Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC OT Z GAUNTLET EA $275

Facility

$280.50

Service Code	HCPCS A6549
Hospital Charge Code	98300082
Hospital Revenue Code	270
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$280.50
Rate for Payer: Aetna Commercial	$252.45
Rate for Payer: Aetna Medicare	$140.25
Rate for Payer: ASR ASR	$272.08
Rate for Payer: ASR Commercial	$272.08
Rate for Payer: BCBS Complete	$112.20
Rate for Payer: BCBS Trust/PPO	$229.70
Rate for Payer: BCN Commercial	$217.47
Rate for Payer: Cash Price	$224.40
Rate for Payer: Cofinity Commercial	$263.67
Rate for Payer: Encore Health Key Benefits Commercial	$224.40
Rate for Payer: Healthscope Commercial	$280.50
Rate for Payer: Healthscope Whirlpool	$272.08
Rate for Payer: Mclaren Commercial	$252.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$238.42
Rate for Payer: Nomi Health Commercial	$230.01
Rate for Payer: Priority Health Cigna Priority Health	$182.32
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$245.77
Rate for Payer: Priority Health Narrow Network	$196.63
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$246.84

HC OT Z GAUNTLET EA $275

Facility

$280.50

Service Code	HCPCS A6549
Hospital Charge Code	98300082
Hospital Revenue Code	270
Min. Negotiated Rate	$182.32
Max. Negotiated Rate	$280.50
Rate for Payer: Aetna Commercial	$252.45
Rate for Payer: ASR ASR	$272.08
Rate for Payer: ASR Commercial	$272.08
Rate for Payer: BCBS Trust/PPO	$228.58
Rate for Payer: BCN Commercial	$217.47
Rate for Payer: Cash Price	$224.40
Rate for Payer: Cofinity Commercial	$263.67
Rate for Payer: Encore Health Key Benefits Commercial	$224.40
Rate for Payer: Healthscope Commercial	$280.50
Rate for Payer: Healthscope Whirlpool	$272.08
Rate for Payer: Mclaren Commercial	$252.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$238.42
Rate for Payer: Nomi Health Commercial	$230.01
Rate for Payer: Priority Health Cigna Priority Health	$182.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$246.84

HC OT Z GAUNTLET EA $300

Facility

$306.00

Service Code	HCPCS A6549
Hospital Charge Code	98300083
Hospital Revenue Code	270
Min. Negotiated Rate	$198.90
Max. Negotiated Rate	$306.00
Rate for Payer: Aetna Commercial	$275.40
Rate for Payer: ASR ASR	$296.82
Rate for Payer: ASR Commercial	$296.82
Rate for Payer: BCBS Trust/PPO	$249.36
Rate for Payer: BCN Commercial	$237.24
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cofinity Commercial	$287.64
Rate for Payer: Encore Health Key Benefits Commercial	$244.80
Rate for Payer: Healthscope Commercial	$306.00
Rate for Payer: Healthscope Whirlpool	$296.82
Rate for Payer: Mclaren Commercial	$275.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$260.10
Rate for Payer: Nomi Health Commercial	$250.92
Rate for Payer: Priority Health Cigna Priority Health	$198.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$269.28

HC OT Z GAUNTLET EA $300

Facility

$306.00

Service Code	HCPCS A6549
Hospital Charge Code	98300083
Hospital Revenue Code	270
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$306.00
Rate for Payer: Aetna Commercial	$275.40
Rate for Payer: Aetna Medicare	$153.00
Rate for Payer: ASR ASR	$296.82
Rate for Payer: ASR Commercial	$296.82
Rate for Payer: BCBS Complete	$122.40
Rate for Payer: BCBS Trust/PPO	$250.58
Rate for Payer: BCN Commercial	$237.24
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cofinity Commercial	$287.64
Rate for Payer: Encore Health Key Benefits Commercial	$244.80
Rate for Payer: Healthscope Commercial	$306.00
Rate for Payer: Healthscope Whirlpool	$296.82
Rate for Payer: Mclaren Commercial	$275.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$260.10
Rate for Payer: Nomi Health Commercial	$250.92
Rate for Payer: Priority Health Cigna Priority Health	$198.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$268.12
Rate for Payer: Priority Health Narrow Network	$214.51
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$269.28

