|
PR CARPECTOMY ALL BONES PROXIMAL ROW
|
Professional
|
Both
|
$2,244.00
|
|
|
Service Code
|
HCPCS 25215
|
| Min. Negotiated Rate |
$403.21 |
| Max. Negotiated Rate |
$1,570.80 |
| Rate for Payer: Aetna Commercial |
$819.85
|
| Rate for Payer: Aetna Medicare |
$636.30
|
| Rate for Payer: BCBS Complete |
$423.37
|
| Rate for Payer: BCBS MAPPO |
$611.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,436.98
|
| Rate for Payer: BCN Commercial |
$916.27
|
| Rate for Payer: BCN Medicare Advantage |
$611.83
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cofinity Commercial |
$881.04
|
| Rate for Payer: Cofinity Commercial |
$819.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$611.83
|
| Rate for Payer: Mclaren Medicaid |
$403.21
|
| Rate for Payer: Meridian Medicaid |
$423.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$642.42
|
| Rate for Payer: PACE SWMI |
$611.83
|
| Rate for Payer: PHP Medicare Advantage |
$611.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$403.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,570.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$957.48
|
| Rate for Payer: Priority Health Medicare |
$611.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$957.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$611.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$611.83
|
| Rate for Payer: UHC Medicare Advantage |
$630.18
|
|
|
PR CARTILAGE GRAFT COSTOCHONDRAL
|
Professional
|
Both
|
$921.00
|
|
|
Service Code
|
HCPCS 20910
|
| Min. Negotiated Rate |
$309.92 |
| Max. Negotiated Rate |
$8,557.53 |
| Rate for Payer: Aetna Commercial |
$624.36
|
| Rate for Payer: Aetna Medicare |
$484.58
|
| Rate for Payer: BCBS Complete |
$325.42
|
| Rate for Payer: BCBS MAPPO |
$465.94
|
| Rate for Payer: BCBS Trust/PPO |
$8,557.53
|
| Rate for Payer: BCN Commercial |
$701.25
|
| Rate for Payer: BCN Medicare Advantage |
$465.94
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cofinity Commercial |
$670.95
|
| Rate for Payer: Cofinity Commercial |
$624.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.94
|
| Rate for Payer: Mclaren Medicaid |
$309.92
|
| Rate for Payer: Meridian Medicaid |
$325.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$489.24
|
| Rate for Payer: PACE SWMI |
$465.94
|
| Rate for Payer: PHP Medicare Advantage |
$465.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$309.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$732.78
|
| Rate for Payer: Priority Health Medicare |
$465.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$732.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$465.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$465.94
|
| Rate for Payer: UHC Medicare Advantage |
$479.92
|
|
|
PR CARTILAGE GRAFT NASAL SEPTUM
|
Professional
|
Both
|
$1,035.00
|
|
|
Service Code
|
HCPCS 20912
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$739.43 |
| Rate for Payer: Aetna Commercial |
$632.77
|
| Rate for Payer: Aetna Medicare |
$491.11
|
| Rate for Payer: BCBS Complete |
$326.98
|
| Rate for Payer: BCBS MAPPO |
$472.22
|
| Rate for Payer: BCBS Trust/PPO |
$86.88
|
| Rate for Payer: BCN Commercial |
$707.61
|
| Rate for Payer: BCN Medicare Advantage |
$472.22
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cofinity Commercial |
$680.00
|
| Rate for Payer: Cofinity Commercial |
$632.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$472.22
|
| Rate for Payer: Mclaren Medicaid |
$311.41
|
| Rate for Payer: Meridian Medicaid |
$326.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$495.83
|
| Rate for Payer: PACE SWMI |
$472.22
|
| Rate for Payer: PHP Medicare Advantage |
$472.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$311.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$739.43
|
| Rate for Payer: Priority Health Medicare |
$472.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$739.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$472.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$472.22
|
| Rate for Payer: UHC Medicare Advantage |
$486.39
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$245.18 |
| Max. Negotiated Rate |
$361.80 |
| Rate for Payer: Aetna Commercial |
$341.70
|
| Rate for Payer: BCBS Trust/PPO |
$310.67
|
| Rate for Payer: BCN Commercial |
$310.67
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cofinity Commercial |
$345.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.60
|
| Rate for Payer: Healthscope Commercial |
$361.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$341.70
|
| Rate for Payer: PHP Commercial |
$341.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$349.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.76
|
| Rate for Payer: UHC Core |
$335.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.50
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS G0104
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$1,681.05 |
| Rate for Payer: Aetna Commercial |
$72.48
|
| Rate for Payer: Aetna Medicare |
