|
PR PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
HCPCS 0575T
|
| Min. Negotiated Rate |
$34.87 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Aetna Commercial |
$65.51
|
| Rate for Payer: Aetna Medicare |
$49.00
|
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: BCN Commercial |
$34.87
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.50
|
|
|
PR PRO HEALTH BACK SCREEN
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000022
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$42.12
|
| Rate for Payer: BCN Commercial |
$42.12
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
PR PRO HEALTH BACK SCREEN
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000022
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$41.93
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$41.93
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$8.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: Meridian Medicaid |
$9.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.50
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.59
|
| Rate for Payer: UHC Exchange |
$12.75
|
| Rate for Payer: UHC Medicaid |
$8.99
|
| Rate for Payer: UHC Medicare Advantage |
$12.75
|
| Rate for Payer: UHCCP Medicaid |
$8.99
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
PR PRO HEALTH FIT FOR DUTY EXAM
|
Facility
|
OP
|
$229.50
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000038
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Aetna Commercial |
$195.07
|
| Rate for Payer: Aetna Medicare |
$59.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.72
|
| Rate for Payer: BCBS Complete |
$42.48
|
| Rate for Payer: BCBS MAPPO |
$57.38
|
| Rate for Payer: BCBS Trust/PPO |
$188.67
|
| Rate for Payer: BCN Commercial |
$188.67
|
| Rate for Payer: BCN Medicare Advantage |
$57.38
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Commercial |
$197.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.38
|
| Rate for Payer: Healthscope Commercial |
$206.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.12
|
| Rate for Payer: Mclaren Medicaid |
$40.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.24
|
| Rate for Payer: Meridian Medicaid |
$42.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$63.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.07
|
| Rate for Payer: Nomi Health Commercial |
$188.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.12
|
| Rate for Payer: PACE Senior Care Partners |
$54.51
|
| Rate for Payer: PACE SWMI |
$57.38
|
| Rate for Payer: PHP Commercial |
$195.07
|
| Rate for Payer: PHP Medicare Advantage |
$57.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$199.66
|
| Rate for Payer: Priority Health Medicare |
$57.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.73
|
| Rate for Payer: Railroad Medicare Medicare |
$57.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.96
|
| Rate for Payer: UHC Core |
$191.63
|
| Rate for Payer: UHC Exchange |
$57.38
|
| Rate for Payer: UHC Medicaid |
$40.46
|
| Rate for Payer: UHC Medicare Advantage |
$57.38
|
| Rate for Payer: UHCCP Medicaid |
$40.46
|
| Rate for Payer: VA VA |
$57.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.12
|
|
|
PR PRO HEALTH FIT FOR DUTY EXAM
|
Facility
|
IP
|
$229.50
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000038
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$159.73 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Aetna Commercial |
$195.07
|
| Rate for Payer: BCBS Trust/PPO |
$189.54
|
| Rate for Payer: BCN Commercial |
$189.54
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Commercial |
$197.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.60
|
| Rate for Payer: Healthscope Commercial |
$206.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.07
|
| Rate for Payer: Nomi Health Commercial |
$188.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.12
|
| Rate for Payer: PHP Commercial |
$195.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$199.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.96
|
| Rate for Payer: UHC Core |
$191.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.12
|
|
|
PR PRO HEALTH LIFT TEST
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$42.12
|
| Rate for Payer: BCN Commercial |
$42.12
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
PR PRO HEALTH LIFT TEST
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$41.93
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$41.93
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$8.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: Meridian Medicaid |
$9.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.50
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.59
|
| Rate for Payer: UHC Exchange |
$12.75
|
| Rate for Payer: UHC Medicaid |
$8.99
|
| Rate for Payer: UHC Medicare Advantage |
$12.75
|
| Rate for Payer: UHCCP Medicaid |
$8.99
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
PR PRO HEALTH NURSE VISIT
|
Facility
|
IP
|
$32.64
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000017
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.72 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: BCBS Trust/PPO |
$26.96
|
| Rate for Payer: BCN Commercial |
$26.96
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.74
|
| Rate for Payer: Nomi Health Commercial |
$26.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.48
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.72
|
| Rate for Payer: UHC Core |
$27.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.48
|
|
|
PR PRO HEALTH NURSE VISIT
|
Facility
|
OP
|
$32.64
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000017