HC OT Z GAUNTLET EA $325

Facility

$331.50

Service Code	HCPCS A6549
Hospital Charge Code	98300084
Hospital Revenue Code	270
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$331.50
Rate for Payer: Aetna Commercial	$298.35
Rate for Payer: Aetna Medicare	$165.75
Rate for Payer: ASR ASR	$321.56
Rate for Payer: ASR Commercial	$321.56
Rate for Payer: BCBS Complete	$132.60
Rate for Payer: BCBS Trust/PPO	$271.47
Rate for Payer: BCN Commercial	$257.01
Rate for Payer: Cash Price	$265.20
Rate for Payer: Cofinity Commercial	$311.61
Rate for Payer: Encore Health Key Benefits Commercial	$265.20
Rate for Payer: Healthscope Commercial	$331.50
Rate for Payer: Healthscope Whirlpool	$321.56
Rate for Payer: Mclaren Commercial	$298.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$281.78
Rate for Payer: Nomi Health Commercial	$271.83
Rate for Payer: Priority Health Cigna Priority Health	$215.48
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$290.46
Rate for Payer: Priority Health Narrow Network	$232.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$291.72

HC OT Z GAUNTLET EA $325

Facility

$331.50

Service Code	HCPCS A6549
Hospital Charge Code	98300084
Hospital Revenue Code	270
Min. Negotiated Rate	$215.48
Max. Negotiated Rate	$331.50
Rate for Payer: Aetna Commercial	$298.35
Rate for Payer: ASR ASR	$321.56
Rate for Payer: ASR Commercial	$321.56
Rate for Payer: BCBS Trust/PPO	$270.14
Rate for Payer: BCN Commercial	$257.01
Rate for Payer: Cash Price	$265.20
Rate for Payer: Cofinity Commercial	$311.61
Rate for Payer: Encore Health Key Benefits Commercial	$265.20
Rate for Payer: Healthscope Commercial	$331.50
Rate for Payer: Healthscope Whirlpool	$321.56
Rate for Payer: Mclaren Commercial	$298.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$281.78
Rate for Payer: Nomi Health Commercial	$271.83
Rate for Payer: Priority Health Cigna Priority Health	$215.48
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$291.72

HC OT Z GAUNTLET EA $350

Facility

$357.00

Service Code	HCPCS A6549
Hospital Charge Code	98300085
Hospital Revenue Code	270
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$357.00
Rate for Payer: Aetna Commercial	$321.30
Rate for Payer: Aetna Medicare	$178.50
Rate for Payer: ASR ASR	$346.29
Rate for Payer: ASR Commercial	$346.29
Rate for Payer: BCBS Complete	$142.80
Rate for Payer: BCBS Trust/PPO	$292.35
Rate for Payer: BCN Commercial	$276.78
Rate for Payer: Cash Price	$285.60
Rate for Payer: Cofinity Commercial	$335.58
Rate for Payer: Encore Health Key Benefits Commercial	$285.60
Rate for Payer: Healthscope Commercial	$357.00
Rate for Payer: Healthscope Whirlpool	$346.29
Rate for Payer: Mclaren Commercial	$321.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$303.45
Rate for Payer: Nomi Health Commercial	$292.74
Rate for Payer: Priority Health Cigna Priority Health	$232.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$312.80
Rate for Payer: Priority Health Narrow Network	$250.26
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$314.16

HC OT Z GAUNTLET EA $350

Facility

$357.00

Service Code	HCPCS A6549
Hospital Charge Code	98300085
Hospital Revenue Code	270
Min. Negotiated Rate	$232.05
Max. Negotiated Rate	$357.00
Rate for Payer: Aetna Commercial	$321.30
Rate for Payer: ASR ASR	$346.29
Rate for Payer: ASR Commercial	$346.29
Rate for Payer: BCBS Trust/PPO	$290.92
Rate for Payer: BCN Commercial	$276.78
Rate for Payer: Cash Price	$285.60
Rate for Payer: Cofinity Commercial	$335.58
Rate for Payer: Encore Health Key Benefits Commercial	$285.60
Rate for Payer: Healthscope Commercial	$357.00
Rate for Payer: Healthscope Whirlpool	$346.29
Rate for Payer: Mclaren Commercial	$321.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$303.45
Rate for Payer: Nomi Health Commercial	$292.74
Rate for Payer: Priority Health Cigna Priority Health	$232.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$314.16

