|
PR CAST SUP LNG ARM SPLNT PED F
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS Q4020
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Aetna Commercial |
$12.19
|
| Rate for Payer: Aetna Medicare |
$9.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.19
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$9.10
|
| Rate for Payer: BCN Medicare Advantage |
$9.10
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$12.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.55
|
| Rate for Payer: Nomi Health Commercial |
$10.92
|
| Rate for Payer: PACE SWMI |
$9.10
|
| Rate for Payer: PHP Commercial |
$12.74
|
| Rate for Payer: PHP Medicare Advantage |
$9.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health Medicare |
$9.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.10
|
| Rate for Payer: UHC Medicare Advantage |
$9.10
|
| Rate for Payer: UMR Bronson Commercial |
$11.04
|
|
|
PR CAST SUP LNG LEG CYLINDER FB
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS Q4034
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$112.18
|
| Rate for Payer: Aetna Medicare |
$87.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.18
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS MAPPO |
$83.72
|
| Rate for Payer: BCN Medicare Advantage |
$83.72
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$120.56
|
| Rate for Payer: Cofinity Commercial |
$112.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.91
|
| Rate for Payer: Nomi Health Commercial |
$100.46
|
| Rate for Payer: PACE SWMI |
$83.72
|
| Rate for Payer: PHP Commercial |
$117.21
|
| Rate for Payer: PHP Medicare Advantage |
$83.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.00
|
| Rate for Payer: Priority Health Medicare |
$83.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.72
|
| Rate for Payer: UHC Medicare Advantage |
$83.72
|
| Rate for Payer: UMR Bronson Commercial |
$46.00
|
|
|
PR CAST SUP LNGLEG CYLNDR PED F
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS Q4036
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$60.32 |
| Rate for Payer: Aetna Commercial |
$56.13
|
| Rate for Payer: Aetna Medicare |
$43.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.13
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS MAPPO |
$41.89
|
| Rate for Payer: BCN Medicare Advantage |
$41.89
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$56.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.98
|
| Rate for Payer: Nomi Health Commercial |
$50.27
|
| Rate for Payer: PACE SWMI |
$41.89
|
| Rate for Payer: PHP Commercial |
$58.65
|
| Rate for Payer: PHP Medicare Advantage |
$41.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health Medicare |
$41.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.89
|
| Rate for Payer: UHC Medicare Advantage |
$41.89
|
| Rate for Payer: UMR Bronson Commercial |
$23.46
|
|
|
PR CAST SUP LNG LEG PED FBRGLS
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS Q4032
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$68.41 |
| Rate for Payer: Aetna Commercial |
$63.66
|
| Rate for Payer: Aetna Medicare |
$49.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.66
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS MAPPO |
$47.51
|
| Rate for Payer: BCN Medicare Advantage |
$47.51
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cofinity Commercial |
$68.41
|
| Rate for Payer: Cofinity Commercial |
$63.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.89
|
| Rate for Payer: Nomi Health Commercial |
$57.01
|
| Rate for Payer: PACE SWMI |
$47.51
|
| Rate for Payer: PHP Commercial |
$66.51
|
| Rate for Payer: PHP Medicare Advantage |
$47.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
| Rate for Payer: Priority Health Medicare |
$47.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.51
|
| Rate for Payer: UHC Medicare Advantage |
$47.51
|
| Rate for Payer: UMR Bronson Commercial |
$24.38
|
|
|
PR CAST SUP LNG LEG SPLNT FBRGL
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS Q4042
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$61.40 |
| Rate for Payer: Aetna Commercial |
$57.14
|
| Rate for Payer: Aetna Medicare |
$44.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.14
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCBS MAPPO |
$42.64
|
| Rate for Payer: BCN Medicare Advantage |
$42.64
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Commercial |
$57.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.77
|
| Rate for Payer: Nomi Health Commercial |
$51.17
|
| Rate for Payer: PACE SWMI |
$42.64
|
| Rate for Payer: PHP Commercial |
$59.70
|
| Rate for Payer: PHP Medicare Advantage |
$42.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: Priority Health Medicare |
$42.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.64
|
| Rate for Payer: UHC Medicare Advantage |
$42.64
|
| Rate for Payer: UMR Bronson Commercial |
$35.42
|
|
|
PR CAST SUP LNG LEG SPLNT PED F
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS Q4044
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$30.74 |
