Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC OT Z STOCKINGS CUSTOM EA $375

Facility

$375.00

Service Code	HCPCS A6549
Hospital Charge Code	98300105
Hospital Revenue Code	270
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$337.50
Rate for Payer: ASR ASR	$363.75
Rate for Payer: BCBS Trust/PPO	$290.74
Rate for Payer: BCN Commercial	$290.74
Rate for Payer: Cash Price	$300.00
Rate for Payer: Cofinity Commercial	$352.50
Rate for Payer: Encore Health Key Benefits Commercial	$300.00
Rate for Payer: Healthscope Commercial	$375.00
Rate for Payer: Healthscope Whirlpool	$363.75
Rate for Payer: Mclaren Commercial	$337.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$318.75
Rate for Payer: Priority Health Cigna Priority Health	$262.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$330.00

HC OT Z STOCKINGS CUSTOM EA $375

Facility

$375.00

Service Code	HCPCS A6549
Hospital Charge Code	98300105
Hospital Revenue Code	270
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$337.50
Rate for Payer: ASR ASR	$363.75
Rate for Payer: BCBS Complete	$150.00
Rate for Payer: BCBS Trust/PPO	$290.74
Rate for Payer: BCN Commercial	$290.74
Rate for Payer: Cash Price	$300.00
Rate for Payer: Cofinity Commercial	$352.50
Rate for Payer: Encore Health Key Benefits Commercial	$300.00
Rate for Payer: Healthscope Commercial	$375.00
Rate for Payer: Healthscope Whirlpool	$363.75
Rate for Payer: Mclaren Commercial	$337.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$318.75
Rate for Payer: Priority Health Cigna Priority Health	$262.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$341.25
Rate for Payer: Priority Health Narrow Network	$266.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$330.00

HC OT Z STOCKINGS CUSTOM EA $40

Facility

$40.00

Service Code	HCPCS A6549
Hospital Charge Code	98300106
Hospital Revenue Code	270
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$36.00
Rate for Payer: ASR ASR	$38.80
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: BCBS Trust/PPO	$31.01
Rate for Payer: BCN Commercial	$31.01
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cofinity Commercial	$37.60
Rate for Payer: Encore Health Key Benefits Commercial	$32.00
Rate for Payer: Healthscope Commercial	$40.00
Rate for Payer: Healthscope Whirlpool	$38.80
Rate for Payer: Mclaren Commercial	$36.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$34.00
Rate for Payer: Priority Health Cigna Priority Health	$28.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36.40
Rate for Payer: Priority Health Narrow Network	$28.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$35.20

HC OT Z STOCKINGS CUSTOM EA $40

Facility

$40.00

Service Code	HCPCS A6549
Hospital Charge Code	98300106
Hospital Revenue Code	270
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$36.00
Rate for Payer: ASR ASR	$38.80
Rate for Payer: BCBS Trust/PPO	$31.01
Rate for Payer: BCN Commercial	$31.01
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cofinity Commercial	$37.60
Rate for Payer: Encore Health Key Benefits Commercial	$32.00
Rate for Payer: Healthscope Commercial	$40.00
Rate for Payer: Healthscope Whirlpool	$38.80
Rate for Payer: Mclaren Commercial	$36.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$34.00
Rate for Payer: Priority Health Cigna Priority Health	$28.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$35.20

HC OT Z STOCKINGS CUSTOM EA $400

Facility

$400.00

Service Code	HCPCS A6549
Hospital Charge Code	98300107
Hospital Revenue Code	270
Min. Negotiated Rate	$280.00
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$360.00
Rate for Payer: ASR ASR	$388.00
Rate for Payer: BCBS Trust/PPO	$310.12
Rate for Payer: BCN Commercial	$310.12
Rate for Payer: Cash Price	$320.00
Rate for Payer: Cofinity Commercial	$376.00
Rate for Payer: Encore Health Key Benefits Commercial	$320.00
Rate for Payer: Healthscope Commercial	$400.00
Rate for Payer: Healthscope Whirlpool	$388.00
Rate for Payer: Mclaren Commercial	$360.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$340.00
Rate for Payer: Priority Health Cigna Priority Health	$280.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$352.00

