Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (IIV4), SPLIT VIRUS, 0.5 ML IM

Facility

$26.01

Service Code	CPT 90688
Hospital Charge Code	63600079
Hospital Revenue Code	636
Min. Negotiated Rate	$16.39
Max. Negotiated Rate	$23.41
Rate for Payer: Aetna Commercial	$22.11
Rate for Payer: Aetna New Business (MI Preferred)	$16.91
Rate for Payer: Cash Price	$20.81
Rate for Payer: Cofinity Commercial	$18.21
Rate for Payer: Cofinity Commercial	$22.37
Rate for Payer: Cofinity Medicare Advantage	$18.21
Rate for Payer: Encore Health Key Benefits Commercial	$20.81
Rate for Payer: Healthscope Commercial	$23.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.11
Rate for Payer: PHP Commercial	$22.11
Rate for Payer: Priority Health Cigna Priority Health	$16.91
Rate for Payer: Priority Health SBD	$16.39

HC INFLUENZA VIRUS VACCINE, QUADRIVALENT, LIVE (LAIV4) INTRANASAL

Facility

$32.25

Service Code	CPT 90672
Hospital Charge Code	63600075
Hospital Revenue Code	636
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$66.48
Rate for Payer: Aetna Commercial	$27.41
Rate for Payer: Aetna Medicare	$16.12
Rate for Payer: Aetna New Business (MI Preferred)	$20.96
Rate for Payer: BCBS Complete	$12.90
Rate for Payer: BCBS Trust/PPO	$66.48
Rate for Payer: BCN Commercial	$66.48
Rate for Payer: Cash Price	$25.80
Rate for Payer: Cash Price	$25.80
Rate for Payer: Cofinity Commercial	$27.74
Rate for Payer: Cofinity Commercial	$22.58
Rate for Payer: Cofinity Medicare Advantage	$22.58
Rate for Payer: Encore Health Key Benefits Commercial	$25.80
Rate for Payer: Healthscope Commercial	$29.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.41
Rate for Payer: PHP Commercial	$27.41
Rate for Payer: Priority Health Cigna Priority Health	$20.96
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$27.79
Rate for Payer: Priority Health Narrow Network	$22.23
Rate for Payer: Priority Health SBD	$20.32
Rate for Payer: UHC All Payor (Choice/PPO)	$24.62

HC INFLUENZA VIRUS VACCINE, QUADRIVALENT, LIVE (LAIV4) INTRANASAL

Facility

$32.25

Service Code	CPT 90672
Hospital Charge Code	63600075
Hospital Revenue Code	636
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$29.02
Rate for Payer: Aetna Commercial	$27.41
Rate for Payer: Aetna New Business (MI Preferred)	$20.96
Rate for Payer: Cash Price	$25.80
Rate for Payer: Cofinity Commercial	$22.58
Rate for Payer: Cofinity Commercial	$27.74
Rate for Payer: Cofinity Medicare Advantage	$22.58
Rate for Payer: Encore Health Key Benefits Commercial	$25.80
Rate for Payer: Healthscope Commercial	$29.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.41
Rate for Payer: PHP Commercial	$27.41
Rate for Payer: Priority Health Cigna Priority Health	$20.96
Rate for Payer: Priority Health SBD	$20.32

HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, 0.25 ML IM

Facility

$26.01

Service Code	CPT 90687
Hospital Charge Code	63600126
Hospital Revenue Code	636
Min. Negotiated Rate	$16.39
Max. Negotiated Rate	$23.41
Rate for Payer: Aetna Commercial	$22.11
Rate for Payer: Aetna New Business (MI Preferred)	$16.91
Rate for Payer: Cash Price	$20.81
Rate for Payer: Cofinity Commercial	$18.21
Rate for Payer: Cofinity Commercial	$22.37
Rate for Payer: Cofinity Medicare Advantage	$18.21
Rate for Payer: Encore Health Key Benefits Commercial	$20.81
Rate for Payer: Healthscope Commercial	$23.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.11
Rate for Payer: PHP Commercial	$22.11
Rate for Payer: Priority Health Cigna Priority Health	$16.91
Rate for Payer: Priority Health SBD	$16.39

HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, 0.25 ML IM

Facility

$26.01

Service Code	CPT 90687
Hospital Charge Code	63600126
Hospital Revenue Code	636
Min. Negotiated Rate	$8.35
Max. Negotiated Rate	$29.89
Rate for Payer: Aetna Commercial	$22.11
Rate for Payer: Aetna Medicare	$13.00
Rate for Payer: Aetna New Business (MI Preferred)	$16.91
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: BCBS Trust/PPO	$29.89
Rate for Payer: BCN Commercial	$29.89
Rate for Payer: Cash Price	$20.81
Rate for Payer: Cash Price	$20.81
Rate for Payer: Cofinity Commercial	$18.21
Rate for Payer: Cofinity Commercial	$22.37
Rate for Payer: Cofinity Medicare Advantage	$18.21
Rate for Payer: Encore Health Key Benefits Commercial	$20.81
Rate for Payer: Healthscope Commercial	$23.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.11
Rate for Payer: PHP Commercial	$22.11
Rate for Payer: Priority Health Cigna Priority Health	$16.91
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10.44
Rate for Payer: Priority Health Narrow Network	$8.35
Rate for Payer: Priority Health SBD	$16.39
Rate for Payer: UHC All Payor (Choice/PPO)	$9.32

HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, 0.5 ML IM

Facility

$26.01

Service Code	CPT 90686
Hospital Charge Code	63600078
Hospital Revenue Code	636
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$62.80
Rate for Payer: Aetna Commercial	$22.11
Rate for Payer: Aetna Medicare	$13.00
Rate for Payer: Aetna New Business (MI Preferred)	$16.91
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: BCBS Trust/PPO	$62.80
Rate for Payer: BCN Commercial	$62.80
Rate for Payer: Cash Price	$20.81
Rate for Payer: Cash Price	$20.81
Rate for Payer: Cofinity Commercial	$22.37
Rate for Payer: Cofinity Commercial	$18.21
Rate for Payer: Cofinity Medicare Advantage	$18.21
Rate for Payer: Encore Health Key Benefits Commercial	$20.81
Rate for Payer: Healthscope Commercial	$23.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.11
Rate for Payer: PHP Commercial	$22.11
Rate for Payer: Priority Health Cigna Priority Health	$16.91
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$22.35
Rate for Payer: Priority Health Narrow Network	$17.88
Rate for Payer: Priority Health SBD	$16.39
Rate for Payer: UHC All Payor (Choice/PPO)	$19.40

HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, 0.5 ML IM

Facility

$26.01

Service Code	CPT 90686
Hospital Charge Code	63600078
Hospital Revenue Code	636
Min. Negotiated Rate	$16.39
Max. Negotiated Rate	$23.41
Rate for Payer: Aetna Commercial	$22.11
Rate for Payer: Aetna New Business (MI Preferred)	$16.91
Rate for Payer: Cash Price	$20.81
Rate for Payer: Cofinity Commercial	$18.21
Rate for Payer: Cofinity Commercial	$22.37
Rate for Payer: Cofinity Medicare Advantage	$18.21
Rate for Payer: Encore Health Key Benefits Commercial	$20.81
Rate for Payer: Healthscope Commercial	$23.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.11
Rate for Payer: PHP Commercial	$22.11
Rate for Payer: Priority Health Cigna Priority Health	$16.91
Rate for Payer: Priority Health SBD	$16.39

HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, CHILD 6-35 MONTHS, IM

Facility

$26.01

Service Code	CPT 90685
Hospital Charge Code	63600077
Hospital Revenue Code	636
Min. Negotiated Rate	$16.39
Max. Negotiated Rate	$23.41
Rate for Payer: Aetna Commercial	$22.11
Rate for Payer: Aetna New Business (MI Preferred)	$16.91
Rate for Payer: Cash Price	$20.81
Rate for Payer: Cofinity Commercial	$18.21
Rate for Payer: Cofinity Commercial	$22.37
Rate for Payer: Cofinity Medicare Advantage	$18.21
Rate for Payer: Encore Health Key Benefits Commercial	$20.81
Rate for Payer: Healthscope Commercial	$23.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.11
Rate for Payer: PHP Commercial	$22.11
Rate for Payer: Priority Health Cigna Priority Health	$16.91
Rate for Payer: Priority Health SBD	$16.39

HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, CHILD 6-35 MONTHS, IM

Facility

$26.01

Service Code	CPT 90685
Hospital Charge Code	63600077
Hospital Revenue Code	636
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$61.13
Rate for Payer: Aetna Commercial	$22.11
Rate for Payer: Aetna Medicare	$13.00
Rate for Payer: Aetna New Business (MI Preferred)	$16.91
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: BCBS Trust/PPO	$61.13
Rate for Payer: BCN Commercial	$61.13
Rate for Payer: Cash Price	$20.81
Rate for Payer: Cash Price	$20.81
Rate for Payer: Cofinity Commercial	$18.21
Rate for Payer: Cofinity Commercial	$22.37
Rate for Payer: Cofinity Medicare Advantage	$18.21
Rate for Payer: Encore Health Key Benefits Commercial	$20.81
Rate for Payer: Healthscope Commercial	$23.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.11
Rate for Payer: PHP Commercial	$22.11
Rate for Payer: Priority Health Cigna Priority Health	$16.91
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$21.64
Rate for Payer: Priority Health Narrow Network	$17.31
Rate for Payer: Priority Health SBD	$16.39
Rate for Payer: UHC All Payor (Choice/PPO)	$13.39

HC INFLUENZA VIRUS VAC, TRIVALENT (CCIIV3) 0.5 ML IM

Facility

$42.00

Service Code	CPT 90661
Hospital Charge Code	63600250
Hospital Revenue Code	636
Min. Negotiated Rate	$26.46
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna Commercial	$35.70
Rate for Payer: Aetna New Business (MI Preferred)	$27.30
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cofinity Commercial	$29.40
Rate for Payer: Cofinity Commercial	$36.12
Rate for Payer: Cofinity Medicare Advantage	$29.40
Rate for Payer: Encore Health Key Benefits Commercial	$33.60
Rate for Payer: Healthscope Commercial	$37.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.70
Rate for Payer: PHP Commercial	$35.70
Rate for Payer: Priority Health Cigna Priority Health	$27.30
Rate for Payer: Priority Health SBD	$26.46

HC INFLUENZA VIRUS VAC, TRIVALENT (CCIIV3) 0.5 ML IM

Facility

$42.00

Service Code	CPT 90661
Hospital Charge Code	63600250
Hospital Revenue Code	636
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$88.17
Rate for Payer: Aetna Commercial	$35.70
Rate for Payer: Aetna Medicare	$21.00
Rate for Payer: Aetna New Business (MI Preferred)	$27.30
Rate for Payer: BCBS Complete	$16.80
Rate for Payer: BCBS Trust/PPO	$88.17
Rate for Payer: BCN Commercial	$88.17
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cofinity Commercial	$36.12
Rate for Payer: Cofinity Commercial	$29.40
Rate for Payer: Cofinity Medicare Advantage	$29.40
Rate for Payer: Encore Health Key Benefits Commercial	$33.60
Rate for Payer: Healthscope Commercial	$37.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.70
Rate for Payer: PHP Commercial	$35.70
Rate for Payer: Priority Health Cigna Priority Health	$27.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36.85
Rate for Payer: Priority Health Narrow Network	$29.48
Rate for Payer: Priority Health SBD	$26.46
Rate for Payer: UHC All Payor (Choice/PPO)	$31.42

HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS, 0.25 ML IM

Facility

$42.00

Service Code	CPT 90657
Hospital Charge Code	63600248
Hospital Revenue Code	636
Min. Negotiated Rate	$26.46
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna Commercial	$35.70
Rate for Payer: Aetna New Business (MI Preferred)	$27.30
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cofinity Commercial	$29.40
Rate for Payer: Cofinity Commercial	$36.12
Rate for Payer: Cofinity Medicare Advantage	$29.40
Rate for Payer: Encore Health Key Benefits Commercial	$33.60
Rate for Payer: Healthscope Commercial	$37.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.70
Rate for Payer: PHP Commercial	$35.70
Rate for Payer: Priority Health Cigna Priority Health	$27.30
Rate for Payer: Priority Health SBD	$26.46

HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS, 0.25 ML IM

Facility

$42.00

Service Code	CPT 90657
Hospital Charge Code	63600248
Hospital Revenue Code	636
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$58.56
Rate for Payer: Aetna Commercial	$35.70
Rate for Payer: Aetna Medicare	$21.00
Rate for Payer: Aetna New Business (MI Preferred)	$27.30
Rate for Payer: BCBS Complete	$16.80
Rate for Payer: BCBS Trust/PPO	$58.56
Rate for Payer: BCN Commercial	$58.56
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cofinity Commercial	$36.12
Rate for Payer: Cofinity Commercial	$29.40
Rate for Payer: Cofinity Medicare Advantage	$29.40
Rate for Payer: Encore Health Key Benefits Commercial	$33.60
Rate for Payer: Healthscope Commercial	$37.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.70
Rate for Payer: PHP Commercial	$35.70
Rate for Payer: Priority Health Cigna Priority Health	$27.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10.93
Rate for Payer: Priority Health Narrow Network	$8.74
Rate for Payer: Priority Health SBD	$26.46
Rate for Payer: UHC All Payor (Choice/PPO)	$9.48

HC INFLUENZA VIRUS VAC TRIVALENT (IIV3), SPLIT VIRUS, 0.5 ML IM

Facility

$42.00

Service Code	CPT 90658
Hospital Charge Code	63600247
Hospital Revenue Code	636
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$58.56
Rate for Payer: Aetna Commercial	$35.70
Rate for Payer: Aetna Medicare	$21.00
Rate for Payer: Aetna New Business (MI Preferred)	$27.30
Rate for Payer: BCBS Complete	$16.80
Rate for Payer: BCBS Trust/PPO	$58.56
Rate for Payer: BCN Commercial	$58.56
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cofinity Commercial	$36.12
Rate for Payer: Cofinity Commercial	$29.40
Rate for Payer: Cofinity Medicare Advantage	$29.40
Rate for Payer: Encore Health Key Benefits Commercial	$33.60
Rate for Payer: Healthscope Commercial	$37.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.70
Rate for Payer: PHP Commercial	$35.70
Rate for Payer: Priority Health Cigna Priority Health	$27.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$21.86
Rate for Payer: Priority Health Narrow Network	$17.49
Rate for Payer: Priority Health SBD	$26.46

HC INFLUENZA VIRUS VAC TRIVALENT (IIV3), SPLIT VIRUS, 0.5 ML IM

Facility

$42.00

Service Code	CPT 90658
Hospital Charge Code	63600247
Hospital Revenue Code	636
Min. Negotiated Rate	$26.46
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna Commercial	$35.70
Rate for Payer: Aetna New Business (MI Preferred)	$27.30
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cofinity Commercial	$29.40
Rate for Payer: Cofinity Commercial	$36.12
Rate for Payer: Cofinity Medicare Advantage	$29.40
Rate for Payer: Encore Health Key Benefits Commercial	$33.60
Rate for Payer: Healthscope Commercial	$37.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.70
Rate for Payer: PHP Commercial	$35.70
Rate for Payer: Priority Health Cigna Priority Health	$27.30
Rate for Payer: Priority Health SBD	$26.46

HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS PF, 0.5 ML IM

Facility

$42.00

Service Code	CPT 90656
Hospital Charge Code	63600072
Hospital Revenue Code	636
Min. Negotiated Rate	$26.46
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna Commercial	$35.70
Rate for Payer: Aetna New Business (MI Preferred)	$27.30
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cofinity Commercial	$29.40
Rate for Payer: Cofinity Commercial	$36.12
Rate for Payer: Cofinity Medicare Advantage	$29.40
Rate for Payer: Encore Health Key Benefits Commercial	$33.60
Rate for Payer: Healthscope Commercial	$37.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.70
Rate for Payer: PHP Commercial	$35.70
Rate for Payer: Priority Health Cigna Priority Health	$27.30
Rate for Payer: Priority Health SBD	$26.46

HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS PF, 0.5 ML IM

Facility

$42.00

Service Code	CPT 90656
Hospital Charge Code	63600072
Hospital Revenue Code	636
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$58.56
Rate for Payer: Aetna Commercial	$35.70
Rate for Payer: Aetna Medicare	$21.00
Rate for Payer: Aetna New Business (MI Preferred)	$27.30
Rate for Payer: BCBS Complete	$16.80
Rate for Payer: BCBS Trust/PPO	$58.56
Rate for Payer: BCN Commercial	$58.56
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cofinity Commercial	$36.12
Rate for Payer: Cofinity Commercial	$29.40
Rate for Payer: Cofinity Medicare Advantage	$29.40
Rate for Payer: Encore Health Key Benefits Commercial	$33.60
Rate for Payer: Healthscope Commercial	$37.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.70
Rate for Payer: PHP Commercial	$35.70
Rate for Payer: Priority Health Cigna Priority Health	$27.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$22.35
Rate for Payer: Priority Health Narrow Network	$17.88
Rate for Payer: Priority Health SBD	$26.46
Rate for Payer: UHC All Payor (Choice/PPO)	$19.79

HC INFLUENZA VIRUS VAC, TRIVALENT LIVE, INTRANASAL

Facility

$68.00

Service Code	CPT 90660
Hospital Charge Code	63600252
Hospital Revenue Code	636
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$61.20
Rate for Payer: Aetna Commercial	$57.80
Rate for Payer: Aetna New Business (MI Preferred)	$44.20
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cofinity Commercial	$47.60
Rate for Payer: Cofinity Commercial	$58.48
Rate for Payer: Cofinity Medicare Advantage	$47.60
Rate for Payer: Encore Health Key Benefits Commercial	$54.40
Rate for Payer: Healthscope Commercial	$61.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.80
Rate for Payer: PHP Commercial	$57.80
Rate for Payer: Priority Health Cigna Priority Health	$44.20
Rate for Payer: Priority Health SBD	$42.84

HC INFLUENZA VIRUS VAC, TRIVALENT LIVE, INTRANASAL

Facility

$68.00

Service Code	CPT 90660
Hospital Charge Code	63600252
Hospital Revenue Code	636
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$69.06
Rate for Payer: Aetna Commercial	$57.80
Rate for Payer: Aetna Medicare	$34.00
Rate for Payer: Aetna New Business (MI Preferred)	$44.20
Rate for Payer: BCBS Complete	$27.20
Rate for Payer: BCBS Trust/PPO	$69.06
Rate for Payer: BCN Commercial	$69.06
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cofinity Commercial	$58.48
Rate for Payer: Cofinity Commercial	$47.60
Rate for Payer: Cofinity Medicare Advantage	$47.60
Rate for Payer: Encore Health Key Benefits Commercial	$54.40
Rate for Payer: Healthscope Commercial	$61.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.80
Rate for Payer: PHP Commercial	$57.80
Rate for Payer: Priority Health Cigna Priority Health	$44.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$28.87
Rate for Payer: Priority Health Narrow Network	$23.10
Rate for Payer: Priority Health SBD	$42.84
Rate for Payer: UHC All Payor (Choice/PPO)	$20.00

HC INFLUENZA VIRUS VAC, TRIVALENT (RIV3), PF IM

Facility

$109.00

Service Code	CPT 90673
Hospital Charge Code	63600249
Hospital Revenue Code	636
Min. Negotiated Rate	$43.60
Max. Negotiated Rate	$199.79
Rate for Payer: Aetna Commercial	$92.65
Rate for Payer: Aetna Medicare	$54.50
Rate for Payer: Aetna New Business (MI Preferred)	$70.85
Rate for Payer: BCBS Complete	$43.60
Rate for Payer: BCBS Trust/PPO	$199.79
Rate for Payer: BCN Commercial	$199.79
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cofinity Commercial	$93.74
Rate for Payer: Cofinity Commercial	$76.30
Rate for Payer: Cofinity Medicare Advantage	$76.30
Rate for Payer: Encore Health Key Benefits Commercial	$87.20
Rate for Payer: Healthscope Commercial	$98.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$92.65
Rate for Payer: PHP Commercial	$92.65
Rate for Payer: Priority Health Cigna Priority Health	$70.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$83.49
Rate for Payer: Priority Health Narrow Network	$66.79
Rate for Payer: Priority Health SBD	$68.67
Rate for Payer: UHC All Payor (Choice/PPO)	$71.18

