Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC OT Z STOCKINGS CUSTOM EA $175

Facility

$178.50

Service Code	HCPCS A6549
Hospital Charge Code	98300097
Hospital Revenue Code	270
Min. Negotiated Rate	$116.02
Max. Negotiated Rate	$178.50
Rate for Payer: Aetna Commercial	$160.65
Rate for Payer: ASR ASR	$173.14
Rate for Payer: ASR Commercial	$173.14
Rate for Payer: BCBS Trust/PPO	$145.46
Rate for Payer: BCN Commercial	$138.39
Rate for Payer: Cash Price	$142.80
Rate for Payer: Cofinity Commercial	$167.79
Rate for Payer: Encore Health Key Benefits Commercial	$142.80
Rate for Payer: Healthscope Commercial	$178.50
Rate for Payer: Healthscope Whirlpool	$173.14
Rate for Payer: Mclaren Commercial	$160.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$151.72
Rate for Payer: Nomi Health Commercial	$146.37
Rate for Payer: Priority Health Cigna Priority Health	$116.02
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$157.08

HC OT Z STOCKINGS CUSTOM EA $200

Facility

$204.00

Service Code	HCPCS A6549
Hospital Charge Code	98300098
Hospital Revenue Code	270
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$204.00
Rate for Payer: Aetna Commercial	$183.60
Rate for Payer: Aetna Medicare	$102.00
Rate for Payer: ASR ASR	$197.88
Rate for Payer: ASR Commercial	$197.88
Rate for Payer: BCBS Complete	$81.60
Rate for Payer: BCBS Trust/PPO	$167.06
Rate for Payer: BCN Commercial	$158.16
Rate for Payer: Cash Price	$163.20
Rate for Payer: Cofinity Commercial	$191.76
Rate for Payer: Encore Health Key Benefits Commercial	$163.20
Rate for Payer: Healthscope Commercial	$204.00
Rate for Payer: Healthscope Whirlpool	$197.88
Rate for Payer: Mclaren Commercial	$183.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.40
Rate for Payer: Nomi Health Commercial	$167.28
Rate for Payer: Priority Health Cigna Priority Health	$132.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$178.74
Rate for Payer: Priority Health Narrow Network	$143.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$179.52

HC OT Z STOCKINGS CUSTOM EA $200

Facility

$204.00

Service Code	HCPCS A6549
Hospital Charge Code	98300098
Hospital Revenue Code	270
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$204.00
Rate for Payer: Aetna Commercial	$183.60
Rate for Payer: ASR ASR	$197.88
Rate for Payer: ASR Commercial	$197.88
Rate for Payer: BCBS Trust/PPO	$166.24
Rate for Payer: BCN Commercial	$158.16
Rate for Payer: Cash Price	$163.20
Rate for Payer: Cofinity Commercial	$191.76
Rate for Payer: Encore Health Key Benefits Commercial	$163.20
Rate for Payer: Healthscope Commercial	$204.00
Rate for Payer: Healthscope Whirlpool	$197.88
Rate for Payer: Mclaren Commercial	$183.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.40
Rate for Payer: Nomi Health Commercial	$167.28
Rate for Payer: Priority Health Cigna Priority Health	$132.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$179.52

HC OT Z STOCKINGS CUSTOM EA $225

Facility

$229.50

Service Code	HCPCS A6549
Hospital Charge Code	98300099
Hospital Revenue Code	270
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna Commercial	$206.55
Rate for Payer: Aetna Medicare	$114.75
Rate for Payer: ASR ASR	$222.62
Rate for Payer: ASR Commercial	$222.62
Rate for Payer: BCBS Complete	$91.80
Rate for Payer: BCBS Trust/PPO	$187.94
Rate for Payer: BCN Commercial	$177.93
Rate for Payer: Cash Price	$183.60
Rate for Payer: Cofinity Commercial	$215.73
Rate for Payer: Encore Health Key Benefits Commercial	$183.60
Rate for Payer: Healthscope Commercial	$229.50
Rate for Payer: Healthscope Whirlpool	$222.62
Rate for Payer: Mclaren Commercial	$206.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$195.08
Rate for Payer: Nomi Health Commercial	$188.19
Rate for Payer: Priority Health Cigna Priority Health	$149.18
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$201.09
Rate for Payer: Priority Health Narrow Network	$160.88
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$201.96

HC OT Z STOCKINGS CUSTOM EA $225

Facility

$229.50

Service Code	HCPCS A6549
Hospital Charge Code	98300099
Hospital Revenue Code	270
Min. Negotiated Rate	$149.18
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna Commercial	$206.55
Rate for Payer: ASR ASR	$222.62
Rate for Payer: ASR Commercial	$222.62
Rate for Payer: BCBS Trust/PPO	$187.02
Rate for Payer: BCN Commercial	$177.93
Rate for Payer: Cash Price	$183.60
Rate for Payer: Cofinity Commercial	$215.73
Rate for Payer: Encore Health Key Benefits Commercial	$183.60
Rate for Payer: Healthscope Commercial	$229.50
Rate for Payer: Healthscope Whirlpool	$222.62
Rate for Payer: Mclaren Commercial	$206.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$195.08
Rate for Payer: Nomi Health Commercial	$188.19
Rate for Payer: Priority Health Cigna Priority Health	$149.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$201.96