HC OT Z STOCKINGS CUSTOM EA $400

Facility

$400.00

Service Code	HCPCS A6549
Hospital Charge Code	98300107
Hospital Revenue Code	270
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$360.00
Rate for Payer: ASR ASR	$388.00
Rate for Payer: BCBS Complete	$160.00
Rate for Payer: BCBS Trust/PPO	$310.12
Rate for Payer: BCN Commercial	$310.12
Rate for Payer: Cash Price	$320.00
Rate for Payer: Cofinity Commercial	$376.00
Rate for Payer: Encore Health Key Benefits Commercial	$320.00
Rate for Payer: Healthscope Commercial	$400.00
Rate for Payer: Healthscope Whirlpool	$388.00
Rate for Payer: Mclaren Commercial	$360.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$340.00
Rate for Payer: Priority Health Cigna Priority Health	$280.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$364.00
Rate for Payer: Priority Health Narrow Network	$284.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$352.00

HC OT Z STOCKINGS CUSTOM EA $425

Facility

$425.00

Service Code	HCPCS A6549
Hospital Charge Code	98300108
Hospital Revenue Code	270
Min. Negotiated Rate	$297.50
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$382.50
Rate for Payer: ASR ASR	$412.25
Rate for Payer: BCBS Trust/PPO	$329.50
Rate for Payer: BCN Commercial	$329.50
Rate for Payer: Cash Price	$340.00
Rate for Payer: Cofinity Commercial	$399.50
Rate for Payer: Encore Health Key Benefits Commercial	$340.00
Rate for Payer: Healthscope Commercial	$425.00
Rate for Payer: Healthscope Whirlpool	$412.25
Rate for Payer: Mclaren Commercial	$382.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$361.25
Rate for Payer: Priority Health Cigna Priority Health	$297.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$374.00

HC OT Z STOCKINGS CUSTOM EA $425

Facility

$425.00

Service Code	HCPCS A6549
Hospital Charge Code	98300108
Hospital Revenue Code	270
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$382.50
Rate for Payer: ASR ASR	$412.25
Rate for Payer: BCBS Complete	$170.00
Rate for Payer: BCBS Trust/PPO	$329.50
Rate for Payer: BCN Commercial	$329.50
Rate for Payer: Cash Price	$340.00
Rate for Payer: Cofinity Commercial	$399.50
Rate for Payer: Encore Health Key Benefits Commercial	$340.00
Rate for Payer: Healthscope Commercial	$425.00
Rate for Payer: Healthscope Whirlpool	$412.25
Rate for Payer: Mclaren Commercial	$382.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$361.25
Rate for Payer: Priority Health Cigna Priority Health	$297.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$386.75
Rate for Payer: Priority Health Narrow Network	$301.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$374.00

HC OT Z STOCKINGS CUSTOM EA $450

Facility

$450.00

Service Code	HCPCS A6549
Hospital Charge Code	98300109
Hospital Revenue Code	270
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$405.00
Rate for Payer: ASR ASR	$436.50
Rate for Payer: BCBS Trust/PPO	$348.88
Rate for Payer: BCN Commercial	$348.88
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cofinity Commercial	$423.00
Rate for Payer: Encore Health Key Benefits Commercial	$360.00
Rate for Payer: Healthscope Commercial	$450.00
Rate for Payer: Healthscope Whirlpool	$436.50
Rate for Payer: Mclaren Commercial	$405.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$382.50
Rate for Payer: Priority Health Cigna Priority Health	$315.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$396.00

HC OT Z STOCKINGS CUSTOM EA $450

Facility

$450.00

Service Code	HCPCS A6549
Hospital Charge Code	98300109
Hospital Revenue Code	270
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$405.00
Rate for Payer: ASR ASR	$436.50
Rate for Payer: BCBS Complete	$180.00
Rate for Payer: BCBS Trust/PPO	$348.88
Rate for Payer: BCN Commercial	$348.88
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cofinity Commercial	$423.00
Rate for Payer: Encore Health Key Benefits Commercial	$360.00
Rate for Payer: Healthscope Commercial	$450.00
Rate for Payer: Healthscope Whirlpool	$436.50
Rate for Payer: Mclaren Commercial	$405.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$382.50
Rate for Payer: Priority Health Cigna Priority Health	$315.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$409.50
Rate for Payer: Priority Health Narrow Network	$319.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$396.00

HC OT Z STOCKINGS CUSTOM EA $50

Facility

$50.00

Service Code	HCPCS A6549
Hospital Charge Code	98300110
Hospital Revenue Code	270
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: ASR ASR	$48.50
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: BCBS Trust/PPO	$38.76
Rate for Payer: BCN Commercial	$38.76
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cofinity Commercial	$47.00
Rate for Payer: Encore Health Key Benefits Commercial	$40.00
Rate for Payer: Healthscope Commercial	$50.00
Rate for Payer: Healthscope Whirlpool	$48.50
Rate for Payer: Mclaren Commercial	$45.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$42.50
Rate for Payer: Priority Health Cigna Priority Health	$35.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$45.50
Rate for Payer: Priority Health Narrow Network	$35.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$44.00

