Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC OT Z SLEEVE OR GLOVE EA $350

Facility

$364.14

Service Code	HCPCS L3999
Hospital Charge Code	96000037
Hospital Revenue Code	270
Min. Negotiated Rate	$273.11
Max. Negotiated Rate	$364.14
Rate for Payer: Aetna Commercial	$327.73
Rate for Payer: ASR ASR	$353.22
Rate for Payer: BCBS Trust/PPO	$299.03
Rate for Payer: BCN Commercial	$299.03
Rate for Payer: Cash Price	$291.31
Rate for Payer: Cofinity Commercial	$342.29
Rate for Payer: Encore Health Key Benefits Commercial	$291.31
Rate for Payer: Healthscope Commercial	$353.22
Rate for Payer: Healthscope Whirlpool	$364.14
Rate for Payer: Mclaren Commercial	$327.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$309.52
Rate for Payer: Nomi Health Commercial	$298.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$273.11
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$320.44

HC OT Z SLEEVE OR GLOVE EA $350

Facility

$364.14

Service Code	HCPCS L3999
Hospital Charge Code	96000037
Hospital Revenue Code	270
Min. Negotiated Rate	$134.73
Max. Negotiated Rate	$364.14
Rate for Payer: Aetna Commercial	$327.73
Rate for Payer: Aetna Medicare	$134.73
Rate for Payer: ASR ASR	$353.22
Rate for Payer: BCBS Complete	$145.66
Rate for Payer: BCBS Trust/PPO	$300.23
Rate for Payer: BCN Commercial	$300.23
Rate for Payer: Cash Price	$291.31
Rate for Payer: Cofinity Commercial	$342.29
Rate for Payer: Encore Health Key Benefits Commercial	$291.31
Rate for Payer: Healthscope Commercial	$353.22
Rate for Payer: Healthscope Whirlpool	$364.14
Rate for Payer: Mclaren Commercial	$327.73
Rate for Payer: MI Amish Medical Board Commercial	$291.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$309.52
Rate for Payer: Nomi Health Commercial	$298.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$273.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$319.06
Rate for Payer: Priority Health Narrow Network	$255.26
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$320.44

HC OT Z SLEEVE OR GLOVE EA $375

Facility

$390.15

Service Code	HCPCS L3999
Hospital Charge Code	96000038
Hospital Revenue Code	270
Min. Negotiated Rate	$144.36
Max. Negotiated Rate	$390.15
Rate for Payer: Aetna Commercial	$351.13
Rate for Payer: Aetna Medicare	$144.36
Rate for Payer: ASR ASR	$378.45
Rate for Payer: BCBS Complete	$156.06
Rate for Payer: BCBS Trust/PPO	$321.68
Rate for Payer: BCN Commercial	$321.68
Rate for Payer: Cash Price	$312.12
Rate for Payer: Cofinity Commercial	$366.74
Rate for Payer: Encore Health Key Benefits Commercial	$312.12
Rate for Payer: Healthscope Commercial	$378.45
Rate for Payer: Healthscope Whirlpool	$390.15
Rate for Payer: Mclaren 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: Nomi Health Commercial	$319.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$292.61
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$341.85
Rate for Payer: Priority Health Narrow Network	$273.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$343.33

HC OT Z SLEEVE OR GLOVE EA $375

Facility

$390.15

Service Code	HCPCS L3999
Hospital Charge Code	96000038
Hospital Revenue Code	270
Min. Negotiated Rate	$292.61
Max. Negotiated Rate	$390.15
Rate for Payer: Aetna Commercial	$351.13
Rate for Payer: ASR ASR	$378.45
Rate for Payer: BCBS Trust/PPO	$320.39
Rate for Payer: BCN Commercial	$320.39
Rate for Payer: Cash Price	$312.12
Rate for Payer: Cofinity Commercial	$366.74
Rate for Payer: Encore Health Key Benefits Commercial	$312.12
Rate for Payer: Healthscope Commercial	$378.45
Rate for Payer: Healthscope Whirlpool	$390.15
Rate for Payer: Mclaren Commercial	$351.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$331.63
Rate for Payer: Nomi Health Commercial	$319.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$292.61
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$343.33

