Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR CAST SUP LNG ARM SPLINT FBRG

Professional

Both

$27.00

Service Code	HCPCS Q4018
Min. Negotiated Rate	$12.17
Max. Negotiated Rate	$20.25
Rate for Payer: Aetna Commercial	$12.17
Rate for Payer: Aetna Medicare	$13.50
Rate for Payer: BCN Commercial	$17.70
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.25

PR CAST SUP LNG ARM SPLINT PLST

Professional

Both

$44.00

Service Code	HCPCS Q4017
Min. Negotiated Rate	$7.63
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$7.63
Rate for Payer: Aetna Medicare	$22.00
Rate for Payer: BCN Commercial	$11.10
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$33.00

PR CAST SUP LNG ARM SPLNT PED F

Professional

Both

$25.00

Service Code	HCPCS Q4020
Min. Negotiated Rate	$6.10
Max. Negotiated Rate	$18.75
Rate for Payer: Aetna Commercial	$6.10
Rate for Payer: Aetna Medicare	$12.50
Rate for Payer: BCN Commercial	$8.89
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$18.75

PR CAST SUP LNG LEG CYLINDER FB

Professional

Both

$103.00

Service Code	HCPCS Q4034
Min. Negotiated Rate	$51.50
Max. Negotiated Rate	$81.76
Rate for Payer: Aetna Commercial	$56.19
Rate for Payer: Aetna Medicare	$51.50
Rate for Payer: BCN Commercial	$81.76
Rate for Payer: Cash Price	$82.40
Rate for Payer: Cash Price	$82.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$77.25

PR CAST SUP LNGLEG CYLNDR PED F

Professional

Both

$53.00

Service Code	HCPCS Q4036
Min. Negotiated Rate	$26.50
Max. Negotiated Rate	$40.91
Rate for Payer: Aetna Commercial	$28.11
Rate for Payer: Aetna Medicare	$26.50
Rate for Payer: BCN Commercial	$40.91
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cash Price	$42.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.75

PR CAST SUP LNG LEG PED FBRGLS

Professional

Both

$55.00

Service Code	HCPCS Q4032
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$46.40
Rate for Payer: Aetna Commercial	$31.89
Rate for Payer: Aetna Medicare	$27.50
Rate for Payer: BCN Commercial	$46.40
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$41.25

PR CAST SUP LNG LEG SPLNT FBRGL

Professional

Both

$79.00

Service Code	HCPCS Q4042
Min. Negotiated Rate	$28.62
Max. Negotiated Rate	$59.25
Rate for Payer: Aetna Commercial	$28.62
Rate for Payer: Aetna Medicare	$39.50
Rate for Payer: BCN Commercial	$41.64
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cash Price	$63.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$59.25

PR CAST SUP LNG LEG SPLNT PED F

Professional

Both

$40.00

Service Code	HCPCS Q4044
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$14.32
Rate for Payer: Aetna Medicare	$20.00
Rate for Payer: BCN Commercial	$20.85
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.00

PR CAST SUP LONG ARM ADULT FBRG

Professional

Both

$58.00

Service Code	HCPCS Q4006
Min. Negotiated Rate	$24.48
Max. Negotiated Rate	$43.50
Rate for Payer: Aetna Commercial	$24.48
Rate for Payer: Aetna Medicare	$29.00
Rate for Payer: BCN Commercial	$35.62
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cash Price	$46.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$43.50

PR CAST SUP LONG ARM PED FBRGLS

Professional

Both

$27.00

Service Code	HCPCS Q4008
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$20.25
Rate for Payer: Aetna Commercial	$12.24
Rate for Payer: Aetna Medicare	$13.50
Rate for Payer: BCN Commercial	$17.80
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.25

PR CAST SUP LONG LEG FIBERGLASS

Professional

Both

$119.00

Service Code	HCPCS Q4030
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$92.79
Rate for Payer: Aetna Commercial	$63.77
Rate for Payer: Aetna Medicare	$59.50
Rate for Payer: BCN Commercial	$92.79
Rate for Payer: Cash Price	$95.20
Rate for Payer: Cash Price	$95.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$89.25

PR CAST SUPPLIES UNLISTED

Professional

Both

$105.00

Service Code	HCPCS Q4050
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$78.75
Rate for Payer: Aetna Medicare	$52.50
Rate for Payer: BCN Commercial	$25.00
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cash Price	$84.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$78.75