| Rate for Payer: Aetna Commercial |
$28.61
|
| Rate for Payer: Aetna Medicare |
$22.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.61
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS MAPPO |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$21.35
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$30.74
|
| Rate for Payer: Cofinity Commercial |
$28.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.42
|
| Rate for Payer: Nomi Health Commercial |
$25.62
|
| Rate for Payer: PACE SWMI |
$21.35
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: PHP Medicare Advantage |
$21.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health Medicare |
$21.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.35
|
| Rate for Payer: UHC Medicare Advantage |
$21.35
|
| Rate for Payer: UMR Bronson Commercial |
$17.94
|
|
|
PR CAST SUP LONG ARM ADULT FBRG
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS Q4006
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$52.52 |
| Rate for Payer: Aetna Commercial |
$48.87
|
| Rate for Payer: Aetna Medicare |
$37.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.87
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS MAPPO |
$36.47
|
| Rate for Payer: BCN Medicare Advantage |
$36.47
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$52.52
|
| Rate for Payer: Cofinity Commercial |
$48.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.29
|
| Rate for Payer: Nomi Health Commercial |
$43.76
|
| Rate for Payer: PACE SWMI |
$36.47
|
| Rate for Payer: PHP Commercial |
$51.06
|
| Rate for Payer: PHP Medicare Advantage |
$36.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health Medicare |
$36.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.47
|
| Rate for Payer: UHC Medicare Advantage |
$36.47
|
| Rate for Payer: UMR Bronson Commercial |
$25.76
|
|
|
PR CAST SUP LONG ARM PED FBRGLS
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS Q4008
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Aetna Commercial |
$24.43
|
| Rate for Payer: Aetna Medicare |
$18.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.43
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS MAPPO |
$18.23
|
| Rate for Payer: BCN Medicare Advantage |
$18.23
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$26.25
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.14
|
| Rate for Payer: Nomi Health Commercial |
$21.88
|
| Rate for Payer: PACE SWMI |
$18.23
|
| Rate for Payer: PHP Commercial |
$25.52
|
| Rate for Payer: PHP Medicare Advantage |
$18.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: Priority Health Medicare |
$18.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.23
|
| Rate for Payer: UHC Medicare Advantage |
$18.23
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
|
|
PR CAST SUP LONG LEG FIBERGLASS
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS Q4030
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$136.83 |
| Rate for Payer: Aetna Commercial |
$127.33
|
| Rate for Payer: Aetna Medicare |
$98.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.33
|
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: BCBS MAPPO |
$95.02
|
| Rate for Payer: BCN Medicare Advantage |
$95.02
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cofinity Commercial |
$136.83
|
| Rate for Payer: Cofinity Commercial |
$127.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.77
|
| Rate for Payer: Nomi Health Commercial |
$114.02
|
| Rate for Payer: PACE SWMI |
$95.02
|
| Rate for Payer: PHP Commercial |
$133.03
|
| Rate for Payer: PHP Medicare Advantage |
$95.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.40
|
| Rate for Payer: Priority Health Medicare |
$95.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.02
|
| Rate for Payer: UHC Medicare Advantage |
$95.02
|
| Rate for Payer: UMR Bronson Commercial |
$53.36
|
|
|
PR CAST SUPPLIES UNLISTED
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS Q4050
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: UMR Bronson Commercial |
$46.92
|
|
|
PR CAST SUP SHOULDER CAST FBRGL
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS Q4004
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$218.87 |
| Rate for Payer: Aetna Commercial |
$203.67
|
| Rate for Payer: Aetna Medicare |
$158.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.87
|
| Rate for Payer: BCBS Complete |
$61.60
|
| Rate for Payer: BCBS MAPPO |
$151.99
|
| Rate for Payer: BCN Medicare Advantage |
$151.99
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cofinity Commercial |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$218.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.59
|
| Rate for Payer: Nomi Health Commercial |
$182.39
|
| Rate for Payer: PACE SWMI |
$151.99
|
| Rate for Payer: PHP Commercial |
$212.79
|
| Rate for Payer: PHP Medicare Advantage |
$151.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.10
|
| Rate for Payer: Priority Health Medicare |
$151.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.99
|
| Rate for Payer: UHC Medicare Advantage |
$151.99
|
