Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC OT Z STOCKINGS CUSTOM EA $50

Facility

$51.00

Service Code	HCPCS A6549
Hospital Charge Code	98300110
Hospital Revenue Code	270
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$51.00
Rate for Payer: Aetna Commercial	$45.90
Rate for Payer: ASR ASR	$49.47
Rate for Payer: ASR Commercial	$49.47
Rate for Payer: BCBS Trust/PPO	$41.56
Rate for Payer: BCN Commercial	$39.54
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Commercial	$47.94
Rate for Payer: Encore Health Key Benefits Commercial	$40.80
Rate for Payer: Healthscope Commercial	$51.00
Rate for Payer: Healthscope Whirlpool	$49.47
Rate for Payer: Mclaren Commercial	$45.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.35
Rate for Payer: Nomi Health Commercial	$41.82
Rate for Payer: Priority Health Cigna Priority Health	$33.15
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$44.88

HC OT Z STOCKINGS CUSTOM EA $50

Facility

$51.00

Service Code	HCPCS A6549
Hospital Charge Code	98300110
Hospital Revenue Code	270
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$51.00
Rate for Payer: Aetna Commercial	$45.90
Rate for Payer: Aetna Medicare	$25.50
Rate for Payer: ASR ASR	$49.47
Rate for Payer: ASR Commercial	$49.47
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: BCBS Trust/PPO	$41.76
Rate for Payer: BCN Commercial	$39.54
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Commercial	$47.94
Rate for Payer: Encore Health Key Benefits Commercial	$40.80
Rate for Payer: Healthscope Commercial	$51.00
Rate for Payer: Healthscope Whirlpool	$49.47
Rate for Payer: Mclaren Commercial	$45.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.35
Rate for Payer: Nomi Health Commercial	$41.82
Rate for Payer: Priority Health Cigna Priority Health	$33.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$44.69
Rate for Payer: Priority Health Narrow Network	$35.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$44.88

HC OT Z STOCKINGS CUSTOM EA $60

Facility

$61.20

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

Facility

$61.20

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

Facility

$71.40

Service Code	HCPCS A6549
Hospital Charge Code	98300112
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 STOCKINGS CUSTOM EA $70

Facility

$71.40

Service Code	HCPCS A6549
Hospital Charge Code	98300112
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 STOCKINGS CUSTOM EA $80

Facility

$81.60

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

Facility

$81.60

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

Facility

$91.80

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

Facility

$91.80

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

Facility

$102.00

Service Code	HCPCS A6549
Hospital Charge Code	98300115
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

HC OT Z STOCKINGS NON CUSTOM $100

Facility

$102.00

Service Code	HCPCS A6549
Hospital Charge Code	98300115
Hospital Revenue Code	270
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$102.00
Rate for Payer: Aetna Commercial	$91.80
Rate for Payer: Aetna Medicare	$51.00
Rate for Payer: ASR ASR	$98.94
Rate for Payer: ASR Commercial	$98.94
Rate for Payer: BCBS Complete	$40.80
Rate for Payer: BCBS Trust/PPO	$83.53
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: Priority Health HMO/PPO/Tiered Network	$89.37
Rate for Payer: Priority Health Narrow Network	$71.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$89.76

HC OT Z STOCKINGS NON CUSTOM $125

Facility

$127.50

Service Code	HCPCS A6549
Hospital Charge Code	98300116
Hospital Revenue Code	270
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$127.50
Rate for Payer: Aetna Commercial	$114.75
Rate for Payer: Aetna Medicare	$63.75
Rate for Payer: ASR ASR	$123.68
Rate for Payer: ASR Commercial	$123.68
Rate for Payer: BCBS Complete	$51.00
Rate for Payer: BCBS Trust/PPO	$104.41
Rate for Payer: BCN Commercial	$98.85
Rate for Payer: Cash Price	$102.00
Rate for Payer: Cofinity Commercial	$119.85
Rate for Payer: Encore Health Key Benefits Commercial	$102.00
Rate for Payer: Healthscope Commercial	$127.50
Rate for Payer: Healthscope Whirlpool	$123.68
Rate for Payer: Mclaren Commercial	$114.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$108.38
Rate for Payer: Nomi Health Commercial	$104.55
Rate for Payer: Priority Health Cigna Priority Health	$82.88
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$111.72
Rate for Payer: Priority Health Narrow Network	$89.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$112.20

