|
PR PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 93281
|
| Min. Negotiated Rate |
$58.16 |
| Max. Negotiated Rate |
$1,457.58 |
| Rate for Payer: Aetna Commercial |
$108.43
|
| Rate for Payer: BCBS Complete |
$90.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,457.58
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.16
|
| Rate for Payer: Priority Health Narrow Network |
$58.16
|
| Rate for Payer: Priority Health SBD |
$120.10
|
| Rate for Payer: UMR Bronson Commercial |
$103.50
|
|
|
PR PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS 93623
|
| Min. Negotiated Rate |
$38.30 |
| Max. Negotiated Rate |
$1,500.37 |
| Rate for Payer: Aetna Commercial |
$217.76
|
| Rate for Payer: Aetna Commercial |
$217.76
|
| Rate for Payer: BCBS Complete |
$95.20
|
| Rate for Payer: BCBS Complete |
$130.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,500.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,500.37
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.30
|
| Rate for Payer: Priority Health Narrow Network |
$38.30
|
| Rate for Payer: Priority Health Narrow Network |
$38.30
|
| Rate for Payer: Priority Health SBD |
$153.68
|
| Rate for Payer: Priority Health SBD |
$153.68
|
| Rate for Payer: UMR Bronson Commercial |
$149.96
|
| Rate for Payer: UMR Bronson Commercial |
$109.48
|
|
|
PR PRO HEALTH BACK SCREEN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000022
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$101.49 |
| Rate for Payer: Aetna American Axle |
$32.50
|
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.50
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS Trust/PPO |
$101.49
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health SBD |
$31.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.82
|
| Rate for Payer: UHC Exchange |
$34.38
|
| Rate for Payer: UMR Bronson Commercial |
$18.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
PR PRO HEALTH BACK SCREEN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000022
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna American Axle |
$32.50
|
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.50
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health SBD |
$31.50
|
| Rate for Payer: UMR Bronson Commercial |
$22.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
PR PRO HEALTH FIT FOR DUTY EXAM
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000038
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna American Axle |
$146.25
|
| Rate for Payer: Aetna Commercial |
$191.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.25
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$157.50
|
| Rate for Payer: Cofinity Commercial |
$193.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.00
|
| Rate for Payer: Healthscope Commercial |
$202.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.25
|
| Rate for Payer: PHP Commercial |
$191.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health SBD |
$141.75
|
| Rate for Payer: UMR Bronson Commercial |
$99.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.75
|
|
|
PR PRO HEALTH FIT FOR DUTY EXAM
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000038
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.25 |
| Max. Negotiated Rate |
$238.48 |
| Rate for Payer: Aetna American Axle |
$146.25
|
| Rate for Payer: Aetna Commercial |
$191.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.25
|
| Rate for Payer: BCBS Complete |
$90.00
|
| Rate for Payer: BCBS Trust/PPO |
$238.48
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$193.50
|
| Rate for Payer: Cofinity Commercial |
$157.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.00
|
| Rate for Payer: Healthscope Commercial |
$202.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.25
|
| Rate for Payer: PHP Commercial |
$191.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health SBD |
$141.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.52
|
| Rate for Payer: UHC Exchange |
$140.47
|
| Rate for Payer: UMR Bronson Commercial |
$83.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.75
|
|
|
PR PRO HEALTH LIFT TEST
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna American Axle |
$32.50
|
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.50
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health SBD |
$31.50
|
| Rate for Payer: UMR Bronson Commercial |
$22.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
PR PRO HEALTH LIFT TEST
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$101.49 |
| Rate for Payer: Aetna American Axle |
$32.50
|
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.50
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS Trust/PPO |
$101.49
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health SBD |
$31.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.82
|
| Rate for Payer: UHC Exchange |
$34.38
|
| Rate for Payer: UMR Bronson Commercial |
$18.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
PR PRO HEALTH NURSE VISIT
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000017
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna American Axle |
$20.80
|
| Rate for Payer: Aetna Commercial |
$27.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$27.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.60
|
| Rate for Payer: Healthscope Commercial |
$28.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.20
|
| Rate for Payer: PHP Commercial |
$27.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health SBD |
$20.16
|
| Rate for Payer: UMR Bronson Commercial |
$14.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.00
|
|
|
PR PRO HEALTH NURSE VISIT
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000017
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$56.49 |
| Rate for Payer: Aetna American Axle |
$20.80
|
| Rate for Payer: Aetna Commercial |
$27.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.80
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$56.49
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$27.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.60
|
| Rate for Payer: Healthscope Commercial |
$28.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.20
|
| Rate for Payer: PHP Commercial |
$27.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health SBD |
$20.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.36
|
| Rate for Payer: UHC Exchange |
$8.51
|
| Rate for Payer: UMR Bronson Commercial |
$11.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.00
|
|
|
PR PRO HEALTH PHYSICAL AGILITY TEST
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$136.73 |
| Rate for Payer: Aetna American Axle |
$45.50
|