HC OT Z SLEEVE OR GLOVE EA $40

Facility

$41.62

Service Code	HCPCS L3999
Hospital Charge Code	96000039
Hospital Revenue Code	270
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$41.62
Rate for Payer: Aetna Commercial	$37.46
Rate for Payer: Aetna Medicare	$15.40
Rate for Payer: ASR ASR	$40.37
Rate for Payer: BCBS Complete	$16.65
Rate for Payer: BCBS Trust/PPO	$34.32
Rate for Payer: BCN Commercial	$34.32
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cofinity Commercial	$39.12
Rate for Payer: Encore Health Key Benefits Commercial	$33.30
Rate for Payer: Healthscope Commercial	$40.37
Rate for Payer: Healthscope Whirlpool	$41.62
Rate for Payer: Mclaren Commercial	$37.46
Rate for Payer: MI Amish Medical Board Commercial	$33.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.38
Rate for Payer: Nomi Health Commercial	$34.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$36.47
Rate for Payer: Priority Health Narrow Network	$29.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$36.63

HC OT Z SLEEVE OR GLOVE EA $40

Facility

$41.62

Service Code	HCPCS L3999
Hospital Charge Code	96000039
Hospital Revenue Code	270
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$41.62
Rate for Payer: Aetna Commercial	$37.46
Rate for Payer: ASR ASR	$40.37
Rate for Payer: BCBS Trust/PPO	$34.18
Rate for Payer: BCN Commercial	$34.18
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cofinity Commercial	$39.12
Rate for Payer: Encore Health Key Benefits Commercial	$33.30
Rate for Payer: Healthscope Commercial	$40.37
Rate for Payer: Healthscope Whirlpool	$41.62
Rate for Payer: Mclaren Commercial	$37.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.38
Rate for Payer: Nomi Health Commercial	$34.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$36.63

HC OT Z SLEEVE OR GLOVE EA $400

Facility

$416.16

Service Code	HCPCS L3999
Hospital Charge Code	96000040
Hospital Revenue Code	270
Min. Negotiated Rate	$312.12
Max. Negotiated Rate	$416.16
Rate for Payer: Aetna Commercial	$374.54
Rate for Payer: ASR ASR	$403.68
Rate for Payer: BCBS Trust/PPO	$341.75
Rate for Payer: BCN Commercial	$341.75
Rate for Payer: Cash Price	$332.93
Rate for Payer: Cofinity Commercial	$391.19
Rate for Payer: Encore Health Key Benefits Commercial	$332.93
Rate for Payer: Healthscope Commercial	$403.68
Rate for Payer: Healthscope Whirlpool	$416.16
Rate for Payer: Mclaren Commercial	$374.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$353.74
Rate for Payer: Nomi Health Commercial	$341.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$312.12
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$366.22

HC OT Z SLEEVE OR GLOVE EA $400

Facility

$416.16

Service Code	HCPCS L3999
Hospital Charge Code	96000040
Hospital Revenue Code	270
Min. Negotiated Rate	$153.98
Max. Negotiated Rate	$416.16
Rate for Payer: Aetna Commercial	$374.54
Rate for Payer: Aetna Medicare	$153.98
Rate for Payer: ASR ASR	$403.68
Rate for Payer: BCBS Complete	$166.46
Rate for Payer: BCBS Trust/PPO	$343.12
Rate for Payer: BCN Commercial	$343.12
Rate for Payer: Cash Price	$332.93
Rate for Payer: Cofinity Commercial	$391.19
Rate for Payer: Encore Health Key Benefits Commercial	$332.93
Rate for Payer: Healthscope Commercial	$403.68
Rate for Payer: Healthscope Whirlpool	$416.16
Rate for Payer: Mclaren 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: Nomi Health Commercial	$341.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$312.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$364.64
Rate for Payer: Priority Health Narrow Network	$291.73
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$366.22