| Rate for Payer: UMR Bronson Commercial |
$70.84
|
|
|
PR CAST SUP SHRT LEG FIBERGLASS
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS Q4038
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$74.09 |
| Rate for Payer: Aetna Commercial |
$68.94
|
| Rate for Payer: Aetna Medicare |
$53.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.94
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS MAPPO |
$51.45
|
| Rate for Payer: BCN Medicare Advantage |
$51.45
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$74.09
|
| Rate for Payer: Cofinity Commercial |
$68.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.02
|
| Rate for Payer: Nomi Health Commercial |
$61.74
|
| Rate for Payer: PACE SWMI |
$51.45
|
| Rate for Payer: PHP Commercial |
$72.03
|
| Rate for Payer: PHP Medicare Advantage |
$51.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: Priority Health Medicare |
$51.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.45
|
| Rate for Payer: UHC Medicare Advantage |
$51.45
|
| Rate for Payer: UMR Bronson Commercial |
$28.06
|
|
|
PR CAST SUP SHRT LEG PED FBRGLS
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS Q4040
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$37.04 |
| Rate for Payer: Aetna Commercial |
$34.46
|
| Rate for Payer: Aetna Medicare |
$26.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.46
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$25.72
|
| Rate for Payer: BCN Medicare Advantage |
$25.72
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$37.04
|
| Rate for Payer: Cofinity Commercial |
$34.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.01
|
| Rate for Payer: Nomi Health Commercial |
$30.86
|
| Rate for Payer: PACE SWMI |
$25.72
|
| Rate for Payer: PHP Commercial |
$36.01
|
| Rate for Payer: PHP Medicare Advantage |
$25.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.65
|
| Rate for Payer: Priority Health Medicare |
$25.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.72
|
| Rate for Payer: UHC Medicare Advantage |
$25.72
|
| Rate for Payer: UMR Bronson Commercial |
$9.66
|
|
|
PR CAST SUP SHT ARM ADULT FBRGL
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS Q4010
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$35.01 |
| Rate for Payer: Aetna Commercial |
$32.58
|
| Rate for Payer: Aetna Medicare |
$25.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.58
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$24.31
|
| Rate for Payer: BCN Medicare Advantage |
$24.31
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$35.01
|
| Rate for Payer: Cofinity Commercial |
$32.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.53
|
| Rate for Payer: Nomi Health Commercial |
$29.17
|
| Rate for Payer: PACE SWMI |
$24.31
|
| Rate for Payer: PHP Commercial |
$34.03
|
| Rate for Payer: PHP Medicare Advantage |
$24.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$24.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.31
|
| Rate for Payer: UHC Medicare Advantage |
$24.31
|
| Rate for Payer: UMR Bronson Commercial |
$19.78
|
|
|
PR CAST SUP SHT ARM PED FBRGLAS
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS Q4012
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Aetna Commercial |
$16.33
|
| Rate for Payer: Aetna Medicare |
$12.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.33
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$12.19
|
| Rate for Payer: BCN Medicare Advantage |
$12.19
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$17.55
|
| Rate for Payer: Cofinity Commercial |
$16.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.80
|
| Rate for Payer: Nomi Health Commercial |
$14.63
|
| Rate for Payer: PACE SWMI |
$12.19
|
| Rate for Payer: PHP Commercial |
$17.07
|
| Rate for Payer: PHP Medicare Advantage |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Medicare |
$12.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.19
|
| Rate for Payer: UHC Medicare Advantage |
$12.19
|
| Rate for Payer: UMR Bronson Commercial |
$9.20
|
|
|
PR CAST SUP SHT ARM SPLINT FBRG
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS Q4022
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$21.89 |
| Rate for Payer: Aetna Commercial |
$20.37
|
| Rate for Payer: Aetna Medicare |
$15.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.37
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS MAPPO |
$15.20
|
| Rate for Payer: BCN Medicare Advantage |
$15.20
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$21.89
|
| Rate for Payer: Cofinity Commercial |
$20.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.96
|
| Rate for Payer: Nomi Health Commercial |
$18.24
|
| Rate for Payer: PACE SWMI |
$15.20
|
| Rate for Payer: PHP Commercial |
$21.28
|
| Rate for Payer: PHP Medicare Advantage |
$15.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: Priority Health Medicare |
$15.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.20
|
| Rate for Payer: UHC Medicare Advantage |
$15.20
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
|
|
PR CAST SUP SHT ARM SPLNT PED F