HC INFLUENZA VIRUS VAC, TRIVALENT (RIV3), PF IM

Facility

$109.00

Service Code	CPT 90673
Hospital Charge Code	63600249
Hospital Revenue Code	636
Min. Negotiated Rate	$68.67
Max. Negotiated Rate	$98.10
Rate for Payer: Aetna Commercial	$92.65
Rate for Payer: Aetna New Business (MI Preferred)	$70.85
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cofinity Commercial	$76.30
Rate for Payer: Cofinity Commercial	$93.74
Rate for Payer: Cofinity Medicare Advantage	$76.30
Rate for Payer: Encore Health Key Benefits Commercial	$87.20
Rate for Payer: Healthscope Commercial	$98.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$92.65
Rate for Payer: PHP Commercial	$92.65
Rate for Payer: Priority Health Cigna Priority Health	$70.85
Rate for Payer: Priority Health SBD	$68.67

HC INF PUMP PROGRAMMABLE LVL 6

Facility

$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 Commercial	$483.00
Rate for Payer: Cofinity Commercial	$593.40
Rate for Payer: Cofinity Medicare Advantage	$483.00
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: PHP Commercial	$586.50
Rate for Payer: Priority Health Cigna Priority Health	$448.50
Rate for Payer: Priority Health SBD	$434.70

HC INF PUMP PROGRAMMABLE LVL 6

Facility

$690.00

Service Code	HCPCS C1772
Hospital Charge Code	27800141
Hospital Revenue Code	278
Min. Negotiated Rate	$276.00
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 Commercial	$483.00
Rate for Payer: Cofinity Commercial	$593.40
Rate for Payer: Cofinity Medicare Advantage	$483.00
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: PHP Commercial	$586.50
Rate for Payer: Priority Health Cigna Priority Health	$448.50
Rate for Payer: Priority Health SBD	$434.70

HC INFRARED THERAPY

Facility

$58.63

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	$49.84
Rate for Payer: Aetna Medicare	$29.32
Rate for Payer: Aetna New Business (MI Preferred)	$38.11
Rate for Payer: BCBS Complete	$23.45
Rate for Payer: BCBS Trust/PPO	$5.49
Rate for Payer: BCN Commercial	$5.49
Rate for Payer: Cash Price	$46.90
Rate for Payer: Cash Price	$46.90
Rate for Payer: Cash Price	$46.90
Rate for Payer: Cofinity Commercial	$41.04
Rate for Payer: Cofinity Commercial	$50.42
Rate for Payer: Cofinity Medicare Advantage	$41.04
Rate for Payer: Encore Health Key Benefits Commercial	$46.90
Rate for Payer: Healthscope Commercial	$52.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$49.84
Rate for Payer: Nomi Health Commercial	$135.00
Rate for Payer: PHP Commercial	$49.84
Rate for Payer: Priority Health Cigna Priority Health	$38.11
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5.00
Rate for Payer: Priority Health Narrow Network	$4.00
Rate for Payer: Priority Health SBD	$36.94
Rate for Payer: UHC All Payor (Choice/PPO)	$6.85
Rate for Payer: UHC Exchange	$43.39

HC INFRARED THERAPY

Facility

$58.63

Service Code	CPT 97026
Hospital Charge Code	42000013
Hospital Revenue Code	420
Min. Negotiated Rate	$36.94
Max. Negotiated Rate	$52.77
Rate for Payer: Aetna Commercial	$49.84
Rate for Payer: Aetna New Business (MI Preferred)	$38.11
Rate for Payer: Cash Price	$46.90
Rate for Payer: Cofinity Commercial	$41.04
Rate for Payer: Cofinity Commercial	$50.42
Rate for Payer: Cofinity Medicare Advantage	$41.04
Rate for Payer: Encore Health Key Benefits Commercial	$46.90
Rate for Payer: Healthscope Commercial	$52.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$49.84
Rate for Payer: PHP Commercial	$49.84
Rate for Payer: Priority Health Cigna Priority Health	$38.11
Rate for Payer: Priority Health SBD	$36.94

Know your out-of-pocket cost for care.

All Charges