Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC OT Z STOCKINGS CUSTOM EA $175

Facility

$178.50

Service Code	HCPCS A6549
Hospital Charge Code	98300097
Hospital Revenue Code	270
Min. Negotiated Rate	$112.45
Max. Negotiated Rate	$160.65
Rate for Payer: Aetna Commercial	$151.72
Rate for Payer: Aetna New Business (MI Preferred)	$116.03
Rate for Payer: Cash Price	$142.80
Rate for Payer: Cofinity Commercial	$124.95
Rate for Payer: Cofinity Commercial	$153.51
Rate for Payer: Cofinity Medicare Advantage	$124.95
Rate for Payer: Encore Health Key Benefits Commercial	$142.80
Rate for Payer: Healthscope Commercial	$160.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$151.72
Rate for Payer: PHP Commercial	$151.72
Rate for Payer: Priority Health Cigna Priority Health	$116.03
Rate for Payer: Priority Health SBD	$112.45

HC OT Z STOCKINGS CUSTOM EA $175

Facility

$178.50

Service Code	HCPCS A6549
Hospital Charge Code	98300097
Hospital Revenue Code	270
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$160.65
Rate for Payer: Aetna Commercial	$151.72
Rate for Payer: Aetna Medicare	$89.25
Rate for Payer: Aetna New Business (MI Preferred)	$116.03
Rate for Payer: BCBS Complete	$71.40
Rate for Payer: Cash Price	$142.80
Rate for Payer: Cofinity Commercial	$124.95
Rate for Payer: Cofinity Commercial	$153.51
Rate for Payer: Cofinity Medicare Advantage	$124.95
Rate for Payer: Encore Health Key Benefits Commercial	$142.80
Rate for Payer: Healthscope Commercial	$160.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$151.72
Rate for Payer: PHP Commercial	$151.72
Rate for Payer: Priority Health Cigna Priority Health	$116.03
Rate for Payer: Priority Health SBD	$112.45

HC OT Z STOCKINGS CUSTOM EA $200

Facility

$204.00

Service Code	HCPCS A6549
Hospital Charge Code	98300098
Hospital Revenue Code	270
Min. Negotiated Rate	$128.52
Max. Negotiated Rate	$183.60
Rate for Payer: Aetna Commercial	$173.40
Rate for Payer: Aetna New Business (MI Preferred)	$132.60
Rate for Payer: Cash Price	$163.20
Rate for Payer: Cofinity Commercial	$142.80
Rate for Payer: Cofinity Commercial	$175.44
Rate for Payer: Cofinity Medicare Advantage	$142.80
Rate for Payer: Encore Health Key Benefits Commercial	$163.20
Rate for Payer: Healthscope Commercial	$183.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.40
Rate for Payer: PHP Commercial	$173.40
Rate for Payer: Priority Health Cigna Priority Health	$132.60
Rate for Payer: Priority Health SBD	$128.52

HC OT Z STOCKINGS CUSTOM EA $200

Facility

$204.00

Service Code	HCPCS A6549
Hospital Charge Code	98300098
Hospital Revenue Code	270
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$183.60
Rate for Payer: Aetna Commercial	$173.40
Rate for Payer: Aetna Medicare	$102.00
Rate for Payer: Aetna New Business (MI Preferred)	$132.60
Rate for Payer: BCBS Complete	$81.60
Rate for Payer: Cash Price	$163.20
Rate for Payer: Cofinity Commercial	$142.80
Rate for Payer: Cofinity Commercial	$175.44
Rate for Payer: Cofinity Medicare Advantage	$142.80
Rate for Payer: Encore Health Key Benefits Commercial	$163.20
Rate for Payer: Healthscope Commercial	$183.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.40
Rate for Payer: PHP Commercial	$173.40
Rate for Payer: Priority Health Cigna Priority Health	$132.60
Rate for Payer: Priority Health SBD	$128.52