HC OT Z SLEEVE OR GLOVE EA $425

Facility

$442.17

Service Code	HCPCS L3999
Hospital Charge Code	96000041
Hospital Revenue Code	270
Min. Negotiated Rate	$163.60
Max. Negotiated Rate	$442.17
Rate for Payer: Aetna Commercial	$397.95
Rate for Payer: Aetna Medicare	$163.60
Rate for Payer: ASR ASR	$428.90
Rate for Payer: BCBS Complete	$176.87
Rate for Payer: BCBS Trust/PPO	$364.57
Rate for Payer: BCN Commercial	$364.57
Rate for Payer: Cash Price	$353.74
Rate for Payer: Cofinity Commercial	$415.64
Rate for Payer: Encore Health Key Benefits Commercial	$353.74
Rate for Payer: Healthscope Commercial	$428.90
Rate for Payer: Healthscope Whirlpool	$442.17
Rate for Payer: Mclaren 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: Nomi Health Commercial	$362.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$331.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$387.43
Rate for Payer: Priority Health Narrow Network	$309.96
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$389.11

HC OT Z SLEEVE OR GLOVE EA $425

Facility

$442.17

Service Code	HCPCS L3999
Hospital Charge Code	96000041
Hospital Revenue Code	270
Min. Negotiated Rate	$331.63
Max. Negotiated Rate	$442.17
Rate for Payer: Aetna Commercial	$397.95
Rate for Payer: ASR ASR	$428.90
Rate for Payer: BCBS Trust/PPO	$363.11
Rate for Payer: BCN Commercial	$363.11
Rate for Payer: Cash Price	$353.74
Rate for Payer: Cofinity Commercial	$415.64
Rate for Payer: Encore Health Key Benefits Commercial	$353.74
Rate for Payer: Healthscope Commercial	$428.90
Rate for Payer: Healthscope Whirlpool	$442.17
Rate for Payer: Mclaren Commercial	$397.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$375.84
Rate for Payer: Nomi Health Commercial	$362.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$331.63
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$389.11

HC OT Z SLEEVE OR GLOVE EA $450

Facility

$468.18

Service Code	HCPCS L3999
Hospital Charge Code	96000042
Hospital Revenue Code	270
Min. Negotiated Rate	$351.13
Max. Negotiated Rate	$468.18
Rate for Payer: Aetna Commercial	$421.36
Rate for Payer: ASR ASR	$454.13
Rate for Payer: BCBS Trust/PPO	$384.47
Rate for Payer: BCN Commercial	$384.47
Rate for Payer: Cash Price	$374.54
Rate for Payer: Cofinity Commercial	$440.09
Rate for Payer: Encore Health Key Benefits Commercial	$374.54
Rate for Payer: Healthscope Commercial	$454.13
Rate for Payer: Healthscope Whirlpool	$468.18
Rate for Payer: Mclaren Commercial	$421.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$397.95
Rate for Payer: Nomi Health Commercial	$383.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$351.13
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$412.00

HC OT Z SLEEVE OR GLOVE EA $450

Facility

$468.18

Service Code	HCPCS L3999
Hospital Charge Code	96000042
Hospital Revenue Code	270
Min. Negotiated Rate	$173.23
Max. Negotiated Rate	$468.18
Rate for Payer: Aetna Commercial	$421.36
Rate for Payer: Aetna Medicare	$173.23
Rate for Payer: ASR ASR	$454.13
Rate for Payer: BCBS Complete	$187.27
Rate for Payer: BCBS Trust/PPO	$386.01
Rate for Payer: BCN Commercial	$386.01
Rate for Payer: Cash Price	$374.54
Rate for Payer: Cofinity Commercial	$440.09
Rate for Payer: Encore Health Key Benefits Commercial	$374.54
Rate for Payer: Healthscope Commercial	$454.13
Rate for Payer: Healthscope Whirlpool	$468.18
Rate for Payer: Mclaren 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: Nomi Health Commercial	$383.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$351.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$410.22
Rate for Payer: Priority Health Narrow Network	$328.19
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$412.00