$56.25
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: BCBS MAPPO |
$54.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,681.05
|
| Rate for Payer: BCN Commercial |
$273.17
|
| Rate for Payer: BCN Medicare Advantage |
$54.09
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cofinity Commercial |
$77.89
|
| Rate for Payer: Cofinity Commercial |
$72.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.09
|
| Rate for Payer: Mclaren Medicaid |
$36.00
|
| Rate for Payer: Meridian Medicaid |
$37.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$56.79
|
| Rate for Payer: PACE SWMI |
$54.09
|
| Rate for Payer: PHP Medicare Advantage |
$54.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.01
|
| Rate for Payer: Priority Health Medicare |
$54.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.09
|
| Rate for Payer: UHC Medicare Advantage |
$55.71
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$95.48 |
| Max. Negotiated Rate |
$629.53 |
| Rate for Payer: Aetna Commercial |
$341.70
|
| Rate for Payer: Aetna Medicare |
$104.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.62
|
| Rate for Payer: BCBS Complete |
$629.53
|
| Rate for Payer: BCBS MAPPO |
$100.50
|
| Rate for Payer: BCBS Trust/PPO |
$312.56
|
| Rate for Payer: BCN Commercial |
$312.56
|
| Rate for Payer: BCN Medicare Advantage |
$100.50
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cofinity Commercial |
$345.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.50
|
| Rate for Payer: Healthscope Commercial |
$361.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.50
|
| Rate for Payer: Mclaren Medicaid |
$599.55
|
| Rate for Payer: Meridian Medicaid |
$629.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$105.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$341.70
|
| Rate for Payer: PACE Senior Care Partners |
$95.48
|
| Rate for Payer: PACE SWMI |
$100.50
|
| Rate for Payer: PHP Commercial |
$341.70
|
| Rate for Payer: PHP Medicare Advantage |
$100.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$599.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$349.74
|
| Rate for Payer: Priority Health Medicare |
$100.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.18
|
| Rate for Payer: Railroad Medicare Medicare |
$100.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.76
|
| Rate for Payer: UHC Core |
$335.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.50
|
| Rate for Payer: UHC Medicare Advantage |
$103.52
|
| Rate for Payer: VA VA |
$100.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.50
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$1,681.05 |
| Rate for Payer: Aetna Commercial |
$72.48
|
| Rate for Payer: Aetna Medicare |
$56.25
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: BCBS MAPPO |
$54.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,681.05
|
| Rate for Payer: BCN Commercial |
$273.17
|
| Rate for Payer: BCN Medicare Advantage |
$54.09
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cofinity Commercial |
$72.48
|
| Rate for Payer: Cofinity Commercial |
$77.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.09
|
| Rate for Payer: Mclaren Medicaid |
$36.00
|
| Rate for Payer: Meridian Medicaid |
$37.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$56.79
|
| Rate for Payer: PACE SWMI |
$54.09
|
| Rate for Payer: PHP Medicare Advantage |
$54.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.01
|
| Rate for Payer: Priority Health Medicare |
$54.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.09
|
| Rate for Payer: UHC Medicare Advantage |
$55.71
|
|
|
PR CA SCREEN;PELVIC/BREAST EXAM
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS G0101
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$1,696.90 |
| Rate for Payer: Aetna Commercial |
$36.26
|
| Rate for Payer: Aetna Medicare |
$28.14
|
| Rate for Payer: BCBS Complete |
$18.34
|
| Rate for Payer: BCBS MAPPO |
$27.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,696.90
|
| Rate for Payer: BCN Commercial |
$57.17
|
| Rate for Payer: BCN Medicare Advantage |
$27.06
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$36.26
|
| Rate for Payer: Cofinity Commercial |
$38.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.06
|
| Rate for Payer: Mclaren Medicaid |
$17.47
|
| Rate for Payer: Meridian Medicaid |
$18.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.41
|
| Rate for Payer: PACE SWMI |
$27.06
|
| Rate for Payer: PHP Medicare Advantage |
$27.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.13
|
| Rate for Payer: Priority Health Medicare |
$27.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.06
|
| Rate for Payer: UHC Medicare Advantage |
$27.87
|
|
|
PR CAST SUP GAUNTLET FIBERGLASS
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS Q4014
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$38.50 |
| Rate for Payer: Aetna Commercial |
$22.26
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: BCN Commercial |
$26.15