HC OT Z STOCKINGS CUSTOM EA $50

Facility

$50.00

Service Code	HCPCS A6549
Hospital Charge Code	98300110
Hospital Revenue Code	270
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: ASR ASR	$48.50
Rate for Payer: BCBS Trust/PPO	$38.76
Rate for Payer: BCN Commercial	$38.76
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cofinity Commercial	$47.00
Rate for Payer: Encore Health Key Benefits Commercial	$40.00
Rate for Payer: Healthscope Commercial	$50.00
Rate for Payer: Healthscope Whirlpool	$48.50
Rate for Payer: Mclaren Commercial	$45.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$42.50
Rate for Payer: Priority Health Cigna Priority Health	$35.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$44.00

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	$24.00
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna Commercial	$54.00
Rate for Payer: ASR ASR	$58.20
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: BCBS Trust/PPO	$46.52
Rate for Payer: BCN Commercial	$46.52
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cofinity Commercial	$56.40
Rate for Payer: Encore Health Key Benefits Commercial	$48.00
Rate for Payer: Healthscope Commercial	$60.00
Rate for Payer: Healthscope Whirlpool	$58.20
Rate for Payer: Mclaren Commercial	$54.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$54.60
Rate for Payer: Priority Health Narrow Network	$42.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$52.80

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	$42.00
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna Commercial	$54.00
Rate for Payer: ASR ASR	$58.20
Rate for Payer: BCBS Trust/PPO	$46.52
Rate for Payer: BCN Commercial	$46.52
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cofinity Commercial	$56.40
Rate for Payer: Encore Health Key Benefits Commercial	$48.00
Rate for Payer: Healthscope Commercial	$60.00
Rate for Payer: Healthscope Whirlpool	$58.20
Rate for Payer: Mclaren Commercial	$54.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$52.80

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	$49.00
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$63.00
Rate for Payer: ASR ASR	$67.90
Rate for Payer: BCBS Trust/PPO	$54.27
Rate for Payer: BCN Commercial	$54.27
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cofinity Commercial	$65.80
Rate for Payer: Encore Health Key Benefits Commercial	$56.00
Rate for Payer: Healthscope Commercial	$70.00
Rate for Payer: Healthscope Whirlpool	$67.90
Rate for Payer: Mclaren Commercial	$63.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.50
Rate for Payer: Priority Health Cigna Priority Health	$49.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.60

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	$70.00
Rate for Payer: Aetna Commercial	$63.00
Rate for Payer: ASR ASR	$67.90
Rate for Payer: BCBS Complete	$28.00
Rate for Payer: BCBS Trust/PPO	$54.27
Rate for Payer: BCN Commercial	$54.27
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cofinity Commercial	$65.80
Rate for Payer: Encore Health Key Benefits Commercial	$56.00
Rate for Payer: Healthscope Commercial	$70.00
Rate for Payer: Healthscope Whirlpool	$67.90
Rate for Payer: Mclaren Commercial	$63.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.50
Rate for Payer: Priority Health Cigna Priority Health	$49.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$63.70
Rate for Payer: Priority Health Narrow Network	$49.70
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.60

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	$56.00
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$72.00
Rate for Payer: ASR ASR	$77.60
Rate for Payer: BCBS Trust/PPO	$62.02
Rate for Payer: BCN Commercial	$62.02
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cofinity Commercial	$75.20
Rate for Payer: Encore Health Key Benefits Commercial	$64.00
Rate for Payer: Healthscope Commercial	$80.00
Rate for Payer: Healthscope Whirlpool	$77.60
Rate for Payer: Mclaren Commercial	$72.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$68.00
Rate for Payer: Priority Health Cigna Priority Health	$56.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$70.40

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	$80.00
Rate for Payer: Aetna Commercial	$72.00
Rate for Payer: ASR ASR	$77.60
Rate for Payer: BCBS Complete	$32.00
Rate for Payer: BCBS Trust/PPO	$62.02
Rate for Payer: BCN Commercial	$62.02
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cofinity Commercial	$75.20
Rate for Payer: Encore Health Key Benefits Commercial	$64.00
Rate for Payer: Healthscope Commercial	$80.00
Rate for Payer: Healthscope Whirlpool	$77.60
Rate for Payer: Mclaren Commercial	$72.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$68.00
Rate for Payer: Priority Health Cigna Priority Health	$56.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$72.80
Rate for Payer: Priority Health Narrow Network	$56.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$70.40

