Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC OT Z STOCKINGS NON CUSTOM $275

Facility

$280.50

Service Code	HCPCS A6549
Hospital Charge Code	98300122
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 NON CUSTOM $275

Facility

$280.50

Service Code	HCPCS A6549
Hospital Charge Code	98300122
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 NON CUSTOM $300

Facility

$306.00

Service Code	HCPCS A6549
Hospital Charge Code	98300123
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 NON CUSTOM $300

Facility

$306.00

Service Code	HCPCS A6549
Hospital Charge Code	98300123
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 NON CUSTOM $325

Facility

$331.50

Service Code	HCPCS A6549
Hospital Charge Code	98300124
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 NON CUSTOM $325

Facility

$331.50

Service Code	HCPCS A6549
Hospital Charge Code	98300124
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 NON CUSTOM $350

Facility

$357.00

Service Code	HCPCS A6549
Hospital Charge Code	98300125
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 NON CUSTOM $350

Facility

$357.00

Service Code	HCPCS A6549
Hospital Charge Code	98300125
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 NON CUSTOM $375

Facility

$382.50

Service Code	HCPCS A6549
Hospital Charge Code	98300126
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 NON CUSTOM $375

Facility

$382.50

Service Code	HCPCS A6549
Hospital Charge Code	98300126
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 NON CUSTOM $40

Facility

$40.80

Service Code	HCPCS A6549
Hospital Charge Code	98300127
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 NON CUSTOM $40

Facility

$40.80

Service Code	HCPCS A6549
Hospital Charge Code	98300127
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 NON CUSTOM $400

Facility

$408.00

Service Code	HCPCS A6549
Hospital Charge Code	98300128
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 NON CUSTOM $400

Facility

$408.00

Service Code	HCPCS A6549
Hospital Charge Code	98300128
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 NON CUSTOM $425

Facility

$433.50

Service Code	HCPCS A6549
Hospital Charge Code	98300129
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 NON CUSTOM $425

Facility

$433.50

Service Code	HCPCS A6549
Hospital Charge Code	98300129
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 NON CUSTOM $450

Facility

$459.00

Service Code	HCPCS A6549
Hospital Charge Code	98300130
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 STOCKINGS NON CUSTOM $450

Facility

$459.00

Service Code	HCPCS A6549
Hospital Charge Code	98300130
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 STOCKINGS NON CUSTOM $50

Facility

$51.00

Service Code	HCPCS A6549
Hospital Charge Code	98300131
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 STOCKINGS NON CUSTOM $50

Facility

$51.00

Service Code	HCPCS A6549
Hospital Charge Code	98300131
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 STOCKINGS NON CUSTOM $60

Facility

$61.20

Service Code	HCPCS A6549
Hospital Charge Code	98300132
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 STOCKINGS NON CUSTOM $60

Facility

$61.20

Service Code	HCPCS A6549
Hospital Charge Code	98300132
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 STOCKINGS NON CUSTOM $70

Facility

$71.40

Service Code	HCPCS A6549
Hospital Charge Code	98300133
Hospital Revenue Code	270
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 STOCKINGS NON CUSTOM $70

Facility

$71.40

Service Code	HCPCS A6549
Hospital Charge Code	98300133
Hospital Revenue Code	270
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 STOCKINGS NON CUSTOM $80

Facility

$81.60

Service Code	HCPCS A6549
Hospital Charge Code	98300134
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

Know your out-of-pocket cost for care.

All Charges