HC OT Z SLEEVE OR GLOVE EA $50

Facility

$52.02

Service Code	HCPCS L3999
Hospital Charge Code	96000043
Hospital Revenue Code	270
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$52.02
Rate for Payer: Aetna Commercial	$46.82
Rate for Payer: Aetna Medicare	$19.25
Rate for Payer: ASR ASR	$50.46
Rate for Payer: BCBS Complete	$20.81
Rate for Payer: BCBS Trust/PPO	$42.89
Rate for Payer: BCN Commercial	$42.89
Rate for Payer: Cash Price	$41.62
Rate for Payer: Cofinity Commercial	$48.90
Rate for Payer: Encore Health Key Benefits Commercial	$41.62
Rate for Payer: Healthscope Commercial	$50.46
Rate for Payer: Healthscope Whirlpool	$52.02
Rate for Payer: Mclaren Commercial	$46.82
Rate for Payer: MI Amish Medical Board Commercial	$41.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.22
Rate for Payer: Nomi Health Commercial	$42.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$45.58
Rate for Payer: Priority Health Narrow Network	$36.47
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$45.78

HC OT Z SLEEVE OR GLOVE EA $50

Facility

$52.02

Service Code	HCPCS L3999
Hospital Charge Code	96000043
Hospital Revenue Code	270
Min. Negotiated Rate	$39.02
Max. Negotiated Rate	$52.02
Rate for Payer: Aetna Commercial	$46.82
Rate for Payer: ASR ASR	$50.46
Rate for Payer: BCBS Trust/PPO	$42.72
Rate for Payer: BCN Commercial	$42.72
Rate for Payer: Cash Price	$41.62
Rate for Payer: Cofinity Commercial	$48.90
Rate for Payer: Encore Health Key Benefits Commercial	$41.62
Rate for Payer: Healthscope Commercial	$50.46
Rate for Payer: Healthscope Whirlpool	$52.02
Rate for Payer: Mclaren Commercial	$46.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.22
Rate for Payer: Nomi Health Commercial	$42.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.02
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$45.78

HC OT Z SLEEVE OR GLOVE EA $60

Facility

$62.42

Service Code	HCPCS L3999
Hospital Charge Code	96000044
Hospital Revenue Code	270
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$62.42
Rate for Payer: Aetna Commercial	$56.18
Rate for Payer: Aetna Medicare	$23.10
Rate for Payer: ASR ASR	$60.55
Rate for Payer: BCBS Complete	$24.97
Rate for Payer: BCBS Trust/PPO	$51.47
Rate for Payer: BCN Commercial	$51.47
Rate for Payer: Cash Price	$49.94
Rate for Payer: Cofinity Commercial	$58.67
Rate for Payer: Encore Health Key Benefits Commercial	$49.94
Rate for Payer: Healthscope Commercial	$60.55
Rate for Payer: Healthscope Whirlpool	$62.42
Rate for Payer: Mclaren 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: Nomi Health Commercial	$51.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$46.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$54.69
Rate for Payer: Priority Health Narrow Network	$43.76
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$54.93

HC OT Z SLEEVE OR GLOVE EA $60

Facility

$62.42

Service Code	HCPCS L3999
Hospital Charge Code	96000044
Hospital Revenue Code	270
Min. Negotiated Rate	$46.81
Max. Negotiated Rate	$62.42
Rate for Payer: Aetna Commercial	$56.18
Rate for Payer: ASR ASR	$60.55
Rate for Payer: BCBS Trust/PPO	$51.26
Rate for Payer: BCN Commercial	$51.26
Rate for Payer: Cash Price	$49.94
Rate for Payer: Cofinity Commercial	$58.67
Rate for Payer: Encore Health Key Benefits Commercial	$49.94
Rate for Payer: Healthscope Commercial	$60.55
Rate for Payer: Healthscope Whirlpool	$62.42
Rate for Payer: Mclaren Commercial	$56.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.06
Rate for Payer: Nomi Health Commercial	$51.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$46.81
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$54.93

HC OT Z SLEEVE OR GLOVE EA $70

Facility

$72.83

Service Code	HCPCS L3999
Hospital Charge Code	96000045
Hospital Revenue Code	960
Min. Negotiated Rate	$26.95
Max. Negotiated Rate	$72.83
Rate for Payer: Aetna Commercial	$65.55
Rate for Payer: Aetna Medicare	$26.95
Rate for Payer: ASR ASR	$70.65
Rate for Payer: BCBS Complete	$29.13
Rate for Payer: BCBS Trust/PPO	$60.05
Rate for Payer: BCN Commercial	$60.05
Rate for Payer: Cash Price	$58.26
Rate for Payer: Cofinity Commercial	$68.46
Rate for Payer: Encore Health Key Benefits Commercial	$58.26
Rate for Payer: Healthscope Commercial	$70.65
Rate for Payer: Healthscope Whirlpool	$72.83
Rate for Payer: Mclaren 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: Nomi Health Commercial	$59.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$54.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$63.81
Rate for Payer: Priority Health Narrow Network	$51.05