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS Q4024
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Medicare |
$7.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.20
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCBS MAPPO |
$7.61
|
| Rate for Payer: BCN Medicare Advantage |
$7.61
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$10.96
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.99
|
| Rate for Payer: Nomi Health Commercial |
$9.13
|
| Rate for Payer: PACE SWMI |
$7.61
|
| Rate for Payer: PHP Commercial |
$10.65
|
| Rate for Payer: PHP Medicare Advantage |
$7.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health Medicare |
$7.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.61
|
| Rate for Payer: UHC Medicare Advantage |
$7.61
|
| Rate for Payer: UMR Bronson Commercial |
$12.88
|
|
|
PR CAST SUP SHT LEG SPLNT FBRGL
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS Q4046
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$33.58 |
| Rate for Payer: Aetna Commercial |
$31.25
|
| Rate for Payer: Aetna Medicare |
$24.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.25
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$23.32
|
| Rate for Payer: BCN Medicare Advantage |
$23.32
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$33.58
|
| Rate for Payer: Cofinity Commercial |
$31.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.49
|
| Rate for Payer: Nomi Health Commercial |
$27.98
|
| Rate for Payer: PACE SWMI |
$23.32
|
| Rate for Payer: PHP Commercial |
$32.65
|
| Rate for Payer: PHP Medicare Advantage |
$23.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$23.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.32
|
| Rate for Payer: UHC Medicare Advantage |
$23.32
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
|
|
PR CAST SUP SHT LEG SPLNT PED F
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS Q4048
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Commercial |
$15.64
|
| Rate for Payer: Aetna Medicare |
$12.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.64
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS MAPPO |
$11.67
|
| Rate for Payer: BCN Medicare Advantage |
$11.67
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$15.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.25
|
| Rate for Payer: Nomi Health Commercial |
$14.00
|
| Rate for Payer: PACE SWMI |
$11.67
|
| Rate for Payer: PHP Commercial |
$16.34
|
| Rate for Payer: PHP Medicare Advantage |
$11.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: Priority Health Medicare |
$11.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.67
|
| Rate for Payer: UHC Medicare Advantage |
$11.67
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
|
|
PR CAST SUP SHT LEG SPLNT PED P
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS Q4047
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$9.67
|
| Rate for Payer: Aetna Medicare |
$7.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.40
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$7.22
|
| Rate for Payer: BCN Medicare Advantage |
$7.22
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$9.67
|
| Rate for Payer: Cofinity Commercial |
$10.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.58
|
| Rate for Payer: Nomi Health Commercial |
$8.66
|
| Rate for Payer: PACE SWMI |
$7.22
|
| Rate for Payer: PHP Commercial |
$10.11
|
| Rate for Payer: PHP Medicare Advantage |
$7.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Medicare |
$7.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.22
|
| Rate for Payer: UHC Medicare Advantage |
$7.22
|
| Rate for Payer: UMR Bronson Commercial |
$9.20
|
|
|
PR CATHETERIZATION UMBILICAL NEWBORN ART DX/THERAPY
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 36660
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$92.32 |
| Rate for Payer: Aetna Commercial |
$85.91
|
| Rate for Payer: Aetna Medicare |
$66.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.91
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCBS MAPPO |
$64.11
|
| Rate for Payer: BCN Medicare Advantage |
$64.11
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$92.32
|
| Rate for Payer: Cofinity Commercial |
$85.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.32
|
| Rate for Payer: Nomi Health Commercial |
$76.93
|
| Rate for Payer: PACE SWMI |
$64.11
|
| Rate for Payer: PHP Commercial |
$89.75
|
| Rate for Payer: PHP Medicare Advantage |
$64.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health Medicare |
$64.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.11
|
| Rate for Payer: UHC Medicare Advantage |
$64.11
|
| Rate for Payer: UMR Bronson Commercial |
$64.86
|
|
|
PR CATHETERIZATION W/BRONCHIAL BRUSH BIOPSY
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 31717
|
| Min. Negotiated Rate |
$99.10 |
| Max. Negotiated Rate |
$344.50 |
| Rate for Payer: Aetna Commercial |
$132.79
|
| Rate for Payer: Aetna Medicare |
$103.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.79
|
| Rate for Payer: BCBS Complete |
$212.00
|