HC OT Z GAUNTLET EA $375

Facility

$382.50

Service Code	HCPCS A6549
Hospital Charge Code	98300086
Hospital Revenue Code	270
Min. Negotiated Rate	$248.62
Max. Negotiated Rate	$382.50
Rate for Payer: Aetna Commercial	$344.25
Rate for Payer: ASR ASR	$371.02
Rate for Payer: ASR Commercial	$371.02
Rate for Payer: BCBS Trust/PPO	$311.70
Rate for Payer: BCN Commercial	$296.55
Rate for Payer: Cash Price	$306.00
Rate for Payer: Cofinity Commercial	$359.55
Rate for Payer: Encore Health Key Benefits Commercial	$306.00
Rate for Payer: Healthscope Commercial	$382.50
Rate for Payer: Healthscope Whirlpool	$371.02
Rate for Payer: Mclaren Commercial	$344.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$325.12
Rate for Payer: Nomi Health Commercial	$313.65
Rate for Payer: Priority Health Cigna Priority Health	$248.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$336.60

HC OT Z GAUNTLET EA $375

Facility

$382.50

Service Code	HCPCS A6549
Hospital Charge Code	98300086
Hospital Revenue Code	270
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$382.50
Rate for Payer: Aetna Commercial	$344.25
Rate for Payer: Aetna Medicare	$191.25
Rate for Payer: ASR ASR	$371.02
Rate for Payer: ASR Commercial	$371.02
Rate for Payer: BCBS Complete	$153.00
Rate for Payer: BCBS Trust/PPO	$313.23
Rate for Payer: BCN Commercial	$296.55
Rate for Payer: Cash Price	$306.00
Rate for Payer: Cofinity Commercial	$359.55
Rate for Payer: Encore Health Key Benefits Commercial	$306.00
Rate for Payer: Healthscope Commercial	$382.50
Rate for Payer: Healthscope Whirlpool	$371.02
Rate for Payer: Mclaren Commercial	$344.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$325.12
Rate for Payer: Nomi Health Commercial	$313.65
Rate for Payer: Priority Health Cigna Priority Health	$248.62
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$335.15
Rate for Payer: Priority Health Narrow Network	$268.13
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$336.60

HC OT Z GAUNTLET EA $400

Facility

$408.00

Service Code	HCPCS A6549
Hospital Charge Code	98300087
Hospital Revenue Code	270
Min. Negotiated Rate	$265.20
Max. Negotiated Rate	$408.00
Rate for Payer: Aetna Commercial	$367.20
Rate for Payer: ASR ASR	$395.76
Rate for Payer: ASR Commercial	$395.76
Rate for Payer: BCBS Trust/PPO	$332.48
Rate for Payer: BCN Commercial	$316.32
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cofinity Commercial	$383.52
Rate for Payer: Encore Health Key Benefits Commercial	$326.40
Rate for Payer: Healthscope Commercial	$408.00
Rate for Payer: Healthscope Whirlpool	$395.76
Rate for Payer: Mclaren Commercial	$367.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$346.80
Rate for Payer: Nomi Health Commercial	$334.56
Rate for Payer: Priority Health Cigna Priority Health	$265.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$359.04

HC OT Z GAUNTLET EA $400

Facility

$408.00

Service Code	HCPCS A6549
Hospital Charge Code	98300087
Hospital Revenue Code	270
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$408.00
Rate for Payer: Aetna Commercial	$367.20
Rate for Payer: Aetna Medicare	$204.00
Rate for Payer: ASR ASR	$395.76
Rate for Payer: ASR Commercial	$395.76
Rate for Payer: BCBS Complete	$163.20
Rate for Payer: BCBS Trust/PPO	$334.11
Rate for Payer: BCN Commercial	$316.32
Rate for Payer: Cash Price	$326.40
Rate for Payer: Cofinity Commercial	$383.52
Rate for Payer: Encore Health Key Benefits Commercial	$326.40
Rate for Payer: Healthscope Commercial	$408.00
Rate for Payer: Healthscope Whirlpool	$395.76
Rate for Payer: Mclaren Commercial	$367.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$346.80
Rate for Payer: Nomi Health Commercial	$334.56
Rate for Payer: Priority Health Cigna Priority Health	$265.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$357.49
Rate for Payer: Priority Health Narrow Network	$286.01
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$359.04