HC OT Z SLEEVE OR GLOVE EA $70

Facility

$72.83

Service Code	HCPCS L3999
Hospital Charge Code	96000045
Hospital Revenue Code	960
Min. Negotiated Rate	$54.62
Max. Negotiated Rate	$72.83
Rate for Payer: Aetna Commercial	$65.55
Rate for Payer: ASR ASR	$70.65
Rate for Payer: BCBS Trust/PPO	$59.81
Rate for Payer: BCN Commercial	$59.81
Rate for Payer: Cash Price	$58.26
Rate for Payer: Cofinity Commercial	$68.46
Rate for Payer: Encore Health Key Benefits Commercial	$58.26
Rate for Payer: Healthscope Commercial	$70.65
Rate for Payer: Healthscope Whirlpool	$72.83
Rate for Payer: Mclaren Commercial	$65.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.91
Rate for Payer: Nomi Health Commercial	$59.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$54.62

HC OT Z SLEEVE OR GLOVE EA $80

Facility

$83.23

Service Code	HCPCS L3999
Hospital Charge Code	96000046
Hospital Revenue Code	270
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$83.23
Rate for Payer: Aetna Commercial	$74.91
Rate for Payer: Aetna Medicare	$30.80
Rate for Payer: ASR ASR	$80.73
Rate for Payer: BCBS Complete	$33.29
Rate for Payer: BCBS Trust/PPO	$68.62
Rate for Payer: BCN Commercial	$68.62
Rate for Payer: Cash Price	$66.58
Rate for Payer: Cofinity Commercial	$78.24
Rate for Payer: Encore Health Key Benefits Commercial	$66.58
Rate for Payer: Healthscope Commercial	$80.73
Rate for Payer: Healthscope Whirlpool	$83.23
Rate for Payer: Mclaren 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: Nomi Health Commercial	$68.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$62.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$72.93
Rate for Payer: Priority Health Narrow Network	$58.34
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$73.24

HC OT Z SLEEVE OR GLOVE EA $80

Facility

$83.23

Service Code	HCPCS L3999
Hospital Charge Code	96000046
Hospital Revenue Code	270
Min. Negotiated Rate	$62.42
Max. Negotiated Rate	$83.23
Rate for Payer: Aetna Commercial	$74.91
Rate for Payer: ASR ASR	$80.73
Rate for Payer: BCBS Trust/PPO	$68.35
Rate for Payer: BCN Commercial	$68.35
Rate for Payer: Cash Price	$66.58
Rate for Payer: Cofinity Commercial	$78.24
Rate for Payer: Encore Health Key Benefits Commercial	$66.58
Rate for Payer: Healthscope Commercial	$80.73
Rate for Payer: Healthscope Whirlpool	$83.23
Rate for Payer: Mclaren Commercial	$74.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.75
Rate for Payer: Nomi Health Commercial	$68.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$62.42
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$73.24

HC OT Z SLEEVE OR GLOVE EA $90

Facility

$93.64

Service Code	HCPCS L3999
Hospital Charge Code	96000047
Hospital Revenue Code	270
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$93.64
Rate for Payer: Aetna Commercial	$84.28
Rate for Payer: Aetna Medicare	$34.65
Rate for Payer: ASR ASR	$90.83
Rate for Payer: BCBS Complete	$37.46
Rate for Payer: BCBS Trust/PPO	$77.21
Rate for Payer: BCN Commercial	$77.21
Rate for Payer: Cash Price	$74.91
Rate for Payer: Cofinity Commercial	$88.02
Rate for Payer: Encore Health Key Benefits Commercial	$74.91
Rate for Payer: Healthscope Commercial	$90.83
Rate for Payer: Healthscope Whirlpool	$93.64
Rate for Payer: Mclaren 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: Nomi Health Commercial	$76.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$82.05
Rate for Payer: Priority Health Narrow Network	$65.64
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$82.40