HC OT Z STOCKINGS CUSTOM EA $225

Facility

$229.50

Service Code	HCPCS A6549
Hospital Charge Code	98300099
Hospital Revenue Code	270
Min. Negotiated Rate	$144.59
Max. Negotiated Rate	$206.55
Rate for Payer: Aetna Commercial	$195.07
Rate for Payer: Aetna New Business (MI Preferred)	$149.18
Rate for Payer: Cash Price	$183.60
Rate for Payer: Cofinity Commercial	$160.65
Rate for Payer: Cofinity Commercial	$197.37
Rate for Payer: Cofinity Medicare Advantage	$160.65
Rate for Payer: Encore Health Key Benefits Commercial	$183.60
Rate for Payer: Healthscope Commercial	$206.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$195.07
Rate for Payer: PHP Commercial	$195.07
Rate for Payer: Priority Health Cigna Priority Health	$149.18
Rate for Payer: Priority Health SBD	$144.59

HC OT Z STOCKINGS CUSTOM EA $225

Facility

$229.50

Service Code	HCPCS A6549
Hospital Charge Code	98300099
Hospital Revenue Code	270
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$206.55
Rate for Payer: Aetna Commercial	$195.07
Rate for Payer: Aetna Medicare	$114.75
Rate for Payer: Aetna New Business (MI Preferred)	$149.18
Rate for Payer: BCBS Complete	$91.80
Rate for Payer: Cash Price	$183.60
Rate for Payer: Cofinity Commercial	$160.65
Rate for Payer: Cofinity Commercial	$197.37
Rate for Payer: Cofinity Medicare Advantage	$160.65
Rate for Payer: Encore Health Key Benefits Commercial	$183.60
Rate for Payer: Healthscope Commercial	$206.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$195.07
Rate for Payer: PHP Commercial	$195.07
Rate for Payer: Priority Health Cigna Priority Health	$149.18
Rate for Payer: Priority Health SBD	$144.59

HC OT Z STOCKINGS CUSTOM EA $250

Facility

$255.00

Service Code	HCPCS A6549
Hospital Charge Code	98300100
Hospital Revenue Code	270
Min. Negotiated Rate	$160.65
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna Commercial	$216.75
Rate for Payer: Aetna New Business (MI Preferred)	$165.75
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cofinity Commercial	$178.50
Rate for Payer: Cofinity Commercial	$219.30
Rate for Payer: Cofinity Medicare Advantage	$178.50
Rate for Payer: Encore Health Key Benefits Commercial	$204.00
Rate for Payer: Healthscope Commercial	$229.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$216.75
Rate for Payer: PHP Commercial	$216.75
Rate for Payer: Priority Health Cigna Priority Health	$165.75
Rate for Payer: Priority Health SBD	$160.65

HC OT Z STOCKINGS CUSTOM EA $250

Facility

$255.00

Service Code	HCPCS A6549
Hospital Charge Code	98300100
Hospital Revenue Code	270
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna Commercial	$216.75
Rate for Payer: Aetna Medicare	$127.50
Rate for Payer: Aetna New Business (MI Preferred)	$165.75
Rate for Payer: BCBS Complete	$102.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cofinity Commercial	$178.50
Rate for Payer: Cofinity Commercial	$219.30
Rate for Payer: Cofinity Medicare Advantage	$178.50
Rate for Payer: Encore Health Key Benefits Commercial	$204.00
Rate for Payer: Healthscope Commercial	$229.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$216.75
Rate for Payer: PHP Commercial	$216.75
Rate for Payer: Priority Health Cigna Priority Health	$165.75
Rate for Payer: Priority Health SBD	$160.65

HC OT Z STOCKINGS CUSTOM EA $275

Facility

$280.50

Service Code	HCPCS A6549
Hospital Charge Code	98300101
Hospital Revenue Code	270
Min. Negotiated Rate	$176.72
Max. Negotiated Rate	$252.45
Rate for Payer: Aetna Commercial	$238.43
Rate for Payer: Aetna New Business (MI Preferred)	$182.32
Rate for Payer: Cash Price	$224.40
Rate for Payer: Cofinity Commercial	$196.35
Rate for Payer: Cofinity Commercial	$241.23
Rate for Payer: Cofinity Medicare Advantage	$196.35
Rate for Payer: Encore Health Key Benefits Commercial	$224.40
Rate for Payer: Healthscope Commercial	$252.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$238.43
Rate for Payer: PHP Commercial	$238.43
Rate for Payer: Priority Health Cigna Priority Health	$182.32
Rate for Payer: Priority Health SBD	$176.72