HC OT Z GAUNTLET EA $425

Facility

$433.50

Service Code	HCPCS A6549
Hospital Charge Code	98300088
Hospital Revenue Code	270
Min. Negotiated Rate	$173.40
Max. Negotiated Rate	$433.50
Rate for Payer: Aetna Commercial	$390.15
Rate for Payer: Aetna Medicare	$216.75
Rate for Payer: ASR ASR	$420.50
Rate for Payer: ASR Commercial	$420.50
Rate for Payer: BCBS Complete	$173.40
Rate for Payer: BCBS Trust/PPO	$354.99
Rate for Payer: BCN Commercial	$336.09
Rate for Payer: Cash Price	$346.80
Rate for Payer: Cofinity Commercial	$407.49
Rate for Payer: Encore Health Key Benefits Commercial	$346.80
Rate for Payer: Healthscope Commercial	$433.50
Rate for Payer: Healthscope Whirlpool	$420.50
Rate for Payer: Mclaren Commercial	$390.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$368.48
Rate for Payer: Nomi Health Commercial	$355.47
Rate for Payer: Priority Health Cigna Priority Health	$281.78
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$379.83
Rate for Payer: Priority Health Narrow Network	$303.88
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$381.48

HC OT Z GAUNTLET EA $425

Facility

$433.50

Service Code	HCPCS A6549
Hospital Charge Code	98300088
Hospital Revenue Code	270
Min. Negotiated Rate	$281.78
Max. Negotiated Rate	$433.50
Rate for Payer: Aetna Commercial	$390.15
Rate for Payer: ASR ASR	$420.50
Rate for Payer: ASR Commercial	$420.50
Rate for Payer: BCBS Trust/PPO	$353.26
Rate for Payer: BCN Commercial	$336.09
Rate for Payer: Cash Price	$346.80
Rate for Payer: Cofinity Commercial	$407.49
Rate for Payer: Encore Health Key Benefits Commercial	$346.80
Rate for Payer: Healthscope Commercial	$433.50
Rate for Payer: Healthscope Whirlpool	$420.50
Rate for Payer: Mclaren Commercial	$390.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$368.48
Rate for Payer: Nomi Health Commercial	$355.47
Rate for Payer: Priority Health Cigna Priority Health	$281.78
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$381.48

HC OT Z GAUNTLET EA $450

Facility

$459.00

Service Code	HCPCS A6549
Hospital Charge Code	98300089
Hospital Revenue Code	270
Min. Negotiated Rate	$298.35
Max. Negotiated Rate	$459.00
Rate for Payer: Aetna Commercial	$413.10
Rate for Payer: ASR ASR	$445.23
Rate for Payer: ASR Commercial	$445.23
Rate for Payer: BCBS Trust/PPO	$374.04
Rate for Payer: BCN Commercial	$355.86
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cofinity Commercial	$431.46
Rate for Payer: Encore Health Key Benefits Commercial	$367.20
Rate for Payer: Healthscope Commercial	$459.00
Rate for Payer: Healthscope Whirlpool	$445.23
Rate for Payer: Mclaren Commercial	$413.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$390.15
Rate for Payer: Nomi Health Commercial	$376.38
Rate for Payer: Priority Health Cigna Priority Health	$298.35
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$403.92

HC OT Z GAUNTLET EA $450

Facility

$459.00

Service Code	HCPCS A6549
Hospital Charge Code	98300089
Hospital Revenue Code	270
Min. Negotiated Rate	$183.60
Max. Negotiated Rate	$459.00
Rate for Payer: Aetna Commercial	$413.10
Rate for Payer: Aetna Medicare	$229.50
Rate for Payer: ASR ASR	$445.23
Rate for Payer: ASR Commercial	$445.23
Rate for Payer: BCBS Complete	$183.60
Rate for Payer: BCBS Trust/PPO	$375.88
Rate for Payer: BCN Commercial	$355.86
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cofinity Commercial	$431.46
Rate for Payer: Encore Health Key Benefits Commercial	$367.20
Rate for Payer: Healthscope Commercial	$459.00
Rate for Payer: Healthscope Whirlpool	$445.23
Rate for Payer: Mclaren Commercial	$413.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$390.15
Rate for Payer: Nomi Health Commercial	$376.38
Rate for Payer: Priority Health Cigna Priority Health	$298.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$402.18
Rate for Payer: Priority Health Narrow Network	$321.76
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$403.92

HC OT Z GAUNTLET EA $60

Facility

$61.20

Service Code	HCPCS A6549
Hospital Charge Code	98300090
Hospital Revenue Code	270
Min. Negotiated Rate	$24.48
Max. Negotiated Rate	$61.20
Rate for Payer: Aetna Commercial	$55.08
Rate for Payer: Aetna Medicare	$30.60
Rate for Payer: ASR ASR	$59.36
Rate for Payer: ASR Commercial	$59.36
Rate for Payer: BCBS Complete	$24.48
Rate for Payer: BCBS Trust/PPO	$50.12
Rate for Payer: BCN Commercial	$47.45
Rate for Payer: Cash Price	$48.96
Rate for Payer: Cofinity Commercial	$57.53
Rate for Payer: Encore Health Key Benefits Commercial	$48.96
Rate for Payer: Healthscope Commercial	$61.20
Rate for Payer: Healthscope Whirlpool	$59.36
Rate for Payer: Mclaren Commercial	$55.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.02
Rate for Payer: Nomi Health Commercial	$50.18
Rate for Payer: Priority Health Cigna Priority Health	$39.78
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$53.62
Rate for Payer: Priority Health Narrow Network	$42.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$53.86

