Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC OT Z STOCKINGS CUSTOM EA $425

Facility

$442.17

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

Facility

$442.17

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

Facility

$468.18

Service Code	HCPCS A6549
Hospital Charge Code	98300109
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 STOCKINGS CUSTOM EA $450

Facility

$468.18

Service Code	HCPCS A6549
Hospital Charge Code	98300109
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 STOCKINGS CUSTOM EA $50

Facility

$52.02

Service Code	HCPCS A6549
Hospital Charge Code	98300110
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 STOCKINGS CUSTOM EA $50

Facility

$52.02

Service Code	HCPCS A6549
Hospital Charge Code	98300110
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 STOCKINGS CUSTOM EA $60

Facility

$62.42

Service Code	HCPCS A6549
Hospital Charge Code	98300111
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 STOCKINGS CUSTOM EA $60

Facility

$62.42

Service Code	HCPCS A6549
Hospital Charge Code	98300111
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 STOCKINGS CUSTOM EA $70

Facility

$72.83

Service Code	HCPCS A6549
Hospital Charge Code	98300112
Hospital Revenue Code	270
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
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$64.09

HC OT Z STOCKINGS CUSTOM EA $70

Facility

$72.83

Service Code	HCPCS A6549
Hospital Charge Code	98300112
Hospital Revenue Code	270
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
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$64.09

HC OT Z STOCKINGS CUSTOM EA $80

Facility

$83.23

Service Code	HCPCS A6549
Hospital Charge Code	98300113
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 STOCKINGS CUSTOM EA $80

Facility

$83.23

Service Code	HCPCS A6549
Hospital Charge Code	98300113
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 STOCKINGS CUSTOM EA $90

Facility

$93.64

Service Code	HCPCS A6549
Hospital Charge Code	98300114
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 STOCKINGS CUSTOM EA $90

Facility

$93.64

Service Code	HCPCS A6549
Hospital Charge Code	98300114
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 NON CUSTOM $100

Facility

$104.04

Service Code	HCPCS A6549
Hospital Charge Code	98300115
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 NON CUSTOM $100

Facility

$104.04

Service Code	HCPCS A6549
Hospital Charge Code	98300115
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 NON CUSTOM $125

Facility

$130.05

Service Code	HCPCS A6549
Hospital Charge Code	98300116
Hospital Revenue Code	270
Min. Negotiated Rate	$48.12
Max. Negotiated Rate	$130.05
Rate for Payer: Aetna Commercial	$117.05
Rate for Payer: Aetna Medicare	$48.12
Rate for Payer: ASR ASR	$126.15
Rate for Payer: BCBS Complete	$52.02
Rate for Payer: BCBS Trust/PPO	$107.23
Rate for Payer: BCN Commercial	$107.23
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: MI Amish Medical Board Commercial	$104.04
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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$113.95
Rate for Payer: Priority Health Narrow Network	$91.17
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$114.44

HC OT Z STOCKINGS NON CUSTOM $125

Facility

$130.05

Service Code	HCPCS A6549
Hospital Charge Code	98300116
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

HC OT Z STOCKINGS NON CUSTOM $150

Facility

$156.06

Service Code	HCPCS A6549
Hospital Charge Code	98300117
Hospital Revenue Code	270
Min. Negotiated Rate	$57.74
Max. Negotiated Rate	$156.06
Rate for Payer: Aetna Commercial	$140.45
Rate for Payer: Aetna Medicare	$57.74
Rate for Payer: ASR ASR	$151.38
Rate for Payer: BCBS Complete	$62.42
Rate for Payer: BCBS Trust/PPO	$128.67
Rate for Payer: BCN Commercial	$128.67
Rate for Payer: Cash Price	$124.85
Rate for Payer: Cofinity Commercial	$146.70
Rate for Payer: Encore Health Key Benefits Commercial	$124.85
Rate for Payer: Healthscope Commercial	$151.38
Rate for Payer: Healthscope Whirlpool	$156.06
Rate for Payer: Mclaren Commercial	$140.45
Rate for Payer: MI Amish Medical Board Commercial	$124.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$132.65
Rate for Payer: Nomi Health Commercial	$127.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$117.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$136.74
Rate for Payer: Priority Health Narrow Network	$109.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$137.33

HC OT Z STOCKINGS NON CUSTOM $150

Facility

$156.06

Service Code	HCPCS A6549
Hospital Charge Code	98300117
Hospital Revenue Code	270
Min. Negotiated Rate	$117.05
Max. Negotiated Rate	$156.06
Rate for Payer: Aetna Commercial	$140.45
Rate for Payer: ASR ASR	$151.38
Rate for Payer: BCBS Trust/PPO	$128.16
Rate for Payer: BCN Commercial	$128.16
Rate for Payer: Cash Price	$124.85
Rate for Payer: Cofinity Commercial	$146.70
Rate for Payer: Encore Health Key Benefits Commercial	$124.85
Rate for Payer: Healthscope Commercial	$151.38
Rate for Payer: Healthscope Whirlpool	$156.06
Rate for Payer: Mclaren Commercial	$140.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$132.65
Rate for Payer: Nomi Health Commercial	$127.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$117.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$137.33