HC OT Z SLEEVE OR GLOVE EA $90

Facility

$93.64

Service Code	HCPCS L3999
Hospital Charge Code	96000047
Hospital Revenue Code	270
Min. Negotiated Rate	$70.23
Max. Negotiated Rate	$93.64
Rate for Payer: Aetna Commercial	$84.28
Rate for Payer: ASR ASR	$90.83
Rate for Payer: BCBS Trust/PPO	$76.90
Rate for Payer: BCN Commercial	$76.90
Rate for Payer: Cash Price	$74.91
Rate for Payer: Cofinity Commercial	$88.02
Rate for Payer: Encore Health Key Benefits Commercial	$74.91
Rate for Payer: Healthscope Commercial	$90.83
Rate for Payer: Healthscope Whirlpool	$93.64
Rate for Payer: Mclaren Commercial	$84.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.59
Rate for Payer: Nomi Health Commercial	$76.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$82.40

HC OT Z STOCKINGS CUSTOM EA $100

Facility

$104.04

Service Code	HCPCS A6549
Hospital Charge Code	98300094
Hospital Revenue Code	270
Min. Negotiated Rate	$38.49
Max. Negotiated Rate	$104.04
Rate for Payer: Aetna Commercial	$93.64
Rate for Payer: Aetna Medicare	$38.49
Rate for Payer: ASR ASR	$100.92
Rate for Payer: BCBS Complete	$41.62
Rate for Payer: BCBS Trust/PPO	$85.78
Rate for Payer: BCN Commercial	$85.78
Rate for Payer: Cash Price	$83.23
Rate for Payer: Cofinity Commercial	$97.80
Rate for Payer: Encore Health Key Benefits Commercial	$83.23
Rate for Payer: Healthscope Commercial	$100.92
Rate for Payer: Healthscope Whirlpool	$104.04
Rate for Payer: Mclaren 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: Nomi Health Commercial	$85.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$78.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$91.16
Rate for Payer: Priority Health Narrow Network	$72.93
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$91.56

HC OT Z STOCKINGS CUSTOM EA $100

Facility

$104.04

Service Code	HCPCS A6549
Hospital Charge Code	98300094
Hospital Revenue Code	270
Min. Negotiated Rate	$78.03
Max. Negotiated Rate	$104.04
Rate for Payer: Aetna Commercial	$93.64
Rate for Payer: ASR ASR	$100.92
Rate for Payer: BCBS Trust/PPO	$85.44
Rate for Payer: BCN Commercial	$85.44
Rate for Payer: Cash Price	$83.23
Rate for Payer: Cofinity Commercial	$97.80
Rate for Payer: Encore Health Key Benefits Commercial	$83.23
Rate for Payer: Healthscope Commercial	$100.92
Rate for Payer: Healthscope Whirlpool	$104.04
Rate for Payer: Mclaren Commercial	$93.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$88.43
Rate for Payer: Nomi Health Commercial	$85.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$78.03
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$91.56

HC OT Z STOCKINGS CUSTOM EA $125

Facility

$130.05

Service Code	HCPCS A6549
Hospital Charge Code	98300095
Hospital Revenue Code	270
Min. Negotiated Rate	$97.54
Max. Negotiated Rate	$130.05
Rate for Payer: Aetna Commercial	$117.05
Rate for Payer: ASR ASR	$126.15
Rate for Payer: BCBS Trust/PPO	$106.80
Rate for Payer: BCN Commercial	$106.80
Rate for Payer: Cash Price	$104.04
Rate for Payer: Cofinity Commercial	$122.25
Rate for Payer: Encore Health Key Benefits Commercial	$104.04
Rate for Payer: Healthscope Commercial	$126.15
Rate for Payer: Healthscope Whirlpool	$130.05
Rate for Payer: Mclaren Commercial	$117.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$110.54
Rate for Payer: Nomi Health Commercial	$106.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$97.54
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$114.44

Know your out-of-pocket cost for care.

All Charges