HC OT Z GAUNTLET EA $60

Facility

$61.20

Service Code	HCPCS A6549
Hospital Charge Code	98300090
Hospital Revenue Code	270
Min. Negotiated Rate	$39.78
Max. Negotiated Rate	$61.20
Rate for Payer: Aetna Commercial	$55.08
Rate for Payer: ASR ASR	$59.36
Rate for Payer: ASR Commercial	$59.36
Rate for Payer: BCBS Trust/PPO	$49.87
Rate for Payer: BCN Commercial	$47.45
Rate for Payer: Cash Price	$48.96
Rate for Payer: Cofinity Commercial	$57.53
Rate for Payer: Encore Health Key Benefits Commercial	$48.96
Rate for Payer: Healthscope Commercial	$61.20
Rate for Payer: Healthscope Whirlpool	$59.36
Rate for Payer: Mclaren Commercial	$55.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.02
Rate for Payer: Nomi Health Commercial	$50.18
Rate for Payer: Priority Health Cigna Priority Health	$39.78
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$53.86

HC OT Z GAUNTLET EA $70

Facility

$71.40

Service Code	HCPCS A6549
Hospital Charge Code	98300091
Hospital Revenue Code	270
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$71.40
Rate for Payer: Aetna Commercial	$64.26
Rate for Payer: ASR ASR	$69.26
Rate for Payer: ASR Commercial	$69.26
Rate for Payer: BCBS Trust/PPO	$58.18
Rate for Payer: BCN Commercial	$55.36
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cofinity Commercial	$67.12
Rate for Payer: Encore Health Key Benefits Commercial	$57.12
Rate for Payer: Healthscope Commercial	$71.40
Rate for Payer: Healthscope Whirlpool	$69.26
Rate for Payer: Mclaren Commercial	$64.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.69
Rate for Payer: Nomi Health Commercial	$58.55
Rate for Payer: Priority Health Cigna Priority Health	$46.41
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$62.83

HC OT Z GAUNTLET EA $70

Facility

$71.40

Service Code	HCPCS A6549
Hospital Charge Code	98300091
Hospital Revenue Code	270
Min. Negotiated Rate	$28.56
Max. Negotiated Rate	$71.40
Rate for Payer: Aetna Commercial	$64.26
Rate for Payer: Aetna Medicare	$35.70
Rate for Payer: ASR ASR	$69.26
Rate for Payer: ASR Commercial	$69.26
Rate for Payer: BCBS Complete	$28.56
Rate for Payer: BCBS Trust/PPO	$58.47
Rate for Payer: BCN Commercial	$55.36
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cofinity Commercial	$67.12
Rate for Payer: Encore Health Key Benefits Commercial	$57.12
Rate for Payer: Healthscope Commercial	$71.40
Rate for Payer: Healthscope Whirlpool	$69.26
Rate for Payer: Mclaren Commercial	$64.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.69
Rate for Payer: Nomi Health Commercial	$58.55
Rate for Payer: Priority Health Cigna Priority Health	$46.41
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$62.56
Rate for Payer: Priority Health Narrow Network	$50.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$62.83

HC OT Z GAUNTLET EA $80

Facility

$81.60

Service Code	HCPCS A6549
Hospital Charge Code	98300092
Hospital Revenue Code	270
Min. Negotiated Rate	$53.04
Max. Negotiated Rate	$81.60
Rate for Payer: Aetna Commercial	$73.44
Rate for Payer: ASR ASR	$79.15
Rate for Payer: ASR Commercial	$79.15
Rate for Payer: BCBS Trust/PPO	$66.50
Rate for Payer: BCN Commercial	$63.26
Rate for Payer: Cash Price	$65.28
Rate for Payer: Cofinity Commercial	$76.70
Rate for Payer: Encore Health Key Benefits Commercial	$65.28
Rate for Payer: Healthscope Commercial	$81.60
Rate for Payer: Healthscope Whirlpool	$79.15
Rate for Payer: Mclaren Commercial	$73.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.36
Rate for Payer: Nomi Health Commercial	$66.91
Rate for Payer: Priority Health Cigna Priority Health	$53.04
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$71.81