HC OT Z STOCKINGS NON CUSTOM $175

Facility

$182.07

Service Code	HCPCS A6549
Hospital Charge Code	98300118
Hospital Revenue Code	270
Min. Negotiated Rate	$67.37
Max. Negotiated Rate	$182.07
Rate for Payer: Aetna Commercial	$163.86
Rate for Payer: Aetna Medicare	$67.37
Rate for Payer: ASR ASR	$176.61
Rate for Payer: BCBS Complete	$72.83
Rate for Payer: BCBS Trust/PPO	$150.12
Rate for Payer: BCN Commercial	$150.12
Rate for Payer: Cash Price	$145.66
Rate for Payer: Cofinity Commercial	$171.15
Rate for Payer: Encore Health Key Benefits Commercial	$145.66
Rate for Payer: Healthscope Commercial	$176.61
Rate for Payer: Healthscope Whirlpool	$182.07
Rate for Payer: Mclaren Commercial	$163.86
Rate for Payer: MI Amish Medical Board Commercial	$145.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$154.76
Rate for Payer: Nomi Health Commercial	$149.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$136.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$159.53
Rate for Payer: Priority Health Narrow Network	$127.63
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$160.22

HC OT Z STOCKINGS NON CUSTOM $175

Facility

$182.07

Service Code	HCPCS A6549
Hospital Charge Code	98300118
Hospital Revenue Code	270
Min. Negotiated Rate	$136.55
Max. Negotiated Rate	$182.07
Rate for Payer: Aetna Commercial	$163.86
Rate for Payer: ASR ASR	$176.61
Rate for Payer: BCBS Trust/PPO	$149.52
Rate for Payer: BCN Commercial	$149.52
Rate for Payer: Cash Price	$145.66
Rate for Payer: Cofinity Commercial	$171.15
Rate for Payer: Encore Health Key Benefits Commercial	$145.66
Rate for Payer: Healthscope Commercial	$176.61
Rate for Payer: Healthscope Whirlpool	$182.07
Rate for Payer: Mclaren Commercial	$163.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$154.76
Rate for Payer: Nomi Health Commercial	$149.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$136.55
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$160.22

HC OT Z STOCKINGS NON CUSTOM $200

Facility

$208.08

Service Code	HCPCS A6549
Hospital Charge Code	98300119
Hospital Revenue Code	270
Min. Negotiated Rate	$156.06
Max. Negotiated Rate	$208.08
Rate for Payer: Aetna Commercial	$187.27
Rate for Payer: ASR ASR	$201.84
Rate for Payer: BCBS Trust/PPO	$170.88
Rate for Payer: BCN Commercial	$170.88
Rate for Payer: Cash Price	$166.46
Rate for Payer: Cofinity Commercial	$195.60
Rate for Payer: Encore Health Key Benefits Commercial	$166.46
Rate for Payer: Healthscope Commercial	$201.84
Rate for Payer: Healthscope Whirlpool	$208.08
Rate for Payer: Mclaren Commercial	$187.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$176.87
Rate for Payer: Nomi Health Commercial	$170.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$156.06
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$183.11

HC OT Z STOCKINGS NON CUSTOM $200

Facility

$208.08

Service Code	HCPCS A6549
Hospital Charge Code	98300119
Hospital Revenue Code	270
Min. Negotiated Rate	$76.99
Max. Negotiated Rate	$208.08
Rate for Payer: Aetna Commercial	$187.27
Rate for Payer: Aetna Medicare	$76.99
Rate for Payer: ASR ASR	$201.84
Rate for Payer: BCBS Complete	$83.23
Rate for Payer: BCBS Trust/PPO	$171.56
Rate for Payer: BCN Commercial	$171.56
Rate for Payer: Cash Price	$166.46
Rate for Payer: Cofinity Commercial	$195.60
Rate for Payer: Encore Health Key Benefits Commercial	$166.46
Rate for Payer: Healthscope Commercial	$201.84
Rate for Payer: Healthscope Whirlpool	$208.08
Rate for Payer: Mclaren Commercial	$187.27
Rate for Payer: MI Amish Medical Board Commercial	$166.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$176.87
Rate for Payer: Nomi Health Commercial	$170.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$156.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$182.32
Rate for Payer: Priority Health Narrow Network	$145.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$183.11

HC OT Z STOCKINGS NON CUSTOM $225

Facility

$234.09

Service Code	HCPCS A6549
Hospital Charge Code	98300120
Hospital Revenue Code	270
Min. Negotiated Rate	$86.61
Max. Negotiated Rate	$234.09
Rate for Payer: Aetna Commercial	$210.68
Rate for Payer: Aetna Medicare	$86.61
Rate for Payer: ASR ASR	$227.07
Rate for Payer: BCBS Complete	$93.64
Rate for Payer: BCBS Trust/PPO	$193.01
Rate for Payer: BCN Commercial	$193.01
Rate for Payer: Cash Price	$187.27
Rate for Payer: Cofinity Commercial	$220.04
Rate for Payer: Encore Health Key Benefits Commercial	$187.27
Rate for Payer: Healthscope Commercial	$227.07
Rate for Payer: Healthscope Whirlpool	$234.09
Rate for Payer: Mclaren Commercial	$210.68
Rate for Payer: MI Amish Medical Board Commercial	$187.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$198.98
Rate for Payer: Nomi Health Commercial	$191.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$175.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$205.11
Rate for Payer: Priority Health Narrow Network	$164.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$206.00

Know your out-of-pocket cost for care.

All Charges