: Cofinity Medicare Advantage	$285.60
Rate for Payer: Encore Health Key Benefits Commercial	$326.40
Rate for Payer: Healthscope Commercial	$367.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$346.80
Rate for Payer: PHP Commercial	$346.80
Rate for Payer: Priority Health Cigna Priority Health	$265.20
Rate for Payer: Priority Health SBD	$257.04

HC OT Z SLEEVE OR GLOVE EA $425

Facility

$433.50

Service Code	HCPCS L3999
Hospital Charge Code	96000041
Hospital Revenue Code	270
Min. Negotiated Rate	$273.11
Max. Negotiated Rate	$390.15
Rate for Payer: Aetna Commercial	$368.48
Rate for Payer: Aetna New Business (MI Preferred)	$281.77
Rate for Payer: Cash Price	$346.80
Rate for Payer: Cofinity Commercial	$303.45
Rate for Payer: Cofinity Commercial	$372.81
Rate for Payer: Cofinity Medicare Advantage	$303.45
Rate for Payer: Encore Health Key Benefits Commercial	$346.80
Rate for Payer: Healthscope Commercial	$390.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$368.48
Rate for Payer: PHP Commercial	$368.48
Rate for Payer: Priority Health Cigna Priority Health	$281.77
Rate for Payer: Priority Health SBD	$273.11

HC OT Z SLEEVE OR GLOVE EA $425

Facility

$433.50

Service Code	HCPCS L3999
Hospital Charge Code	96000041
Hospital Revenue Code	270
Min. Negotiated Rate	$173.40
Max. Negotiated Rate	$390.15
Rate for Payer: Aetna Commercial	$368.48
Rate for Payer: Aetna Medicare	$216.75
Rate for Payer: Aetna New Business (MI Preferred)	$281.77
Rate for Payer: BCBS Complete	$173.40
Rate for Payer: Cash Price	$346.80
Rate for Payer: Cofinity Commercial	$303.45
Rate for Payer: Cofinity Commercial	$372.81
Rate for Payer: Cofinity Medicare Advantage	$303.45
Rate for Payer: Encore Health Key Benefits Commercial	$346.80
Rate for Payer: Healthscope Commercial	$390.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$368.48
Rate for Payer: PHP Commercial	$368.48
Rate for Payer: Priority Health Cigna Priority Health	$281.77
Rate for Payer: Priority Health SBD	$273.11

HC OT Z SLEEVE OR GLOVE EA $450

Facility

$459.00

Service Code	HCPCS L3999
Hospital Charge Code	96000042
Hospital Revenue Code	270
Min. Negotiated Rate	$289.17
Max. Negotiated Rate	$413.10
Rate for Payer: Aetna Commercial	$390.15
Rate for Payer: Aetna New Business (MI Preferred)	$298.35
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cofinity Commercial	$321.30
Rate for Payer: Cofinity Commercial	$394.74
Rate for Payer: Cofinity Medicare Advantage	$321.30
Rate for Payer: Encore Health Key Benefits Commercial	$367.20
Rate for Payer: Healthscope Commercial	$413.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$390.15
Rate for Payer: PHP Commercial	$390.15
Rate for Payer: Priority Health Cigna Priority Health	$298.35
Rate for Payer: Priority Health SBD	$289.17

HC OT Z SLEEVE OR GLOVE EA $450

Facility

$459.00

Service Code	HCPCS L3999
Hospital Charge Code	96000042
Hospital Revenue Code	270
Min. Negotiated Rate	$183.60
Max. Negotiated Rate	$413.10
Rate for Payer: Aetna Commercial	$390.15
Rate for Payer: Aetna Medicare	$229.50
Rate for Payer: Aetna New Business (MI Preferred)	$298.35
Rate for Payer: BCBS Complete	$183.60
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cofinity Commercial	$321.30
Rate for Payer: Cofinity Commercial	$394.74
Rate for Payer: Cofinity Medicare Advantage	$321.30
Rate for Payer: Encore Health Key Benefits Commercial	$367.20
Rate for Payer: Healthscope Commercial	$413.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$390.15
Rate for Payer: PHP Commercial	$390.15
Rate for Payer: Priority Health Cigna Priority Health	$298.35
Rate for Payer: Priority Health SBD	$289.17

HC OT Z SLEEVE OR GLOVE EA $50

Facility

$51.00

Service Code	HCPCS L3999
Hospital Charge Code	96000043
Hospital Revenue Code	270
Min. Negotiated Rate	$32.13
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna Commercial	$43.35
Rate for Payer: Aetna New Business (MI Preferred)	$33.15
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Commercial	$35.70
Rate for Payer: Cofinity Commercial	$43.86
Rate for Payer: Cofinity Medicare Advantage	$35.70
Rate for Payer: Encore Health Key Benefits Commercial	$40.80
Rate for Payer: Healthscope Commercial	$45.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.35
Rate for Payer: PHP Commercial	$43.35
Rate for Payer: Priority Health Cigna Priority Health	$33.15
Rate for Payer: Priority Health SBD	$32.13

