|
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 |
$84.92 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Aetna American Axle |
$149.18
|
| Rate for Payer: Aetna Commercial |
$195.07
|
| Rate for Payer: Aetna Medicare |
$114.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.18
|
| Rate for Payer: BCBS Complete |
$91.80
|
| Rate for Payer: BCBS Trust/PPO |
$200.88
|
| Rate for Payer: BCN Commercial |
$200.88
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Advantage |
$160.65
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$160.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$183.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.12
|
| Rate for Payer: PHP Commercial |
$195.07
|
| Rate for Payer: Priority Health SBD |
$144.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.18
|
| Rate for Payer: UHC Core |
$119.57
|
| Rate for Payer: UHC Exchange |
$90.19
|
| Rate for Payer: UMR Bronson Commercial |
$84.92
|
| 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 |
$22.44 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Advantage |
$35.70
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| 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 |
$18.87 |
| Max. Negotiated Rate |
$84.65 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$84.65
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$84.65
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Advantage |
$35.70
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.15
|
| Rate for Payer: UHC Core |
$26.57
|
| Rate for Payer: UHC Exchange |
$20.04
|
| Rate for Payer: UMR Bronson Commercial |
$18.87
|
| 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 |
$14.36 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna American Axle |
$21.22
|
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Advantage |
$22.85
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.48
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: Priority Health SBD |
$20.56
|
| Rate for Payer: UMR Bronson Commercial |
$14.36
|
| 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 |
$12.08 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Aetna American Axle |
$21.22
|
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna Medicare |
$16.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: BCBS Complete |
$13.06
|
| Rate for Payer: BCBS Trust/PPO |
$47.11
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$47.11
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Advantage |
$22.85
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.48
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: Priority Health SBD |
$20.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.22
|
| Rate for Payer: UHC Core |
$17.01
|
| Rate for Payer: UHC Exchange |
$12.83
|
| Rate for Payer: UMR Bronson Commercial |
$12.08
|
| 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 |
$31.42 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna American Axle |
$46.41
|
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Advantage |
$49.98
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$49.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.55
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health SBD |
$44.98
|
| Rate for Payer: UMR Bronson Commercial |
$31.42
|
| 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 |
$26.42 |
| Max. Negotiated Rate |
$114.04 |
| Rate for Payer: Aetna American Axle |
$46.41
|
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna Medicare |
$35.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: BCBS Trust/PPO |
$114.04
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$114.04
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Advantage |
$49.98
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$49.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.55
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health SBD |
$44.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.41
|
| Rate for Payer: UHC Core |
$37.20
|
| Rate for Payer: UHC Exchange |
$28.06
|
| Rate for Payer: UMR Bronson Commercial |
$26.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
PR PRO HEALTH VISION TESTING
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000018
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Aetna American Axle |
$16.57
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$12.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.57
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$47.11
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$47.11
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Advantage |
$17.85
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.12
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health SBD |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.57
|
| Rate for Payer: UHC Core |
$13.29
|
| Rate for Payer: UHC Exchange |
$10.02
|
| Rate for Payer: UMR Bronson Commercial |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
PR PRO HEALTH VISION TESTING
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000018
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna American Axle |
$16.57
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.57
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Advantage |
$17.85
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.12
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health SBD |
$16.07
|