| Rate for Payer: BCBS MAPPO |
$99.10
|
| Rate for Payer: BCN Medicare Advantage |
$99.10
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Cofinity Commercial |
$142.70
|
| Rate for Payer: Cofinity Commercial |
$132.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.06
|
| Rate for Payer: Nomi Health Commercial |
$118.92
|
| Rate for Payer: PACE SWMI |
$99.10
|
| Rate for Payer: PHP Commercial |
$138.74
|
| Rate for Payer: PHP Medicare Advantage |
$99.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.50
|
| Rate for Payer: Priority Health Medicare |
$99.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.10
|
| Rate for Payer: UHC Medicare Advantage |
$99.10
|
| Rate for Payer: UMR Bronson Commercial |
$243.80
|
|
|
PR CATHETERIZE FOR URINE SPEC
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS P9612
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Aetna Commercial |
$12.18
|
| Rate for Payer: Aetna Medicare |
$9.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.18
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$9.09
|
| Rate for Payer: BCN Medicare Advantage |
$9.09
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$13.09
|
| Rate for Payer: Cofinity Commercial |
$12.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.54
|
| Rate for Payer: Nomi Health Commercial |
$10.91
|
| Rate for Payer: PACE SWMI |
$9.09
|
| Rate for Payer: PHP Commercial |
$12.73
|
| Rate for Payer: PHP Medicare Advantage |
$9.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health Medicare |
$9.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.09
|
| Rate for Payer: UHC Medicare Advantage |
$9.09
|
| Rate for Payer: UMR Bronson Commercial |
$13.80
|
|
|
PR CATHJ UMBILICAL VEIN DX/THER NB
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 36510
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$187.85 |
| Rate for Payer: Aetna Commercial |
$66.21
|
| Rate for Payer: Aetna Medicare |
$51.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.21
|
| Rate for Payer: BCBS Complete |
$115.60
|
| Rate for Payer: BCBS MAPPO |
$49.41
|
| Rate for Payer: BCN Medicare Advantage |
$49.41
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cofinity Commercial |
$71.15
|
| Rate for Payer: Cofinity Commercial |
$66.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.88
|
| Rate for Payer: Nomi Health Commercial |
$59.29
|
| Rate for Payer: PACE SWMI |
$49.41
|
| Rate for Payer: PHP Commercial |
$69.17
|
| Rate for Payer: PHP Medicare Advantage |
$49.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.85
|
| Rate for Payer: Priority Health Medicare |
$49.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.41
|
| Rate for Payer: UHC Medicare Advantage |
$49.41
|
| Rate for Payer: UMR Bronson Commercial |
$132.94
|
|
|
PR CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I
|
Professional
|
Both
|
$782.00
|
|
|
Service Code
|
HCPCS 93454
|
| Min. Negotiated Rate |
$312.80 |
| Max. Negotiated Rate |
$1,126.04 |
| Rate for Payer: Aetna Commercial |
$1,047.84
|
| Rate for Payer: Aetna Commercial |
$1,047.84
|
| Rate for Payer: Aetna Medicare |
$813.25
|
| Rate for Payer: Aetna Medicare |
$813.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,047.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,126.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,126.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,047.84
|
| Rate for Payer: BCBS Complete |
$685.20
|
| Rate for Payer: BCBS Complete |
$312.80
|
| Rate for Payer: BCBS MAPPO |
$781.97
|
| Rate for Payer: BCBS MAPPO |
$781.97
|
| Rate for Payer: BCN Medicare Advantage |
$781.97
|
| Rate for Payer: BCN Medicare Advantage |
$781.97
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cash Price |
$625.60
|
| Rate for Payer: Cash Price |
$625.60
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cofinity Commercial |
$1,126.04
|
| Rate for Payer: Cofinity Commercial |
$1,047.84
|
| Rate for Payer: Cofinity Commercial |
$1,126.04
|
| Rate for Payer: Cofinity Commercial |
$1,047.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$821.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$821.07
|
| Rate for Payer: Nomi Health Commercial |
$938.36
|
| Rate for Payer: Nomi Health Commercial |
$938.36
|
| Rate for Payer: PACE SWMI |
$781.97
|
| Rate for Payer: PACE SWMI |
$781.97
|
| Rate for Payer: PHP Commercial |
$1,094.76
|
| Rate for Payer: PHP Commercial |
$1,094.76
|
| Rate for Payer: PHP Medicare Advantage |
$781.97
|
| Rate for Payer: PHP Medicare Advantage |
$781.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,113.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$508.30
|
| Rate for Payer: Priority Health Medicare |
$781.97
|
| Rate for Payer: Priority Health Medicare |
$781.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$781.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$781.97
|
| Rate for Payer: UHC Medicare Advantage |
$781.97
|
| Rate for Payer: UHC Medicare Advantage |
$781.97
|
| Rate for Payer: UMR Bronson Commercial |
$787.98
|
| Rate for Payer: UMR Bronson Commercial |
$359.72
|
|