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna Medicare |
$8.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.20
|
| Rate for Payer: BCBS Complete |
$6.04
|
| Rate for Payer: BCBS MAPPO |
$8.16
|
| Rate for Payer: BCBS Trust/PPO |
$26.83
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$26.83
|
| Rate for Payer: BCN Medicare Advantage |
$8.16
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.48
|
| Rate for Payer: Mclaren Medicaid |
$5.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.57
|
| Rate for Payer: Meridian Medicaid |
$6.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.74
|
| Rate for Payer: Nomi Health Commercial |
$26.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.48
|
| Rate for Payer: PACE Senior Care Partners |
$7.75
|
| Rate for Payer: PACE SWMI |
$8.16
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: PHP Medicare Advantage |
$8.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.40
|
| Rate for Payer: Priority Health Medicare |
$8.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.72
|
| Rate for Payer: Railroad Medicare Medicare |
$8.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.72
|
| Rate for Payer: UHC Core |
$27.25
|
| Rate for Payer: UHC Exchange |
$8.16
|
| Rate for Payer: UHC Medicaid |
$5.75
|
| Rate for Payer: UHC Medicare Advantage |
$8.16
|
| Rate for Payer: UHCCP Medicaid |
$5.75
|
| Rate for Payer: VA VA |
$8.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.48
|
|
|
PR PRO HEALTH PHYSICAL AGILITY TEST
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.69 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: BCBS Trust/PPO |
$58.97
|
| Rate for Payer: BCN Commercial |
$58.97
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.55
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.83
|
| Rate for Payer: UHC Core |
$59.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
PR PRO HEALTH PHYSICAL AGILITY TEST
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$87.68 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna Medicare |
$18.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.31
|
| Rate for Payer: BCBS Complete |
$13.22
|
| Rate for Payer: BCBS MAPPO |
$17.85
|
| Rate for Payer: BCBS Trust/PPO |
$58.70
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$58.70
|
| Rate for Payer: BCN Medicare Advantage |
$17.85
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Mclaren Medicaid |
$12.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.74
|
| Rate for Payer: Meridian Medicaid |
$13.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.55
|
| Rate for Payer: PACE Senior Care Partners |
$16.96
|
| Rate for Payer: PACE SWMI |
$17.85
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: PHP Medicare Advantage |
$17.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.12
|
| Rate for Payer: Priority Health Medicare |
$18.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.69
|
| Rate for Payer: Railroad Medicare Medicare |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.83
|
| Rate for Payer: UHC Core |
$59.62
|
| Rate for Payer: UHC Exchange |
$17.85
|
| Rate for Payer: UHC Medicaid |
$12.59
|
| Rate for Payer: UHC Medicare Advantage |
$17.85
|
| Rate for Payer: UHCCP Medicaid |
$12.59
|
| Rate for Payer: VA VA |
$17.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
PR PRO HEALTH VISION TESTING
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000018
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$21.06
|
| Rate for Payer: BCN Commercial |
$21.06
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Nomi Health Commercial |
$20.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.12
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
PR PRO HEALTH VISION TESTING
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000018
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$6.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.97
|
| Rate for Payer: BCBS Complete |
$4.72
|
| Rate for Payer: BCBS MAPPO |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$20.96
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$20.96
|
| Rate for Payer: BCN Medicare Advantage |
$6.38
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Mclaren Medicaid |
$4.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.69
|
| Rate for Payer: Meridian Medicaid |
$4.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Nomi Health Commercial |
$20.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.12
|
| Rate for Payer: PACE Senior Care Partners |
$6.06
|
| Rate for Payer: PACE SWMI |
$6.38
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.18
|
| Rate for Payer: Priority Health Medicare |
$6.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.75
|
| Rate for Payer: Railroad Medicare Medicare |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: UHC Exchange |
$6.38
|
| Rate for Payer: UHC Medicaid |
$4.50
|
| Rate for Payer: UHC Medicare Advantage |
$6.38
|
| Rate for Payer: UHCCP Medicaid |
$4.50
|
| Rate for Payer: VA VA |
$6.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
PR PROHEALTH WORKSTATION EVAL
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
98300182
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$73.08 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: BCBS Trust/PPO |
$86.72
|
| Rate for Payer: BCN Commercial |
$86.72
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.25
|
| Rate for Payer: Nomi Health Commercial |
$86.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$91.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.08
|
| Rate for Payer: UHC Core |
$87.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
PR PROHEALTH WORKSTATION EVAL