| Rate for Payer: UMR Bronson Commercial |
$11.22
|
| 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 |
$46.20 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna American Axle |
$68.25
|
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Advantage |
$73.50
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$73.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health SBD |
$66.15
|
| Rate for Payer: UMR Bronson Commercial |
$46.20
|
| 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 |
$38.85 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna American Axle |
$68.25
|
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna Medicare |
$52.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Advantage |
$73.50
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$73.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health SBD |
$66.15
|
| Rate for Payer: UMR Bronson Commercial |
$38.85
|
| 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: Aetna New Business (MI Preferred) |
$52.40
|
| 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/Narrow Network |
$48.37
|
| Rate for Payer: Priority Health SBD |
$48.37
|
| Rate for Payer: Priority Health Tiered Network |
$48.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.91
|
| Rate for Payer: UHC Core |
$76.91
|
| Rate for Payer: UHC Exchange |
$76.91
|
| Rate for Payer: UMR Bronson Commercial |
$57.50
|
|
|
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: Aetna New Business (MI Preferred) |
$109.68
|
| 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/Narrow Network |
$117.81
|
| Rate for Payer: Priority Health SBD |
$117.81
|
| Rate for Payer: Priority Health Tiered Network |
$117.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.42
|
| Rate for Payer: UHC Core |
$157.42
|
| Rate for Payer: UHC Exchange |
$157.42
|
| Rate for Payer: UMR Bronson Commercial |
$114.54
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$1,313.30
|
|
|
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: Aetna New Business (MI Preferred) |
$38.86
|
| 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: 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/Narrow Network |
$52.42
|
| Rate for Payer: Priority Health SBD |
$52.42
|
| Rate for Payer: Priority Health Tiered Network |
$52.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.09
|
| Rate for Payer: UHC Core |
$58.09
|
| Rate for Payer: UHC Exchange |
$58.09
|
| Rate for Payer: UHC Medicaid |
$22.15
|
| Rate for Payer: UHCCP Medicaid |
$22.15
|
| Rate for Payer: UMR Bronson Commercial |
$37.26
|
|
|
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: Aetna New Business (MI Preferred) |
$32.84
|
| 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: 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/Narrow Network |
$39.87
|
| Rate for Payer: Priority Health SBD |
$39.87
|
| Rate for Payer: Priority Health Tiered Network |
$39.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.48
|
| Rate for Payer: UHC Core |
$46.48
|
| Rate for Payer: UHC Exchange |
$46.48
|
| Rate for Payer: UHC Medicaid |
$16.83
|
| Rate for Payer: UHCCP Medicaid |
$16.83
|
| Rate for Payer: UMR Bronson Commercial |
$31.28
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$143.52
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$75.90
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$110.40
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$81.88
|
|
|
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 |
$36.77
|
| Rate for Payer: Aetna Medicare |
$28.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.51
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: BCBS MAPPO |
$27.44
|
| Rate for Payer: BCN Commercial |
$45.32
|
| Rate for Payer: BCN Medicare Advantage |
$27.44
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$36.77
|
| Rate for Payer: Cofinity Commercial |
$39.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.18
|
| Rate for Payer: Nomi Health Commercial |
$32.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.75
|
| Rate for Payer: PACE SWMI |
$27.44
|
| Rate for Payer: PHP Commercial |
$38.42
|
| Rate for Payer: PHP Medicare Advantage |
$27.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$40.77
|
| Rate for Payer: Priority Health Medicare |
$27.44
|
| Rate for Payer: Priority Health SBD |
$40.77
|
| Rate for Payer: Priority Health Tiered Network |
$40.77
|
| Rate for Payer: Railroad Medicare Medicare |
$27.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.03
|
| Rate for Payer: UHC Core |
$45.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.44
|
| Rate for Payer: UHC Exchange |
$45.03
|
| Rate for Payer: UMR Bronson Commercial |
$29.90
|
|
|
PR PROLONG OUTPT/OFFICE VIS
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS G2212
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$36.37
|
| Rate for Payer: Aetna Medicare |
$28.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.08
|
| Rate for Payer: BCBS Complete |
$18.34
|
| Rate for Payer: BCBS MAPPO |
$27.14
|
| Rate for Payer: BCN Commercial |
$37.27
|
| Rate for Payer: BCN Medicare Advantage |
$27.14
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$36.37
|
| Rate for Payer: Cofinity Commercial |
$39.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.50
|
| Rate for Payer: Meridian Medicaid |
$18.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.85
|
| Rate for Payer: Nomi Health Commercial |