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCBS Trust/PPO |
$136.73
|
| Rate for Payer: BCCCP Commercial |
$72.85
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health SBD |
$44.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.60
|
| Rate for Payer: UHC Exchange |
$64.18
|
| Rate for Payer: UMR Bronson Commercial |
$25.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
PR PRO HEALTH PHYSICAL AGILITY TEST
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna American Axle |
$45.50
|
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health SBD |
$44.10
|
| Rate for Payer: UMR Bronson Commercial |
$30.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
PR PRO HEALTH VISION TESTING
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000018
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$56.49 |
| Rate for Payer: Aetna American Axle |
$16.25
|
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.25
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$56.49
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health SBD |
$15.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.36
|
| Rate for Payer: UHC Exchange |
$8.51
|
| Rate for Payer: UMR Bronson Commercial |
$9.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.75
|
|
|
PR PRO HEALTH VISION TESTING
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000018
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna American Axle |
$16.25
|
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.25
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health SBD |
$15.75
|
| Rate for Payer: UMR Bronson Commercial |
$11.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.75
|
|
|
PR PROHEALTH WORKSTATION EVAL
|
Facility
|
IP
|
$100.00
|
|
| Hospital Charge Code |
98300182
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna American Axle |
$65.00
|
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$70.00
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.00
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.00
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| Rate for Payer: UMR Bronson Commercial |
$44.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.00
|
|
|
PR PROHEALTH WORKSTATION EVAL
|
Facility
|
OP
|
$100.00
|
|
| Hospital Charge Code |
98300182
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna American Axle |
$65.00
|
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.00
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$70.00
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.00
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.00
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| Rate for Payer: UMR Bronson Commercial |
$37.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.00
|
|
|
PR PROLNG E/M BEFORE&/AFTER DIR CARE EA 30 MINUTES
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 99359
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$295.85 |
| Rate for Payer: Aetna Commercial |
$52.40
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: BCBS Trust/PPO |
$295.85
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.40
|
| Rate for Payer: Priority Health Narrow Network |
$54.40
|
| Rate for Payer: Priority Health SBD |
$54.40
|
| Rate for Payer: UMR Bronson Commercial |
$54.74
|
|
|
PR PROLNG E/M SVC BEFORE&/AFTER DIR PT CARE 1ST HR
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 99358
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$165.90 |
| Rate for Payer: Aetna Commercial |
$109.68
|
| Rate for Payer: BCBS Complete |
$94.80
|
| Rate for Payer: BCBS Trust/PPO |
$147.73
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.22
|
| Rate for Payer: Priority Health Narrow Network |
$115.22
|
| Rate for Payer: Priority Health SBD |
$115.22
|
| Rate for Payer: UMR Bronson Commercial |
$109.02
|
|
|
PR PROLONGED EXTRACORPOREAL CIRCULATION INIT DAY
|
Professional
|
Both
|
$2,718.00
|
|
|
Service Code
|
HCPCS 33960
|
| Min. Negotiated Rate |
$1,087.20 |
| Max. Negotiated Rate |
$1,902.60 |
| Rate for Payer: BCBS Complete |
$1,087.20
|
| Rate for Payer: Cash Price |
$2,174.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,902.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,250.28
|
|
|
PR PROLONGED INPATIENT/OBSERVATION EM SVC EA 15 MIN
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 99418
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$1,631.44 |
| Rate for Payer: Aetna Commercial |
$38.86
|
| Rate for Payer: BCBS Complete |
$26.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,631.44
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Meridian Medicaid |
$26.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.69
|
| Rate for Payer: Priority Health Narrow Network |
$49.69
|
| Rate for Payer: Priority Health SBD |
$49.69
|
| Rate for Payer: UMR Bronson Commercial |
$35.42
|
|
|
PR PROLONGED OUTPATIENT E/M SERVICE EACH 15 MINUTES
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 99417
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$1,097.28 |
| Rate for Payer: Aetna Commercial |
$32.84
|
| Rate for Payer: BCBS Complete |
$19.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,097.28
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Meridian Medicaid |
$19.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.12
|
| Rate for Payer: Priority Health Narrow Network |
$38.12
|
| Rate for Payer: Priority Health SBD |
$38.12
|
| Rate for Payer: UMR Bronson Commercial |
$29.90
|
|
|
PR PROLONGED SVC I/P OR OBS SETTING 1ST HOUR
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
HCPCS 99356
|
| Min. Negotiated Rate |
$118.80 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: BCBS Complete |
$118.80
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.90
|
| Rate for Payer: UMR Bronson Commercial |
$136.62
|
|
|
PR PROLONGED SVC I/P OR OBS SETTING EA ADDL 30 MIN
|
Professional
|
Both
|
$157.00
|
|
|
Service Code
|
HCPCS 99357
|
| Min. Negotiated Rate |
$62.80 |
| Max. Negotiated Rate |
$109.90 |
| Rate for Payer: BCBS Complete |
$62.80
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.90
|
| Rate for Payer: UMR Bronson Commercial |
$72.22
|
|
|
PR PROLONGED SVC OUTPATIENT SETTING 1ST HOUR
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
HCPCS 99354
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: BCBS Complete |
$91.20
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.60
|
| Rate for Payer: UMR Bronson Commercial |
$104.88
|
|
|
PR PROLONGED SVC OUTPATIENT SETTING EA ADDL 30 MIN
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 99355
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: BCBS Complete |
$68.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.00
|
| Rate for Payer: UMR Bronson Commercial |
$78.20
|
|