HC OT Z SLEEVE OR GLOVE EA $50

Facility

$51.00

Service Code	HCPCS L3999
Hospital Charge Code	96000043
Hospital Revenue Code	270
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$45.90
Rate for Payer: Aetna Commercial	$43.35
Rate for Payer: Aetna Medicare	$25.50
Rate for Payer: Aetna New Business (MI Preferred)	$33.15
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Commercial	$35.70
Rate for Payer: Cofinity Commercial	$43.86
Rate for Payer: Cofinity Medicare Advantage	$35.70
Rate for Payer: Encore Health Key Benefits Commercial	$40.80
Rate for Payer: Healthscope Commercial	$45.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.35
Rate for Payer: PHP Commercial	$43.35
Rate for Payer: Priority Health Cigna Priority Health	$33.15
Rate for Payer: Priority Health SBD	$32.13

HC OT Z SLEEVE OR GLOVE EA $60

Facility

$61.20

Service Code	HCPCS L3999
Hospital Charge Code	96000044
Hospital Revenue Code	270
Min. Negotiated Rate	$24.48
Max. Negotiated Rate	$55.08
Rate for Payer: Aetna Commercial	$52.02
Rate for Payer: Aetna Medicare	$30.60
Rate for Payer: Aetna New Business (MI Preferred)	$39.78
Rate for Payer: BCBS Complete	$24.48
Rate for Payer: Cash Price	$48.96
Rate for Payer: Cofinity Commercial	$42.84
Rate for Payer: Cofinity Commercial	$52.63
Rate for Payer: Cofinity Medicare Advantage	$42.84
Rate for Payer: Encore Health Key Benefits Commercial	$48.96
Rate for Payer: Healthscope Commercial	$55.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.02
Rate for Payer: PHP Commercial	$52.02
Rate for Payer: Priority Health Cigna Priority Health	$39.78
Rate for Payer: Priority Health SBD	$38.56

HC OT Z SLEEVE OR GLOVE EA $60

Facility

$61.20

Service Code	HCPCS L3999
Hospital Charge Code	96000044
Hospital Revenue Code	270
Min. Negotiated Rate	$38.56
Max. Negotiated Rate	$55.08
Rate for Payer: Aetna Commercial	$52.02
Rate for Payer: Aetna New Business (MI Preferred)	$39.78
Rate for Payer: Cash Price	$48.96
Rate for Payer: Cofinity Commercial	$42.84
Rate for Payer: Cofinity Commercial	$52.63
Rate for Payer: Cofinity Medicare Advantage	$42.84
Rate for Payer: Encore Health Key Benefits Commercial	$48.96
Rate for Payer: Healthscope Commercial	$55.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.02
Rate for Payer: PHP Commercial	$52.02
Rate for Payer: Priority Health Cigna Priority Health	$39.78
Rate for Payer: Priority Health SBD	$38.56

HC OT Z SLEEVE OR GLOVE EA $70

Facility

$71.40

Service Code	HCPCS L3999
Hospital Charge Code	96000045
Hospital Revenue Code	960
Min. Negotiated Rate	$44.98
Max. Negotiated Rate	$64.26
Rate for Payer: Aetna Commercial	$60.69
Rate for Payer: Aetna New Business (MI Preferred)	$46.41
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cofinity Commercial	$49.98
Rate for Payer: Cofinity Commercial	$61.40
Rate for Payer: Cofinity Medicare Advantage	$49.98
Rate for Payer: Encore Health Key Benefits Commercial	$57.12
Rate for Payer: Healthscope Commercial	$64.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.69
Rate for Payer: PHP Commercial	$60.69
Rate for Payer: Priority Health Cigna Priority Health	$46.41
Rate for Payer: Priority Health SBD	$44.98

HC OT Z SLEEVE OR GLOVE EA $70

Facility

$71.40

Service Code	HCPCS L3999
Hospital Charge Code	96000045
Hospital Revenue Code	960
Min. Negotiated Rate	$28.56
Max. Negotiated Rate	$64.26
Rate for Payer: Aetna Commercial	$60.69
Rate for Payer: Aetna Medicare	$35.70
Rate for Payer: Aetna New Business (MI Preferred)	$46.41
Rate for Payer: BCBS Complete	$28.56
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cofinity Commercial	$49.98
Rate for Payer: Cofinity Commercial	$61.40
Rate for Payer: Cofinity Medicare Advantage	$49.98
Rate for Payer: Encore Health Key Benefits Commercial	$57.12
Rate for Payer: Healthscope Commercial	$64.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.69
Rate for Payer: PHP Commercial	$60.69
Rate for Payer: Priority Health Cigna Priority Health	$46.41
Rate for Payer: Priority Health SBD	$44.98