$32.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.00
|
| Rate for Payer: PACE SWMI |
$27.14
|
| Rate for Payer: PHP Commercial |
$38.00
|
| Rate for Payer: PHP Medicare Advantage |
$27.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34.88
|
| Rate for Payer: Priority Health Medicare |
$27.14
|
| Rate for Payer: Priority Health SBD |
$34.88
|
| Rate for Payer: Priority Health Tiered Network |
$34.88
|
| Rate for Payer: Railroad Medicare Medicare |
$27.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.48
|
| Rate for Payer: UHC Core |
$46.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.14
|
| Rate for Payer: UHC Exchange |
$46.48
|
| Rate for Payer: UHC Medicaid |
$17.47
|
| Rate for Payer: UHCCP Medicaid |
$17.47
|
| Rate for Payer: UMR Bronson Commercial |
$31.28
|
|
|
PR PROMETHAZINE HCL INJECTION
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J2550
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Aetna Commercial |
$4.48
|
| Rate for Payer: Aetna Medicare |
$3.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.81
|
| Rate for Payer: BCBS MAPPO |
$3.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.33
|
| Rate for Payer: BCN Commercial |
$0.27
|
| Rate for Payer: BCN Medicare Advantage |
$3.34
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$4.48
|
| Rate for Payer: Cofinity Commercial |
$4.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.67
|
| Rate for Payer: Nomi Health Commercial |
$4.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.25
|
| Rate for Payer: PACE SWMI |
$3.34
|
| Rate for Payer: PHP Commercial |
$4.68
|
| Rate for Payer: PHP Medicare Advantage |
$3.34
|
| Rate for Payer: Priority Health Medicare |
$3.34
|
| Rate for Payer: Railroad Medicare Medicare |
$3.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.97
|
| Rate for Payer: UHC Core |
$3.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.34
|
| Rate for Payer: UHC Exchange |
$3.97
|
| Rate for Payer: UMR Bronson Commercial |
$6.90
|
|
|
PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE FEMUR
|
Professional
|
Both
|
$2,865.00
|
|
|
Service Code
|
HCPCS 27495
|
| Min. Negotiated Rate |
$1,017.27 |
| Max. Negotiated Rate |
$2,148.75 |
| Rate for Payer: Aetna Commercial |
$1,363.14
|
| Rate for Payer: Aetna Medicare |
$1,057.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,363.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,464.87
|
| Rate for Payer: BCBS Complete |
$1,146.00
|
| Rate for Payer: BCBS MAPPO |
$1,017.27
|
| Rate for Payer: BCN Commercial |
$1,711.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,017.27
|
| Rate for Payer: Cash Price |
$2,292.00
|
| Rate for Payer: Cash Price |
$2,292.00
|
| Rate for Payer: Cofinity Commercial |
$1,464.87
|
| Rate for Payer: Cofinity Commercial |
$1,363.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,017.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,068.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,119.00
|
| Rate for Payer: Nomi Health Commercial |
$1,220.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,148.75
|
| Rate for Payer: PACE SWMI |
$1,017.27
|
| Rate for Payer: PHP Commercial |
$1,424.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,017.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,829.61
|
| Rate for Payer: Priority Health Medicare |
$1,017.27
|
| Rate for Payer: Priority Health SBD |
$1,829.61
|
| Rate for Payer: Priority Health Tiered Network |
$1,829.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1,017.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,978.62
|
| Rate for Payer: UHC Core |
$1,978.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,017.27
|
| Rate for Payer: UHC Exchange |
$1,978.62
|
| Rate for Payer: UMR Bronson Commercial |
$1,317.90
|
|
|
PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE TIBIA
|
Professional
|
Both
|
$2,212.00
|
|
|
Service Code
|
HCPCS 27745
|
| Min. Negotiated Rate |
$663.17 |
| Max. Negotiated Rate |
$1,659.00 |
| Rate for Payer: Aetna Commercial |
$888.65
|
| Rate for Payer: Aetna Medicare |
$689.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$954.96
|
| Rate for Payer: BCBS Complete |
$884.80
|
| Rate for Payer: BCBS MAPPO |
$663.17
|
| Rate for Payer: BCN Commercial |
$1,116.47
|
| Rate for Payer: BCN Medicare Advantage |
$663.17
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Cofinity Commercial |
$954.96
|
| Rate for Payer: Cofinity Commercial |
$888.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$663.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$696.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$729.49
|
| Rate for Payer: Nomi Health Commercial |
$795.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,659.00
|
| Rate for Payer: PACE SWMI |
$663.17
|
| Rate for Payer: PHP Commercial |
$928.44
|
| Rate for Payer: PHP Medicare Advantage |
$663.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,193.48
|
| Rate for Payer: Priority Health Medicare |
$663.17
|
| Rate for Payer: Priority Health SBD |
$1,193.48
|
| Rate for Payer: Priority Health Tiered Network |
$1,193.48
|
| Rate for Payer: Railroad Medicare Medicare |
$663.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,328.59
|
| Rate for Payer: UHC Core |
$1,328.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$663.17
|
| Rate for Payer: UHC Exchange |
$1,328.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,017.52
|
|
