|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, 0.25 ML IM
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 90687
|
| Hospital Charge Code |
63600126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, 0.25 ML IM
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 90687
|
| Hospital Charge Code |
63600126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$13.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: BCBS Complete |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$22.70
|
| Rate for Payer: BCN Commercial |
$22.70
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10.44
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: Priority Health Tiered Network |
$8.35
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, 0.5 ML IM
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
63600078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, 0.5 ML IM
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
63600078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$48.58 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$13.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: BCBS Complete |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$48.58
|
| Rate for Payer: BCN Commercial |
$48.58
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22.35
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: Priority Health Tiered Network |
$17.88
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, CHILD 6-35 MONTHS, IM
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 90685
|
| Hospital Charge Code |
63600077
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, CHILD 6-35 MONTHS, IM
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 90685
|
| Hospital Charge Code |
63600077
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$54.30 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$13.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: BCBS Complete |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$54.30
|
| Rate for Payer: BCN Commercial |
$54.30
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21.64
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: Priority Health Tiered Network |
$17.31
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (CCIIV3) 0.5 ML IM
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
CPT 90661
|
| Hospital Charge Code |
63600250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.99 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Advantage |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health SBD |
$26.99
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (CCIIV3) 0.5 ML IM
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
CPT 90661
|
| Hospital Charge Code |
63600250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$107.21 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$107.21
|
| Rate for Payer: BCN Commercial |
$107.21
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Advantage |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$49.50
|
| Rate for Payer: Priority Health SBD |
$26.99
|
| Rate for Payer: Priority Health Tiered Network |
$39.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.68
|
| Rate for Payer: UHC Core |
$81.68
|
| Rate for Payer: UHC Exchange |
$81.68
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS, 0.25 ML IM
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
CPT 90657
|
| Hospital Charge Code |
63600248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.99 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Advantage |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health SBD |
$26.99
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS, 0.25 ML IM
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
CPT 90657
|
| Hospital Charge Code |
63600248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$50.45 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$50.45
|
| Rate for Payer: BCN Commercial |
$50.45
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Advantage |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.03
|
| Rate for Payer: Priority Health SBD |
$26.99
|
| Rate for Payer: Priority Health Tiered Network |
$8.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.20
|
| Rate for Payer: UHC Core |
$18.20
|
| Rate for Payer: UHC Exchange |
$18.20
|
|
|
HC INFLUENZA VIRUS VAC TRIVALENT (IIV3), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
CPT 90658
|
| Hospital Charge Code |
63600247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$50.45 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$50.45
|
| Rate for Payer: BCN Commercial |
$50.45
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Advantage |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22.07
|
| Rate for Payer: Priority Health SBD |
$26.99
|
| Rate for Payer: Priority Health Tiered Network |
$17.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.42
|
| Rate for Payer: UHC Core |
$36.42
|
| Rate for Payer: UHC Exchange |
$36.42
|
|
|
HC INFLUENZA VIRUS VAC TRIVALENT (IIV3), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
CPT 90658
|
| Hospital Charge Code |
63600247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.99 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Advantage |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health SBD |