HC OT Z SLEEVE OR GLOVE EA $80

Facility

$81.60

Service Code	HCPCS L3999
Hospital Charge Code	96000046
Hospital Revenue Code	270
Min. Negotiated Rate	$32.64
Max. Negotiated Rate	$73.44
Rate for Payer: Aetna Commercial	$69.36
Rate for Payer: Aetna Medicare	$40.80
Rate for Payer: Aetna New Business (MI Preferred)	$53.04
Rate for Payer: BCBS Complete	$32.64
Rate for Payer: Cash Price	$65.28
Rate for Payer: Cofinity Commercial	$57.12
Rate for Payer: Cofinity Commercial	$70.18
Rate for Payer: Cofinity Medicare Advantage	$57.12
Rate for Payer: Encore Health Key Benefits Commercial	$65.28
Rate for Payer: Healthscope Commercial	$73.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.36
Rate for Payer: PHP Commercial	$69.36
Rate for Payer: Priority Health Cigna Priority Health	$53.04
Rate for Payer: Priority Health SBD	$51.41

HC OT Z SLEEVE OR GLOVE EA $80

Facility

$81.60

Service Code	HCPCS L3999
Hospital Charge Code	96000046
Hospital Revenue Code	270
Min. Negotiated Rate	$51.41
Max. Negotiated Rate	$73.44
Rate for Payer: Aetna Commercial	$69.36
Rate for Payer: Aetna New Business (MI Preferred)	$53.04
Rate for Payer: Cash Price	$65.28
Rate for Payer: Cofinity Commercial	$57.12
Rate for Payer: Cofinity Commercial	$70.18
Rate for Payer: Cofinity Medicare Advantage	$57.12
Rate for Payer: Encore Health Key Benefits Commercial	$65.28
Rate for Payer: Healthscope Commercial	$73.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.36
Rate for Payer: PHP Commercial	$69.36
Rate for Payer: Priority Health Cigna Priority Health	$53.04
Rate for Payer: Priority Health SBD	$51.41

HC OT Z SLEEVE OR GLOVE EA $90

Facility

$91.80

Service Code	HCPCS L3999
Hospital Charge Code	96000047
Hospital Revenue Code	270
Min. Negotiated Rate	$36.72
Max. Negotiated Rate	$82.62
Rate for Payer: Aetna Commercial	$78.03
Rate for Payer: Aetna Medicare	$45.90
Rate for Payer: Aetna New Business (MI Preferred)	$59.67
Rate for Payer: BCBS Complete	$36.72
Rate for Payer: Cash Price	$73.44
Rate for Payer: Cofinity Commercial	$64.26
Rate for Payer: Cofinity Commercial	$78.95
Rate for Payer: Cofinity Medicare Advantage	$64.26
Rate for Payer: Encore Health Key Benefits Commercial	$73.44
Rate for Payer: Healthscope Commercial	$82.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.03
Rate for Payer: PHP Commercial	$78.03
Rate for Payer: Priority Health Cigna Priority Health	$59.67
Rate for Payer: Priority Health SBD	$57.83

HC OT Z SLEEVE OR GLOVE EA $90

Facility

$91.80

Service Code	HCPCS L3999
Hospital Charge Code	96000047
Hospital Revenue Code	270
Min. Negotiated Rate	$57.83
Max. Negotiated Rate	$82.62
Rate for Payer: Aetna Commercial	$78.03
Rate for Payer: Aetna New Business (MI Preferred)	$59.67
Rate for Payer: Cash Price	$73.44
Rate for Payer: Cofinity Commercial	$64.26
Rate for Payer: Cofinity Commercial	$78.95
Rate for Payer: Cofinity Medicare Advantage	$64.26
Rate for Payer: Encore Health Key Benefits Commercial	$73.44
Rate for Payer: Healthscope Commercial	$82.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.03
Rate for Payer: PHP Commercial	$78.03
Rate for Payer: Priority Health Cigna Priority Health	$59.67
Rate for Payer: Priority Health SBD	$57.83

HC OT Z STOCKINGS CUSTOM EA $100

Facility

$102.00

Service Code	HCPCS A6549
Hospital Charge Code	98300094
Hospital Revenue Code	270
Min. Negotiated Rate	$64.26
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna Commercial	$86.70
Rate for Payer: Aetna New Business (MI Preferred)	$66.30
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cofinity Commercial	$71.40
Rate for Payer: Cofinity Commercial	$87.72
Rate for Payer: Cofinity Medicare Advantage	$71.40
Rate for Payer: Encore Health Key Benefits Commercial	$81.60
Rate for Payer: Healthscope Commercial	$91.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.70
Rate for Payer: PHP Commercial	$86.70
Rate for Payer: Priority Health Cigna Priority Health	$66.30
Rate for Payer: Priority Health SBD	$64.26