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	$36.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna Commercial	$81.00
Rate for Payer: ASR ASR	$87.30
Rate for Payer: BCBS Complete	$36.00
Rate for Payer: BCBS Trust/PPO	$69.78
Rate for Payer: BCN Commercial	$69.78
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cofinity Commercial	$84.60
Rate for Payer: Encore Health Key Benefits Commercial	$72.00
Rate for Payer: Healthscope Commercial	$90.00
Rate for Payer: Healthscope Whirlpool	$87.30
Rate for Payer: Mclaren Commercial	$81.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.50
Rate for Payer: Priority Health Cigna Priority Health	$63.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$81.90
Rate for Payer: Priority Health Narrow Network	$63.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$79.20

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	$63.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna Commercial	$81.00
Rate for Payer: ASR ASR	$87.30
Rate for Payer: BCBS Trust/PPO	$69.78
Rate for Payer: BCN Commercial	$69.78
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cofinity Commercial	$84.60
Rate for Payer: Encore Health Key Benefits Commercial	$72.00
Rate for Payer: Healthscope Commercial	$90.00
Rate for Payer: Healthscope Whirlpool	$87.30
Rate for Payer: Mclaren Commercial	$81.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.50
Rate for Payer: Priority Health Cigna Priority Health	$63.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$79.20

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	$70.00
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$90.00
Rate for Payer: ASR ASR	$97.00
Rate for Payer: BCBS Trust/PPO	$77.53
Rate for Payer: BCN Commercial	$77.53
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cofinity Commercial	$94.00
Rate for Payer: Encore Health Key Benefits Commercial	$80.00
Rate for Payer: Healthscope Commercial	$100.00
Rate for Payer: Healthscope Whirlpool	$97.00
Rate for Payer: Mclaren Commercial	$90.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$85.00
Rate for Payer: Priority Health Cigna Priority Health	$70.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$88.00

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	$40.00
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$90.00
Rate for Payer: ASR ASR	$97.00
Rate for Payer: BCBS Complete	$40.00
Rate for Payer: BCBS Trust/PPO	$77.53
Rate for Payer: BCN Commercial	$77.53
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cofinity Commercial	$94.00
Rate for Payer: Encore Health Key Benefits Commercial	$80.00
Rate for Payer: Healthscope Commercial	$100.00
Rate for Payer: Healthscope Whirlpool	$97.00
Rate for Payer: Mclaren Commercial	$90.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$85.00
Rate for Payer: Priority Health Cigna Priority Health	$70.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$91.00
Rate for Payer: Priority Health Narrow Network	$71.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$88.00

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	$125.00
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: ASR ASR	$121.25
Rate for Payer: BCBS Complete	$50.00
Rate for Payer: BCBS Trust/PPO	$96.91
Rate for Payer: BCN Commercial	$96.91
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cofinity Commercial	$117.50
Rate for Payer: Encore Health Key Benefits Commercial	$100.00
Rate for Payer: Healthscope Commercial	$125.00
Rate for Payer: Healthscope Whirlpool	$121.25
Rate for Payer: Mclaren Commercial	$112.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$106.25
Rate for Payer: Priority Health Cigna Priority Health	$87.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$113.75
Rate for Payer: Priority Health Narrow Network	$88.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$110.00

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	$87.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: ASR ASR	$121.25
Rate for Payer: BCBS Trust/PPO	$96.91
Rate for Payer: BCN Commercial	$96.91
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cofinity Commercial	$117.50
Rate for Payer: Encore Health Key Benefits Commercial	$100.00
Rate for Payer: Healthscope Commercial	$125.00
Rate for Payer: Healthscope Whirlpool	$121.25
Rate for Payer: Mclaren Commercial	$112.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$106.25
Rate for Payer: Priority Health Cigna Priority Health	$87.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$110.00

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	$105.00
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$135.00
Rate for Payer: ASR ASR	$145.50
Rate for Payer: BCBS Trust/PPO	$116.30
Rate for Payer: BCN Commercial	$116.30
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cofinity Commercial	$141.00
Rate for Payer: Encore Health Key Benefits Commercial	$120.00
Rate for Payer: Healthscope Commercial	$150.00
Rate for Payer: Healthscope Whirlpool	$145.50
Rate for Payer: Mclaren Commercial	$135.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$127.50
Rate for Payer: Priority Health Cigna Priority Health	$105.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$132.00

Know your out-of-pocket cost for care.

All Charges