HC OT Z STOCKINGS NON CUSTOM $125

Facility

$127.50

Service Code	HCPCS A6549
Hospital Charge Code	98300116
Hospital Revenue Code	270
Min. Negotiated Rate	$82.88
Max. Negotiated Rate	$127.50
Rate for Payer: Aetna Commercial	$114.75
Rate for Payer: ASR ASR	$123.68
Rate for Payer: ASR Commercial	$123.68
Rate for Payer: BCBS Trust/PPO	$103.90
Rate for Payer: BCN Commercial	$98.85
Rate for Payer: Cash Price	$102.00
Rate for Payer: Cofinity Commercial	$119.85
Rate for Payer: Encore Health Key Benefits Commercial	$102.00
Rate for Payer: Healthscope Commercial	$127.50
Rate for Payer: Healthscope Whirlpool	$123.68
Rate for Payer: Mclaren Commercial	$114.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$108.38
Rate for Payer: Nomi Health Commercial	$104.55
Rate for Payer: Priority Health Cigna Priority Health	$82.88
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$112.20

HC OT Z STOCKINGS NON CUSTOM $150

Facility

$153.00

Service Code	HCPCS A6549
Hospital Charge Code	98300117
Hospital Revenue Code	270
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna Commercial	$137.70
Rate for Payer: Aetna Medicare	$76.50
Rate for Payer: ASR ASR	$148.41
Rate for Payer: ASR Commercial	$148.41
Rate for Payer: BCBS Complete	$61.20
Rate for Payer: BCBS Trust/PPO	$125.29
Rate for Payer: BCN Commercial	$118.62
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cofinity Commercial	$143.82
Rate for Payer: Encore Health Key Benefits Commercial	$122.40
Rate for Payer: Healthscope Commercial	$153.00
Rate for Payer: Healthscope Whirlpool	$148.41
Rate for Payer: Mclaren Commercial	$137.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.05
Rate for Payer: Nomi Health Commercial	$125.46
Rate for Payer: Priority Health Cigna Priority Health	$99.45
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$134.06
Rate for Payer: Priority Health Narrow Network	$107.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$134.64

HC OT Z STOCKINGS NON CUSTOM $150

Facility

$153.00

Service Code	HCPCS A6549
Hospital Charge Code	98300117
Hospital Revenue Code	270
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna Commercial	$137.70
Rate for Payer: ASR ASR	$148.41
Rate for Payer: ASR Commercial	$148.41
Rate for Payer: BCBS Trust/PPO	$124.68
Rate for Payer: BCN Commercial	$118.62
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cofinity Commercial	$143.82
Rate for Payer: Encore Health Key Benefits Commercial	$122.40
Rate for Payer: Healthscope Commercial	$153.00
Rate for Payer: Healthscope Whirlpool	$148.41
Rate for Payer: Mclaren Commercial	$137.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.05
Rate for Payer: Nomi Health Commercial	$125.46
Rate for Payer: Priority Health Cigna Priority Health	$99.45
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$134.64

HC OT Z STOCKINGS NON CUSTOM $175

Facility

$178.50

Service Code	HCPCS A6549
Hospital Charge Code	98300118
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 NON CUSTOM $175

Facility

$178.50

Service Code	HCPCS A6549
Hospital Charge Code	98300118
Hospital Revenue Code	270
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$178.50
Rate for Payer: Aetna Commercial	$160.65
Rate for Payer: Aetna Medicare	$89.25
Rate for Payer: ASR ASR	$173.14
Rate for Payer: ASR Commercial	$173.14
Rate for Payer: BCBS Complete	$71.40
Rate for Payer: BCBS Trust/PPO	$146.17
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: Priority Health HMO/PPO/Tiered Network	$156.40
Rate for Payer: Priority Health Narrow Network	$125.13
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$157.08

HC OT Z STOCKINGS NON CUSTOM $200

Facility

$204.00

Service Code	HCPCS A6549
Hospital Charge Code	98300119
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 NON CUSTOM $200

Facility

$204.00

Service Code	HCPCS A6549
Hospital Charge Code	98300119
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 NON CUSTOM $225

Facility

$229.50

Service Code	HCPCS A6549
Hospital Charge Code	98300120
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 NON CUSTOM $225

Facility

$229.50

Service Code	HCPCS A6549
Hospital Charge Code	98300120
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 NON CUSTOM $250

Facility

$255.00

Service Code	HCPCS A6549
Hospital Charge Code	98300121
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 NON CUSTOM $250

Facility

$255.00

Service Code	HCPCS A6549
Hospital Charge Code	98300121
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 NON CUSTOM $275

Facility

$280.50

Service Code	HCPCS A6549
Hospital Charge Code	98300122
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

Know your out-of-pocket cost for care.

All Charges