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
|
|
PR CAST SUP LNG ARM SPLINT FBRG
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS Q4018
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna Commercial |
$12.17
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCN Commercial |
$14.28
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
|
|
PR CAST SUP LNG ARM SPLNT PED F
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS Q4020
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna Commercial |
$6.10
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCN Commercial |
$7.17
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
|
|
PR CAST SUP LNG LEG CYLINDER FB
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
HCPCS Q4034
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$68.60 |
| Rate for Payer: Aetna Commercial |
$56.19
|
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: BCN Commercial |
$65.98
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
|
|
PR CAST SUP LNGLEG CYLNDR PED F
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS Q4036
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial |
$28.11
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCN Commercial |
$33.01
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
|
|
PR CAST SUP LNG LEG PED FBRGLS
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS Q4032
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$37.44 |
| Rate for Payer: Aetna Commercial |
$31.89
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCN Commercial |
$37.44
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
|
|
PR CAST SUP LNG LEG SPLNT FBRGL
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS Q4042
|
| Min. Negotiated Rate |
$28.62 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Aetna Commercial |
$28.62
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCN Commercial |
$33.60
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
|
|
PR CAST SUP LNG LEG SPLNT PED F
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS Q4044
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: Aetna Commercial |
$14.32
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCN Commercial |
$16.82
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.60
|
|
|
PR CAST SUP LONG ARM ADULT FBRG
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS Q4006
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$38.50 |
| Rate for Payer: Aetna Commercial |
$24.48
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: BCN Commercial |
$28.75
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
|
|
PR CAST SUP LONG ARM PED FBRGLS
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS Q4008
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna Commercial |
$12.24
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCN Commercial |
$14.36
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
|
|
PR CAST SUP LONG LEG FIBERGLASS
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS Q4030
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$63.77
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCN Commercial |
$74.88
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.80
|
|
|
PR CAST SUPPLIES UNLISTED
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS Q4050
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCN Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
|
|
PR CAST SUP SHOULDER CAST FBRGL
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS Q4004
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$119.78 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: BCBS Complete |
$60.40
|
| Rate for Payer: BCN Commercial |
$119.78
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.70
|
|
|
PR CAST SUP SHRT LEG FIBERGLASS
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS Q4038
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna Commercial |
$34.52
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCN Commercial |
$40.55
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
|
|
PR CAST SUP SHRT LEG PED FBRGLS
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS Q4040
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$20.27 |
| Rate for Payer: Aetna Commercial |
$17.26
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCN Commercial |
$20.27
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.70
|
|
|
PR CAST SUP SHT ARM ADULT FBRGL
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS Q4010
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$29.40 |
| Rate for Payer: Aetna Commercial |
$16.32
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCN Commercial |
$19.16
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
|
|
PR CAST SUP SHT ARM PED FBRGLAS
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS Q4012
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna Commercial |
$8.18
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCN Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
|