$26.99
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS PF, 0.5 ML IM
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
63600072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.99 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Advantage |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health SBD |
$26.99
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS PF, 0.5 ML IM
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
63600072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$50.45 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$50.45
|
| Rate for Payer: BCN Commercial |
$50.45
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Advantage |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23.22
|
| Rate for Payer: Priority Health SBD |
$26.99
|
| Rate for Payer: Priority Health Tiered Network |
$18.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.31
|
| Rate for Payer: UHC Core |
$38.31
|
| Rate for Payer: UHC Exchange |
$38.31
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT LIVE, INTRANASAL
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
CPT 90660
|
| Hospital Charge Code |
63600252
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.77 |
| Max. Negotiated Rate |
$64.49 |
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna Medicare |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.08
|
| Rate for Payer: BCBS Complete |
$27.74
|
| Rate for Payer: BCBS Trust/PPO |
$64.49
|
| Rate for Payer: BCN Commercial |
$64.49
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Advantage |
$48.55
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.02
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29.71
|
| Rate for Payer: Priority Health SBD |
$43.70
|
| Rate for Payer: Priority Health Tiered Network |
$23.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.02
|
| Rate for Payer: UHC Core |
$49.02
|
| Rate for Payer: UHC Exchange |
$49.02
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT LIVE, INTRANASAL
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
CPT 90660
|
| Hospital Charge Code |
63600252
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.70 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.08
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Advantage |
$48.55
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.02
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: Priority Health SBD |
$43.70
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (RIV3), PF IM
|
Facility
|
IP
|
$111.18
|
|
|
Service Code
|
CPT 90673
|
| Hospital Charge Code |
63600249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.04 |
| Max. Negotiated Rate |
$100.06 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.27
|
| Rate for Payer: Cash Price |
$88.94
|
| Rate for Payer: Cofinity Advantage |
$77.83
|
| Rate for Payer: Cofinity Commercial |
$95.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.94
|
| Rate for Payer: Healthscope Commercial |
$100.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.39
|
| Rate for Payer: PHP Commercial |
$94.50
|
| Rate for Payer: Priority Health SBD |
$70.04
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (RIV3), PF IM
|
Facility
|
OP
|
$111.18
|
|
|
Service Code
|
CPT 90673
|
| Hospital Charge Code |
63600249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.47 |
| Max. Negotiated Rate |
$212.33 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Medicare |
$55.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.27
|
| Rate for Payer: BCBS Complete |
$44.47
|
| Rate for Payer: BCBS Trust/PPO |
$212.33
|
| Rate for Payer: BCN Commercial |
$212.33
|
| Rate for Payer: Cash Price |
$88.94
|
| Rate for Payer: Cash Price |
$88.94
|
| Rate for Payer: Cofinity Advantage |
$77.83
|
| Rate for Payer: Cofinity Commercial |
$95.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.94
|
| Rate for Payer: Healthscope Commercial |
$100.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.39
|
| Rate for Payer: PHP Commercial |
$94.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$98.16
|
| Rate for Payer: Priority Health SBD |
$70.04
|
| Rate for Payer: Priority Health Tiered Network |
$78.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.96
|
| Rate for Payer: UHC Core |
$161.96
|
| Rate for Payer: UHC Exchange |
$161.96
|
|
|
HC INF PUMP PROGRAMMABLE LVL 6
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS C1772
|
| Hospital Charge Code |
27800141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.70 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Commercial |
$586.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.50
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cofinity Advantage |
$483.00
|
| Rate for Payer: Cofinity Commercial |
$593.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.00
|
| Rate for Payer: Healthscope Commercial |
$621.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$586.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$517.50
|
| Rate for Payer: PHP Commercial |
$586.50
|
| Rate for Payer: Priority Health SBD |
$434.70
|
|
|
HC INF PUMP PROGRAMMABLE LVL 6