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
98300182
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$18.51 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna Medicare |
$27.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.81
|
| Rate for Payer: BCBS Complete |
$19.44
|
| Rate for Payer: BCBS MAPPO |
$26.25
|
| Rate for Payer: BCBS Trust/PPO |
$86.32
|
| Rate for Payer: BCN Commercial |
$86.32
|
| Rate for Payer: BCN Medicare Advantage |
$26.25
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.25
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Mclaren Medicaid |
$18.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.56
|
| Rate for Payer: Meridian Medicaid |
$19.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.25
|
| Rate for Payer: Nomi Health Commercial |
$86.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
| Rate for Payer: PACE Senior Care Partners |
$24.94
|
| Rate for Payer: PACE SWMI |
$26.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: PHP Medicare Advantage |
$26.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$91.35
|
| Rate for Payer: Priority Health Medicare |
$26.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.08
|
| Rate for Payer: Railroad Medicare Medicare |
$26.25
|
| Rate for Payer: UHC Core |
$87.67
|
| Rate for Payer: UHC Exchange |
$26.25
|
| Rate for Payer: UHC Medicaid |
$18.51
|
| Rate for Payer: UHC Medicare Advantage |
$26.25
|
| Rate for Payer: UHCCP Medicaid |
$18.51
|
| Rate for Payer: VA VA |
$26.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
PR PROLNG E/M BEFORE&/AFTER DIR CARE EA 30 MINUTES
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 99359
|
| Min. Negotiated Rate |
$48.37 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Aetna Commercial |
$52.40
|
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCN Commercial |
$53.78
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$48.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.37
|
|
|
PR PROLNG E/M SVC BEFORE&/AFTER DIR PT CARE 1ST HR
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 99358
|
| Min. Negotiated Rate |
$99.60 |
| Max. Negotiated Rate |
$186.75 |
| Rate for Payer: Aetna Commercial |
$109.68
|
| Rate for Payer: Aetna Medicare |
$124.50
|
| Rate for Payer: BCBS Complete |
$99.60
|
| Rate for Payer: BCN Commercial |
$130.97
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$117.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.81
|
|
|
PR PROLONGED EXTRACORPOREAL CIRCULATION INIT DAY
|
Professional
|
Both
|
$2,855.00
|
|
|
Service Code
|
HCPCS 33960
|
| Min. Negotiated Rate |
$1,142.00 |
| Max. Negotiated Rate |
$2,141.25 |
| Rate for Payer: Aetna Medicare |
$1,427.50
|
| Rate for Payer: BCBS Complete |
$1,142.00
|
| Rate for Payer: Cash Price |
$2,284.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,141.25
|
|
|
PR PROLONGED INPATIENT/OBSERVATION EM SVC EA 15 MIN
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 99418
|
| Min. Negotiated Rate |
$22.15 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Aetna Commercial |
$38.86
|
| Rate for Payer: Aetna Medicare |
$40.50
|
| Rate for Payer: BCBS Complete |
$23.26
|
| Rate for Payer: BCN Commercial |
$58.26
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Mclaren Medicaid |
$22.15
|
| Rate for Payer: Meridian Medicaid |
$23.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$52.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.42
|
| Rate for Payer: UHC Medicaid |
$22.15
|
| Rate for Payer: UHCCP Medicaid |
$22.15
|
|
|
PR PROLONGED OUTPATIENT E/M SERVICE EACH 15 MINUTES
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 99417
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$32.84
|
| Rate for Payer: Aetna Medicare |
$34.00
|
| Rate for Payer: BCBS Complete |
$17.67
|
| Rate for Payer: BCN Commercial |
$44.32
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Mclaren Medicaid |
$16.83
|
| Rate for Payer: Meridian Medicaid |
$17.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$39.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.87
|
| Rate for Payer: UHC Medicaid |
$16.83
|
| Rate for Payer: UHCCP Medicaid |
$16.83
|
|
|
PR PROLONGED SVC I/P OR OBS SETTING 1ST HOUR
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 99356
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna Medicare |
$156.00
|
| Rate for Payer: BCBS Complete |
$124.80
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.00
|
|
|
PR PROLONGED SVC I/P OR OBS SETTING EA ADDL 30 MIN
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 99357
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Aetna Medicare |
$82.50
|
| Rate for Payer: BCBS Complete |
$66.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.75
|
|
|
PR PROLONGED SVC OUTPATIENT SETTING 1ST HOUR
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 99354
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Medicare |
$120.00
|
| Rate for Payer: BCBS Complete |
$96.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.00
|
|
|
PR PROLONGED SVC OUTPATIENT SETTING EA ADDL 30 MIN
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS 99355
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Aetna Medicare |
$89.00
|
| Rate for Payer: BCBS Complete |
$71.20
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.50
|
|
|
PR PROLONG INPT EVAL ADD15 M
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS G0316
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna Commercial |
$30.15
|
| Rate for Payer: Aetna Medicare |
$32.50
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: BCN Commercial |
$45.32
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.77
|
|
