|
PR CARTILAGE GRAFT NASAL SEPTUM
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 20912
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$743.95 |
| Rate for Payer: Aetna Commercial |
$615.57
|
| Rate for Payer: Aetna Medicare |
$477.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.51
|
| Rate for Payer: BCBS Complete |
$327.87
|
| Rate for Payer: BCBS MAPPO |
$459.38
|
| Rate for Payer: BCBS Trust/PPO |
$86.88
|
| Rate for Payer: BCN Commercial |
$707.61
|
| Rate for Payer: BCN Medicare Advantage |
$459.38
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$615.57
|
| Rate for Payer: Cofinity Commercial |
$661.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$459.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$482.35
|
| Rate for Payer: Meridian Medicaid |
$327.87
|
| Rate for Payer: Nomi Health Commercial |
$551.26
|
| Rate for Payer: PACE SWMI |
$459.38
|
| Rate for Payer: PHP Commercial |
$643.13
|
| Rate for Payer: PHP Medicare Advantage |
$459.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$312.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$743.95
|
| Rate for Payer: Priority Health Medicare |
$459.38
|
| Rate for Payer: Priority Health Narrow Network |
$743.95
|
| Rate for Payer: Priority Health SBD |
$743.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$459.38
|
| Rate for Payer: UHC Medicare Advantage |
$459.38
|
| Rate for Payer: UHCCP Medicaid |
$312.26
|
| Rate for Payer: UMR Bronson Commercial |
$485.76
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$53.89 |
| Max. Negotiated Rate |
$2,807.55 |
| Rate for Payer: Aetna American Axle |
$266.50
|
| Rate for Payer: Aetna Commercial |
$348.50
|
| Rate for Payer: Aetna Medicare |
$929.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,116.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,116.60
|
| Rate for Payer: BCBS Complete |
$502.74
|
| Rate for Payer: BCBS MAPPO |
$893.28
|
| Rate for Payer: BCBS Trust/PPO |
$785.12
|
| Rate for Payer: BCN Commercial |
$785.12
|
| Rate for Payer: BCN Medicare Advantage |
$893.28
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$287.00
|
| Rate for Payer: Cofinity Commercial |
$352.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$893.28
|
| Rate for Payer: Healthscope Commercial |
$369.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.50
|
| Rate for Payer: Mclaren Medicaid |
$478.80
|
| Rate for Payer: Mclaren Medicare |
$893.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$937.94
|
| Rate for Payer: Meridian Medicaid |
$502.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,027.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.50
|
| Rate for Payer: Nomi Health Commercial |
$1,875.89
|
| Rate for Payer: PACE Medicare |
$848.62
|
| Rate for Payer: PACE SWMI |
$893.28
|
| Rate for Payer: PHP Commercial |
$348.50
|
| Rate for Payer: PHP Medicare Advantage |
$893.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$478.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,807.55
|
| Rate for Payer: Priority Health Medicare |
$893.28
|
| Rate for Payer: Priority Health Narrow Network |
$2,246.04
|
| Rate for Payer: Priority Health SBD |
$258.30
|
| Rate for Payer: Railroad Medicare Medicare |
$893.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.28
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$893.28
|
| Rate for Payer: UHC Exchange |
$53.89
|
| Rate for Payer: UHC Medicare Advantage |
$893.28
|
| Rate for Payer: UHCCP Medicaid |
$478.80
|
| Rate for Payer: UMR Bronson Commercial |
$151.70
|
| Rate for Payer: VA VA |
$893.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.50
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS G0104
|
| Min. Negotiated Rate |
$36.21 |
| Max. Negotiated Rate |
$1,681.05 |
| Rate for Payer: Aetna Commercial |
$71.73
|
| Rate for Payer: Aetna Medicare |
$55.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.08
|
| Rate for Payer: BCBS Complete |
$38.02
|
| Rate for Payer: BCBS MAPPO |
$53.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,681.05
|
| Rate for Payer: BCN Commercial |
$273.17
|
| Rate for Payer: BCN Medicare Advantage |
$53.53
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$71.73
|
| Rate for Payer: Cofinity Commercial |
$77.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.21
|
| Rate for Payer: Meridian Medicaid |
$38.02
|
| Rate for Payer: Nomi Health Commercial |
$64.24
|
| Rate for Payer: PACE SWMI |
$53.53
|
| Rate for Payer: PHP Commercial |
$74.94
|
| Rate for Payer: PHP Medicare Advantage |
$53.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.83
|
| Rate for Payer: Priority Health Medicare |
$53.53
|
| Rate for Payer: Priority Health Narrow Network |
$100.83
|
| Rate for Payer: Priority Health SBD |
$100.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.53
|
| Rate for Payer: UHC Medicare Advantage |
$53.53
|
| Rate for Payer: UHCCP Medicaid |
$36.21
|
| Rate for Payer: UMR Bronson Commercial |
$188.60
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$180.40 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Aetna American Axle |
$266.50
|
| Rate for Payer: Aetna Commercial |
$348.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.50
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$287.00
|
| Rate for Payer: Cofinity Commercial |
$352.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.00
|
| Rate for Payer: Healthscope Commercial |
$369.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.50
|
| Rate for Payer: PHP Commercial |
$348.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health SBD |
$258.30
|
| Rate for Payer: UMR Bronson Commercial |
$180.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.50
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
| Min. Negotiated Rate |
$36.21 |
| Max. Negotiated Rate |
$1,681.05 |
| Rate for Payer: Aetna Commercial |
$71.73
|
| Rate for Payer: Aetna Medicare |
$55.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.08
|
| Rate for Payer: BCBS Complete |
$38.02
|
| Rate for Payer: BCBS MAPPO |
$53.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,681.05
|
| Rate for Payer: BCN Commercial |