HC OT Z GAUNTLET EA $80

Facility

$81.60

Service Code	HCPCS A6549
Hospital Charge Code	98300092
Hospital Revenue Code	270
Min. Negotiated Rate	$32.64
Max. Negotiated Rate	$81.60
Rate for Payer: Aetna Commercial	$73.44
Rate for Payer: Aetna Medicare	$40.80
Rate for Payer: ASR ASR	$79.15
Rate for Payer: ASR Commercial	$79.15
Rate for Payer: BCBS Complete	$32.64
Rate for Payer: BCBS Trust/PPO	$66.82
Rate for Payer: BCN Commercial	$63.26
Rate for Payer: Cash Price	$65.28
Rate for Payer: Cofinity Commercial	$76.70
Rate for Payer: Encore Health Key Benefits Commercial	$65.28
Rate for Payer: Healthscope Commercial	$81.60
Rate for Payer: Healthscope Whirlpool	$79.15
Rate for Payer: Mclaren Commercial	$73.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.36
Rate for Payer: Nomi Health Commercial	$66.91
Rate for Payer: Priority Health Cigna Priority Health	$53.04
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$71.50
Rate for Payer: Priority Health Narrow Network	$57.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$71.81

HC OT Z GAUNTLET EA $90

Facility

$91.80

Service Code	HCPCS A6549
Hospital Charge Code	98300093
Hospital Revenue Code	270
Min. Negotiated Rate	$59.67
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna Commercial	$82.62
Rate for Payer: ASR ASR	$89.05
Rate for Payer: ASR Commercial	$89.05
Rate for Payer: BCBS Trust/PPO	$74.81
Rate for Payer: BCN Commercial	$71.17
Rate for Payer: Cash Price	$73.44
Rate for Payer: Cofinity Commercial	$86.29
Rate for Payer: Encore Health Key Benefits Commercial	$73.44
Rate for Payer: Healthscope Commercial	$91.80
Rate for Payer: Healthscope Whirlpool	$89.05
Rate for Payer: Mclaren Commercial	$82.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.03
Rate for Payer: Nomi Health Commercial	$75.28
Rate for Payer: Priority Health Cigna Priority Health	$59.67
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$80.78

HC OT Z GAUNTLET EA $90

Facility

$91.80

Service Code	HCPCS A6549
Hospital Charge Code	98300093
Hospital Revenue Code	270
Min. Negotiated Rate	$36.72
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna Commercial	$82.62
Rate for Payer: Aetna Medicare	$45.90
Rate for Payer: ASR ASR	$89.05
Rate for Payer: ASR Commercial	$89.05
Rate for Payer: BCBS Complete	$36.72
Rate for Payer: BCBS Trust/PPO	$75.18
Rate for Payer: BCN Commercial	$71.17
Rate for Payer: Cash Price	$73.44
Rate for Payer: Cofinity Commercial	$86.29
Rate for Payer: Encore Health Key Benefits Commercial	$73.44
Rate for Payer: Healthscope Commercial	$91.80
Rate for Payer: Healthscope Whirlpool	$89.05
Rate for Payer: Mclaren Commercial	$82.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.03
Rate for Payer: Nomi Health Commercial	$75.28
Rate for Payer: Priority Health Cigna Priority Health	$59.67
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$80.44
Rate for Payer: Priority Health Narrow Network	$64.35
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$80.78

HC OT Z SLEEVE OR GLOVE EA $100

Facility

$102.00

Service Code	HCPCS L3999
Hospital Charge Code	96000026
Hospital Revenue Code	270
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$102.00
Rate for Payer: Aetna Commercial	$91.80
Rate for Payer: ASR ASR	$98.94
Rate for Payer: ASR Commercial	$98.94
Rate for Payer: BCBS Trust/PPO	$83.12
Rate for Payer: BCN Commercial	$79.08
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cofinity Commercial	$95.88
Rate for Payer: Encore Health Key Benefits Commercial	$81.60
Rate for Payer: Healthscope Commercial	$102.00
Rate for Payer: Healthscope Whirlpool	$98.94
Rate for Payer: Mclaren Commercial	$91.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.70
Rate for Payer: Nomi Health Commercial	$83.64
Rate for Payer: Priority Health Cigna Priority Health	$66.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$89.76

Know your out-of-pocket cost for care.

All Charges