HC OT Z STOCKINGS CUSTOM EA $100

Facility

$102.00

Service Code	HCPCS A6549
Hospital Charge Code	98300094
Hospital Revenue Code	270
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna Commercial	$86.70
Rate for Payer: Aetna Medicare	$51.00
Rate for Payer: Aetna New Business (MI Preferred)	$66.30
Rate for Payer: BCBS Complete	$40.80
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cofinity Commercial	$71.40
Rate for Payer: Cofinity Commercial	$87.72
Rate for Payer: Cofinity Medicare Advantage	$71.40
Rate for Payer: Encore Health Key Benefits Commercial	$81.60
Rate for Payer: Healthscope Commercial	$91.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.70
Rate for Payer: PHP Commercial	$86.70
Rate for Payer: Priority Health Cigna Priority Health	$66.30
Rate for Payer: Priority Health SBD	$64.26

HC OT Z STOCKINGS CUSTOM EA $125

Facility

$127.50

Service Code	HCPCS A6549
Hospital Charge Code	98300095
Hospital Revenue Code	270
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$114.75
Rate for Payer: Aetna Commercial	$108.38
Rate for Payer: Aetna Medicare	$63.75
Rate for Payer: Aetna New Business (MI Preferred)	$82.88
Rate for Payer: BCBS Complete	$51.00
Rate for Payer: Cash Price	$102.00
Rate for Payer: Cofinity Commercial	$109.65
Rate for Payer: Cofinity Commercial	$89.25
Rate for Payer: Cofinity Medicare Advantage	$89.25
Rate for Payer: Encore Health Key Benefits Commercial	$102.00
Rate for Payer: Healthscope Commercial	$114.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$108.38
Rate for Payer: PHP Commercial	$108.38
Rate for Payer: Priority Health Cigna Priority Health	$82.88
Rate for Payer: Priority Health SBD	$80.33

HC OT Z STOCKINGS CUSTOM EA $125

Facility

$127.50

Service Code	HCPCS A6549
Hospital Charge Code	98300095
Hospital Revenue Code	270
Min. Negotiated Rate	$80.33
Max. Negotiated Rate	$114.75
Rate for Payer: Aetna Commercial	$108.38
Rate for Payer: Aetna New Business (MI Preferred)	$82.88
Rate for Payer: Cash Price	$102.00
Rate for Payer: Cofinity Commercial	$109.65
Rate for Payer: Cofinity Commercial	$89.25
Rate for Payer: Cofinity Medicare Advantage	$89.25
Rate for Payer: Encore Health Key Benefits Commercial	$102.00
Rate for Payer: Healthscope Commercial	$114.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$108.38
Rate for Payer: PHP Commercial	$108.38
Rate for Payer: Priority Health Cigna Priority Health	$82.88
Rate for Payer: Priority Health SBD	$80.33

HC OT Z STOCKINGS CUSTOM EA $150

Facility

$153.00

Service Code	HCPCS A6549
Hospital Charge Code	98300096
Hospital Revenue Code	270
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$137.70
Rate for Payer: Aetna Commercial	$130.05
Rate for Payer: Aetna Medicare	$76.50
Rate for Payer: Aetna New Business (MI Preferred)	$99.45
Rate for Payer: BCBS Complete	$61.20
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cofinity Commercial	$107.10
Rate for Payer: Cofinity Commercial	$131.58
Rate for Payer: Cofinity Medicare Advantage	$107.10
Rate for Payer: Encore Health Key Benefits Commercial	$122.40
Rate for Payer: Healthscope Commercial	$137.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.05
Rate for Payer: PHP Commercial	$130.05
Rate for Payer: Priority Health Cigna Priority Health	$99.45
Rate for Payer: Priority Health SBD	$96.39

HC OT Z STOCKINGS CUSTOM EA $150

Facility

$153.00

Service Code	HCPCS A6549
Hospital Charge Code	98300096
Hospital Revenue Code	270
Min. Negotiated Rate	$96.39
Max. Negotiated Rate	$137.70
Rate for Payer: Aetna Commercial	$130.05
Rate for Payer: Aetna New Business (MI Preferred)	$99.45
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cofinity Commercial	$107.10
Rate for Payer: Cofinity Commercial	$131.58
Rate for Payer: Cofinity Medicare Advantage	$107.10
Rate for Payer: Encore Health Key Benefits Commercial	$122.40
Rate for Payer: Healthscope Commercial	$137.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.05
Rate for Payer: PHP Commercial	$130.05
Rate for Payer: Priority Health Cigna Priority Health	$99.45
Rate for Payer: Priority Health SBD	$96.39

Know your out-of-pocket cost for care.

All Charges