HC OT Z STOCKINGS CUSTOM EA $250

Facility

$255.00

Service Code	HCPCS A6549
Hospital Charge Code	98300100
Hospital Revenue Code	270
Min. Negotiated Rate	$165.75
Max. Negotiated Rate	$255.00
Rate for Payer: Aetna Commercial	$229.50
Rate for Payer: ASR ASR	$247.35
Rate for Payer: ASR Commercial	$247.35
Rate for Payer: BCBS Trust/PPO	$207.80
Rate for Payer: BCN Commercial	$197.70
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cofinity Commercial	$239.70
Rate for Payer: Encore Health Key Benefits Commercial	$204.00
Rate for Payer: Healthscope Commercial	$255.00
Rate for Payer: Healthscope Whirlpool	$247.35
Rate for Payer: Mclaren Commercial	$229.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$216.75
Rate for Payer: Nomi Health Commercial	$209.10
Rate for Payer: Priority Health Cigna Priority Health	$165.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$224.40

HC OT Z STOCKINGS CUSTOM EA $250

Facility

$255.00

Service Code	HCPCS A6549
Hospital Charge Code	98300100
Hospital Revenue Code	270
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$255.00
Rate for Payer: Aetna Commercial	$229.50
Rate for Payer: Aetna Medicare	$127.50
Rate for Payer: ASR ASR	$247.35
Rate for Payer: ASR Commercial	$247.35
Rate for Payer: BCBS Complete	$102.00
Rate for Payer: BCBS Trust/PPO	$208.82
Rate for Payer: BCN Commercial	$197.70
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cofinity Commercial	$239.70
Rate for Payer: Encore Health Key Benefits Commercial	$204.00
Rate for Payer: Healthscope Commercial	$255.00
Rate for Payer: Healthscope Whirlpool	$247.35
Rate for Payer: Mclaren Commercial	$229.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$216.75
Rate for Payer: Nomi Health Commercial	$209.10
Rate for Payer: Priority Health Cigna Priority Health	$165.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$223.43
Rate for Payer: Priority Health Narrow Network	$178.76
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$224.40

HC OT Z STOCKINGS CUSTOM EA $275

Facility

$280.50

Service Code	HCPCS A6549
Hospital Charge Code	98300101
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 STOCKINGS CUSTOM EA $275

Facility

$280.50

Service Code	HCPCS A6549
Hospital Charge Code	98300101
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 STOCKINGS CUSTOM EA $300

Facility

$306.00

Service Code	HCPCS A6549
Hospital Charge Code	98300102
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 STOCKINGS CUSTOM EA $300

Facility

$306.00

Service Code	HCPCS A6549
Hospital Charge Code	98300102
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 STOCKINGS CUSTOM EA $325

Facility

$331.50

Service Code	HCPCS A6549
Hospital Charge Code	98300103
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 STOCKINGS CUSTOM EA $325

Facility

$331.50

Service Code	HCPCS A6549
Hospital Charge Code	98300103
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 STOCKINGS CUSTOM EA $350

Facility

$357.00

Service Code	HCPCS A6549
Hospital Charge Code	98300104
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 STOCKINGS CUSTOM EA $350

Facility

$357.00

Service Code	HCPCS A6549
Hospital Charge Code	98300104
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 STOCKINGS CUSTOM EA $375

Facility

$382.50

Service Code	HCPCS A6549
Hospital Charge Code	98300105
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 STOCKINGS CUSTOM EA $375

Facility

$382.50

Service Code	HCPCS A6549
Hospital Charge Code	98300105
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 STOCKINGS CUSTOM EA $40

Facility

$40.80

Service Code	HCPCS A6549
Hospital Charge Code	98300106
Hospital Revenue Code	270
Min. Negotiated Rate	$16.32
Max. Negotiated Rate	$40.80
Rate for Payer: Aetna Commercial	$36.72
Rate for Payer: Aetna Medicare	$20.40
Rate for Payer: ASR ASR	$39.58
Rate for Payer: ASR Commercial	$39.58
Rate for Payer: BCBS Complete	$16.32
Rate for Payer: BCBS Trust/PPO	$33.41
Rate for Payer: BCN Commercial	$31.63
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cofinity Commercial	$38.35
Rate for Payer: Encore Health Key Benefits Commercial	$32.64
Rate for Payer: Healthscope Commercial	$40.80
Rate for Payer: Healthscope Whirlpool	$39.58
Rate for Payer: Mclaren Commercial	$36.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.68
Rate for Payer: Nomi Health Commercial	$33.46
Rate for Payer: Priority Health Cigna Priority Health	$26.52
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.75
Rate for Payer: Priority Health Narrow Network	$28.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$35.90

HC OT Z STOCKINGS CUSTOM EA $40

Facility

$40.80

Service Code	HCPCS A6549
Hospital Charge Code	98300106
Hospital Revenue Code	270
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$40.80
Rate for Payer: Aetna Commercial	$36.72
Rate for Payer: ASR ASR	$39.58
Rate for Payer: ASR Commercial	$39.58
Rate for Payer: BCBS Trust/PPO	$33.25
Rate for Payer: BCN Commercial	$31.63
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cofinity Commercial	$38.35
Rate for Payer: Encore Health Key Benefits Commercial	$32.64
Rate for Payer: Healthscope Commercial	$40.80
Rate for Payer: Healthscope Whirlpool	$39.58
Rate for Payer: Mclaren Commercial	$36.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.68
Rate for Payer: Nomi Health Commercial	$33.46
Rate for Payer: Priority Health Cigna Priority Health	$26.52
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$35.90

HC OT Z STOCKINGS CUSTOM EA $400

Facility

$408.00

Service Code	HCPCS A6549
Hospital Charge Code	98300107
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 STOCKINGS CUSTOM EA $400

Facility

$408.00

Service Code	HCPCS A6549
Hospital Charge Code	98300107
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 STOCKINGS CUSTOM EA $425

Facility

$433.50

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

Facility

$433.50

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

Facility

$459.00

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

Facility

$459.00

Service Code	HCPCS A6549
Hospital Charge Code	98300109
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

Know your out-of-pocket cost for care.

All Charges