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS C1772
|
| Hospital Charge Code |
27800141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.17 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Commercial |
$586.50
|
| Rate for Payer: Aetna Medicare |
$345.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.50
|
| Rate for Payer: BCBS Complete |
$276.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cofinity Advantage |
$483.00
|
| Rate for Payer: Cofinity Commercial |
$593.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.00
|
| Rate for Payer: Healthscope Commercial |
$621.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$552.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$586.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$517.50
|
| Rate for Payer: PHP Commercial |
$586.50
|
| Rate for Payer: Priority Health SBD |
$434.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.50
|
| Rate for Payer: UHC Core |
$359.49
|
| Rate for Payer: UHC Exchange |
$271.17
|
|
|
HC INFRARED THERAPY
|
Facility
|
IP
|
$59.80
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
42000013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.67 |
| Max. Negotiated Rate |
$53.82 |
| Rate for Payer: Aetna Commercial |
$50.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.87
|
| Rate for Payer: Cash Price |
$47.84
|
| Rate for Payer: Cofinity Advantage |
$41.86
|
| Rate for Payer: Cofinity Commercial |
$51.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.84
|
| Rate for Payer: Healthscope Commercial |
$53.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.85
|
| Rate for Payer: PHP Commercial |
$50.83
|
| Rate for Payer: Priority Health SBD |
$37.67
|
|
|
HC INFRARED THERAPY
|
Facility
|
OP
|
$59.80
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
42000013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$50.83
|
| Rate for Payer: Aetna Medicare |
$29.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.87
|
| Rate for Payer: BCBS Complete |
$23.92
|
| Rate for Payer: BCBS Trust/PPO |
$6.40
|
| Rate for Payer: BCN Commercial |
$6.40
|
| Rate for Payer: Cash Price |
$47.84
|
| Rate for Payer: Cash Price |
$47.84
|
| Rate for Payer: Cash Price |
$47.84
|
| Rate for Payer: Cofinity Advantage |
$41.86
|
| Rate for Payer: Cofinity Commercial |
$51.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.84
|
| Rate for Payer: Healthscope Commercial |
$53.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.83
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.85
|
| Rate for Payer: PHP Commercial |
$50.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.00
|
| Rate for Payer: Priority Health SBD |
$37.67
|
| Rate for Payer: Priority Health Tiered Network |
$4.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.87
|
| Rate for Payer: UHC Core |
$31.16
|
| Rate for Payer: UHC Exchange |
$23.50
|
|
|
HC INFUSION CATHETER LVL 1
|
Facility
|
IP
|
$160.65
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.21 |
| Max. Negotiated Rate |
$144.59 |
| Rate for Payer: Aetna Commercial |
$136.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.42
|
| Rate for Payer: Cash Price |
$128.52
|
| Rate for Payer: Cofinity Advantage |
$112.45
|
| Rate for Payer: Cofinity Commercial |
$138.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.52
|
| Rate for Payer: Healthscope Commercial |
$144.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.49
|
| Rate for Payer: PHP Commercial |
$136.55
|
| Rate for Payer: Priority Health SBD |
$101.21
|
|
|
HC INFUSION CATHETER LVL 1
|
Facility
|
OP
|
$160.65
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.14 |
| Max. Negotiated Rate |
$144.59 |
| Rate for Payer: Aetna Commercial |
$136.55
|
| Rate for Payer: Aetna Medicare |
$80.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.42
|
| Rate for Payer: BCBS Complete |
$64.26
|
| Rate for Payer: Cash Price |
$128.52
|
| Rate for Payer: Cofinity Advantage |
$112.45
|
| Rate for Payer: Cofinity Commercial |
$138.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.52
|
| Rate for Payer: Healthscope Commercial |
$144.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.49
|
| Rate for Payer: PHP Commercial |
$136.55
|
| Rate for Payer: Priority Health SBD |
$101.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.42
|
| Rate for Payer: UHC Core |
$83.70
|
| Rate for Payer: UHC Exchange |
$63.14
|
|
|
HC INFUSION CATHETER LVL 2
|
Facility
|
OP
|
$241.86
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.05 |
| Max. Negotiated Rate |
$217.67 |
| Rate for Payer: Aetna Commercial |
$205.58
|
| Rate for Payer: Aetna Medicare |
$120.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.21
|
| Rate for Payer: BCBS Complete |
$96.74
|
| Rate for Payer: Cash Price |
$193.49
|
| Rate for Payer: Cofinity Advantage |
$169.30
|
| Rate for Payer: Cofinity Commercial |
$208.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.49
|
| Rate for Payer: Healthscope Commercial |
$217.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.40
|
| Rate for Payer: PHP Commercial |
$205.58
|
| Rate for Payer: Priority Health SBD |
$152.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.21
|
| Rate for Payer: UHC Core |
$126.01
|
| Rate for Payer: UHC Exchange |
$95.05
|
|