$273.17
|
| Rate for Payer: BCN Medicare Advantage |
$53.53
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$77.08
|
| Rate for Payer: Cofinity Commercial |
$71.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.21
|
| Rate for Payer: Meridian Medicaid |
$38.02
|
| Rate for Payer: Nomi Health Commercial |
$64.24
|
| Rate for Payer: PACE SWMI |
$53.53
|
| Rate for Payer: PHP Commercial |
$74.94
|
| Rate for Payer: PHP Medicare Advantage |
$53.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.83
|
| Rate for Payer: Priority Health Medicare |
$53.53
|
| Rate for Payer: Priority Health Narrow Network |
$100.83
|
| Rate for Payer: Priority Health SBD |
$100.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.53
|
| Rate for Payer: UHC Medicare Advantage |
$53.53
|
| Rate for Payer: UHCCP Medicaid |
$36.21
|
| Rate for Payer: UMR Bronson Commercial |
$188.60
|
|
|
PR CA SCREEN;PELVIC/BREAST EXAM
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS G0101
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$1,696.90 |
| Rate for Payer: Aetna Commercial |
$34.40
|
| Rate for Payer: Aetna Medicare |
$26.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.96
|
| Rate for Payer: BCBS Complete |
$18.11
|
| Rate for Payer: BCBS MAPPO |
$25.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,696.90
|
| Rate for Payer: BCN Commercial |
$57.17
|
| Rate for Payer: BCN Medicare Advantage |
$25.67
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$36.96
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.95
|
| Rate for Payer: Meridian Medicaid |
$18.11
|
| Rate for Payer: Nomi Health Commercial |
$30.80
|
| Rate for Payer: PACE SWMI |
$25.67
|
| Rate for Payer: PHP Commercial |
$35.94
|
| Rate for Payer: PHP Medicare Advantage |
$25.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.80
|
| Rate for Payer: Priority Health Medicare |
$25.67
|
| Rate for Payer: Priority Health Narrow Network |
$36.80
|
| Rate for Payer: Priority Health SBD |
$36.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.67
|
| Rate for Payer: UHC Medicare Advantage |
$25.67
|
| Rate for Payer: UHCCP Medicaid |
$17.25
|
| Rate for Payer: UMR Bronson Commercial |
$31.28
|
|
|
PR CAST SUP GAUNTLET FIBERGLASS
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS Q4014
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$36.40 |
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCN Commercial |
$26.15
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: UMR Bronson Commercial |
$25.76
|
|
|
PR CAST SUP LNG ARM SPLINT FBRG
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS Q4018
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCN Commercial |
$14.28
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
|
|
PR CAST SUP LNG ARM SPLINT PLST
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS Q4017
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCN Commercial |
$8.96
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: UMR Bronson Commercial |
$19.78
|
|
|
PR CAST SUP LNG ARM SPLNT PED F
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS Q4020
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$15.60 |
| 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 |
$15.60
|
| 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 |
$65.98 |
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCN Commercial |
$65.98
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.00
|
| 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 |
$33.15 |
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCN Commercial |
$33.01
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| 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 |
$37.44 |
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCN Commercial |
$37.44
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
| 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 |
$50.05 |
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCN Commercial |
$33.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| 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 |
$25.35 |
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCN Commercial |
$16.82
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| 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 |
$36.40 |
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCN Commercial |
$28.75
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| 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 |
$16.90 |
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCN Commercial |
$14.36
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| 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 |
$75.40 |
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: BCN Commercial |
$74.88
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.40
|
| Rate for Payer: UMR Bronson Commercial |
$53.36
|
|
|
PR CAST SUPPLIES UNLISTED
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS Q4050
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCN Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$81.60
|
| 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 |
$119.78 |
| Rate for Payer: BCBS Complete |
$61.60
|
| Rate for Payer: BCN Commercial |
$119.78
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.10
|
| 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 |
$40.55 |
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCN Commercial |
$40.55
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| 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 |
$20.27 |
| 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 |
$13.65
|
| 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 |
$27.95 |
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCN Commercial |
$19.16
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| 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 |
$13.00 |
| 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 |
$13.00
|
| 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 |
$16.90 |
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCN Commercial |
$11.97
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
|