PR CAST SUP SHOULDER CAST FBRGL

Professional

Both

$159.00

Service Code	HCPCS Q4004
Min. Negotiated Rate	$79.50
Max. Negotiated Rate	$148.43
Rate for Payer: Aetna Commercial	$102.02
Rate for Payer: Aetna Medicare	$79.50
Rate for Payer: BCN Commercial	$148.43
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cash Price	$127.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$119.25

PR CAST SUP SHRT LEG FIBERGLASS

Professional

Both

$63.00

Service Code	HCPCS Q4038
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$50.24
Rate for Payer: Aetna Commercial	$34.52
Rate for Payer: Aetna Medicare	$31.50
Rate for Payer: BCN Commercial	$50.24
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$47.25

PR CAST SUP SHRT LEG PED FBRGLS

Professional

Both

$22.00

Service Code	HCPCS Q4040
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$25.12
Rate for Payer: Aetna Commercial	$17.26
Rate for Payer: Aetna Medicare	$11.00
Rate for Payer: BCN Commercial	$25.12
Rate for Payer: Cash Price	$17.60
Rate for Payer: Cash Price	$17.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$16.50

PR CAST SUP SHT ARM ADULT FBRGL

Professional

Both

$44.00

Service Code	HCPCS Q4010
Min. Negotiated Rate	$16.32
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$16.32
Rate for Payer: Aetna Medicare	$22.00
Rate for Payer: BCN Commercial	$23.74
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$33.00

PR CAST SUP SHT ARM ADULT PLSTR

Professional

Both

$11.00

Service Code	HCPCS Q4009
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$10.56
Rate for Payer: Aetna Commercial	$7.26
Rate for Payer: Aetna Medicare	$5.50
Rate for Payer: BCN Commercial	$10.56
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cash Price	$8.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$8.25

PR CAST SUP SHT ARM PED FBRGLAS

Professional

Both

$21.00

Service Code	HCPCS Q4012
Min. Negotiated Rate	$8.18
Max. Negotiated Rate	$15.75
Rate for Payer: Aetna Commercial	$8.18
Rate for Payer: Aetna Medicare	$10.50
Rate for Payer: BCN Commercial	$11.90
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.75

PR CAST SUP SHT ARM SPLINT FBRG

Professional

Both

$27.00

Service Code	HCPCS Q4022
Min. Negotiated Rate	$10.18
Max. Negotiated Rate	$20.25
Rate for Payer: Aetna Commercial	$10.18
Rate for Payer: Aetna Medicare	$13.50
Rate for Payer: BCN Commercial	$14.84
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.25

PR CAST SUP SHT ARM SPLINT PLST

Professional

Both

$9.00

Service Code	HCPCS Q4021
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$8.22
Rate for Payer: Aetna Commercial	$5.65
Rate for Payer: Aetna Medicare	$4.50
Rate for Payer: BCN Commercial	$8.22
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.75

PR CAST SUP SHT ARM SPLNT PED F

Professional

Both

$29.00

Service Code	HCPCS Q4024
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$21.75
Rate for Payer: Aetna Commercial	$5.11
Rate for Payer: Aetna Medicare	$14.50
Rate for Payer: BCN Commercial	$7.43
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cash Price	$23.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.75

PR CAST SUP SHT ARM SPLNT PED P

Professional

Both

$16.00

Service Code	HCPCS Q4023
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$2.84
Rate for Payer: Aetna Medicare	$8.00
Rate for Payer: BCN Commercial	$4.13
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cash Price	$12.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$12.00

PR CAST SUP SHT LEG SPLNT FBRGL

Professional

Both

$32.00

Service Code	HCPCS Q4046
Min. Negotiated Rate	$15.64
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$15.64
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: BCN Commercial	$22.77
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.00

PR CAST SUP SHT LEG SPLNT PED F

Professional

Both

$27.00

Service Code	HCPCS Q4048
Min. Negotiated Rate	$7.83
Max. Negotiated Rate	$20.25
Rate for Payer: Aetna Commercial	$7.83
Rate for Payer: Aetna Medicare	$13.50
Rate for Payer: BCN Commercial	$11.40
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.25

PR CAST SUP SHT LEG SPLNT PED P

Professional

Both

$21.00

Service Code	HCPCS Q4047
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$15.75
Rate for Payer: Aetna Commercial	$4.84
Rate for Payer: Aetna Medicare	$10.50
Rate for Payer: BCN Commercial	$7.05
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.75

Know your out-of-pocket cost for care.

All Charges