HC OT Z STOCKINGS CUSTOM EA $275

Facility

$280.50

Service Code	HCPCS A6549
Hospital Charge Code	98300101
Hospital Revenue Code	270
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$252.45
Rate for Payer: Aetna Commercial	$238.43
Rate for Payer: Aetna Medicare	$140.25
Rate for Payer: Aetna New Business (MI Preferred)	$182.32
Rate for Payer: BCBS Complete	$112.20
Rate for Payer: Cash Price	$224.40
Rate for Payer: Cofinity Commercial	$196.35
Rate for Payer: Cofinity Commercial	$241.23
Rate for Payer: Cofinity Medicare Advantage	$196.35
Rate for Payer: Encore Health Key Benefits Commercial	$224.40
Rate for Payer: Healthscope Commercial	$252.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$238.43
Rate for Payer: PHP Commercial	$238.43
Rate for Payer: Priority Health Cigna Priority Health	$182.32
Rate for Payer: Priority Health SBD	$176.72

HC OT Z STOCKINGS CUSTOM EA $300

Facility

$306.00

Service Code	HCPCS A6549
Hospital Charge Code	98300102
Hospital Revenue Code	270
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$275.40
Rate for Payer: Aetna Commercial	$260.10
Rate for Payer: Aetna Medicare	$153.00
Rate for Payer: Aetna New Business (MI Preferred)	$198.90
Rate for Payer: BCBS Complete	$122.40
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cofinity Commercial	$214.20
Rate for Payer: Cofinity Commercial	$263.16
Rate for Payer: Cofinity Medicare Advantage	$214.20
Rate for Payer: Encore Health Key Benefits Commercial	$244.80
Rate for Payer: Healthscope Commercial	$275.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$260.10
Rate for Payer: PHP Commercial	$260.10
Rate for Payer: Priority Health Cigna Priority Health	$198.90
Rate for Payer: Priority Health SBD	$192.78

HC OT Z STOCKINGS CUSTOM EA $300

Facility

$306.00

Service Code	HCPCS A6549
Hospital Charge Code	98300102
Hospital Revenue Code	270
Min. Negotiated Rate	$192.78
Max. Negotiated Rate	$275.40
Rate for Payer: Aetna Commercial	$260.10
Rate for Payer: Aetna New Business (MI Preferred)	$198.90
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cofinity Commercial	$214.20
Rate for Payer: Cofinity Commercial	$263.16
Rate for Payer: Cofinity Medicare Advantage	$214.20
Rate for Payer: Encore Health Key Benefits Commercial	$244.80
Rate for Payer: Healthscope Commercial	$275.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$260.10
Rate for Payer: PHP Commercial	$260.10
Rate for Payer: Priority Health Cigna Priority Health	$198.90
Rate for Payer: Priority Health SBD	$192.78

HC OT Z STOCKINGS CUSTOM EA $325

Facility

$331.50

Service Code	HCPCS A6549
Hospital Charge Code	98300103
Hospital Revenue Code	270
Min. Negotiated Rate	$208.84
Max. Negotiated Rate	$298.35
Rate for Payer: Aetna Commercial	$281.77
Rate for Payer: Aetna New Business (MI Preferred)	$215.47
Rate for Payer: Cash Price	$265.20
Rate for Payer: Cofinity Commercial	$232.05
Rate for Payer: Cofinity Commercial	$285.09
Rate for Payer: Cofinity Medicare Advantage	$232.05
Rate for Payer: Encore Health Key Benefits Commercial	$265.20
Rate for Payer: Healthscope Commercial	$298.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$281.77
Rate for Payer: PHP Commercial	$281.77
Rate for Payer: Priority Health Cigna Priority Health	$215.47
Rate for Payer: Priority Health SBD	$208.84

HC OT Z STOCKINGS CUSTOM EA $325

Facility

$331.50

Service Code	HCPCS A6549
Hospital Charge Code	98300103
Hospital Revenue Code	270
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$298.35
Rate for Payer: Aetna Commercial	$281.77
Rate for Payer: Aetna Medicare	$165.75
Rate for Payer: Aetna New Business (MI Preferred)	$215.47
Rate for Payer: BCBS Complete	$132.60
Rate for Payer: Cash Price	$265.20
Rate for Payer: Cofinity Commercial	$232.05
Rate for Payer: Cofinity Commercial	$285.09
Rate for Payer: Cofinity Medicare Advantage	$232.05
Rate for Payer: Encore Health Key Benefits Commercial	$265.20
Rate for Payer: Healthscope Commercial	$298.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$281.77
Rate for Payer: PHP Commercial	$281.77
Rate for Payer: Priority Health Cigna Priority Health	$215.47
Rate for Payer: Priority Health SBD	$208.84

HC OT Z STOCKINGS CUSTOM EA $350

Facility

$357.00

Service Code	HCPCS A6549
Hospital Charge Code	98300104
Hospital Revenue Code	270
Min. Negotiated Rate	$224.91
Max. Negotiated Rate	$321.30
Rate for Payer: Aetna Commercial	$303.45
Rate for Payer: Aetna New Business (MI Preferred)	$232.05
Rate for Payer: Cash Price	$285.60
Rate for Payer: Cofinity Commercial	$249.90
Rate for Payer: Cofinity Commercial	$307.02
Rate for Payer: Cofinity Medicare Advantage	$249.90
Rate for Payer: Encore Health Key Benefits Commercial	$285.60
Rate for Payer: Healthscope Commercial	$321.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$303.45
Rate for Payer: PHP Commercial	$303.45
Rate for Payer: Priority Health Cigna Priority Health	$232.05
Rate for Payer: Priority Health SBD	$224.91

HC OT Z STOCKINGS CUSTOM EA $350

Facility

$357.00

Service Code	HCPCS A6549
Hospital Charge Code	98300104
Hospital Revenue Code	270
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$321.30
Rate for Payer: Aetna Commercial	$303.45
Rate for Payer: Aetna Medicare	$178.50
Rate for Payer: Aetna New Business (MI Preferred)	$232.05
Rate for Payer: BCBS Complete	$142.80
Rate for Payer: Cash Price	$285.60
Rate for Payer: Cofinity Commercial	$249.90
Rate for Payer: Cofinity Commercial	$307.02
Rate for Payer: Cofinity Medicare Advantage	$249.90
Rate for Payer: Encore Health Key Benefits Commercial	$285.60
Rate for Payer: Healthscope Commercial	$321.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$303.45
Rate for Payer: PHP Commercial	$303.45
Rate for Payer: Priority Health Cigna Priority Health	$232.05
Rate for Payer: Priority Health SBD	$224.91

HC OT Z STOCKINGS CUSTOM EA $375

Facility

$382.50

Service Code	HCPCS A6549
Hospital Charge Code	98300105
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 STOCKINGS CUSTOM EA $375

Facility

$382.50

Service Code	HCPCS A6549
Hospital Charge Code	98300105
Hospital Revenue Code	270
Min. Negotiated Rate	$240.97
Max. Negotiated Rate	$344.25
Rate for Payer: Aetna Commercial	$325.12
Rate for Payer: Aetna New Business (MI Preferred)	$248.62
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 STOCKINGS CUSTOM EA $40

Facility

$40.80

Service Code	HCPCS A6549
Hospital Charge Code	98300106
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 STOCKINGS CUSTOM EA $40

Facility

$40.80

Service Code	HCPCS A6549
Hospital Charge Code	98300106
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 STOCKINGS CUSTOM EA $400

Facility

$408.00

Service Code	HCPCS A6549
Hospital Charge Code	98300107
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 STOCKINGS CUSTOM EA $400

Facility

$408.00

Service Code	HCPCS A6549
Hospital Charge Code	98300107
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 STOCKINGS CUSTOM EA $425

Facility

$433.50

Service Code	HCPCS A6549
Hospital Charge Code	98300108
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 STOCKINGS CUSTOM EA $425

Facility

$433.50

Service Code	HCPCS A6549
Hospital Charge Code	98300108
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 STOCKINGS CUSTOM EA $450

Facility

$459.00

Service Code	HCPCS A6549
Hospital Charge Code	98300109
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

Know your out-of-pocket cost for care.

All Charges