|
HC INFLUENZA VAC, INACTIV ADJUVANT IM
|
Facility
|
IP
|
$170.34
|
|
|
Service Code
|
CPT 90653
|
| Hospital Charge Code |
63600251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.95 |
| Max. Negotiated Rate |
$153.31 |
| Rate for Payer: Aetna American Axle |
$110.72
|
| Rate for Payer: Aetna Commercial |
$144.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.72
|
| Rate for Payer: Cash Price |
$136.27
|
| Rate for Payer: Cofinity Advantage |
$119.24
|
| Rate for Payer: Cofinity Commercial |
$146.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.27
|
| Rate for Payer: Healthscope Commercial |
$153.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.75
|
| Rate for Payer: PHP Commercial |
$144.79
|
| Rate for Payer: Priority Health SBD |
$107.31
|
| Rate for Payer: UMR Bronson Commercial |
$74.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.75
|
|
|
HC INFLUENZA VAC, INACTIV ADJUVANT IM
|
Facility
|
OP
|
$170.34
|
|
|
Service Code
|
CPT 90653
|
| Hospital Charge Code |
63600251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.03 |
| Max. Negotiated Rate |
$274.44 |
| Rate for Payer: Aetna American Axle |
$110.72
|
| Rate for Payer: Aetna Commercial |
$144.79
|
| Rate for Payer: Aetna Medicare |
$85.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.72
|
| Rate for Payer: BCBS Complete |
$68.14
|
| Rate for Payer: BCBS Trust/PPO |
$274.44
|
| Rate for Payer: BCN Commercial |
$274.44
|
| Rate for Payer: Cash Price |
$136.27
|
| Rate for Payer: Cash Price |
$136.27
|
| Rate for Payer: Cofinity Advantage |
$119.24
|
| Rate for Payer: Cofinity Commercial |
$146.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.27
|
| Rate for Payer: Healthscope Commercial |
$153.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.75
|
| Rate for Payer: PHP Commercial |
$144.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$98.16
|
| Rate for Payer: Priority Health SBD |
$107.31
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$63.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.75
|
|
|
HC INFLUENZA VIRUS VACCINE (IIV), SPLIT VIRUS, PRESERVATIVE FREE IM
|
Facility
|
IP
|
$111.18
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
63600073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.92 |
| Max. Negotiated Rate |
$100.06 |
| Rate for Payer: Aetna American Axle |
$72.27
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$77.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.39
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$48.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.39
|
|
|
HC INFLUENZA VIRUS VACCINE (IIV), SPLIT VIRUS, PRESERVATIVE FREE IM
|
Facility
|
OP
|
$111.18
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
63600073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.14 |
| Max. Negotiated Rate |
$274.44 |
| Rate for Payer: Aetna American Axle |
$72.27
|
| 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 |
$274.44
|
| Rate for Payer: BCN Commercial |
$274.44
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$77.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.39
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$41.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.39
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (IIV4), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
63600079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$58.69 |
| Rate for Payer: Aetna American Axle |
$17.24
|
| 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 |
$58.69
|
| Rate for Payer: BCN Commercial |
$58.69
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$18.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.90
|
| 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 |
$20.88
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: Priority Health Tiered Network |
$16.70
|
| Rate for Payer: UMR Bronson Commercial |
$9.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.90
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (IIV4), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
63600079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna American Axle |
$17.24
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$18.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.90
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$11.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.90
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT, LIVE (LAIV4) INTRANASAL
|
Facility
|
OP
|
$32.90
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
63600075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$77.97 |
| Rate for Payer: Aetna American Axle |
$21.39
|
| Rate for Payer: Aetna Commercial |
$27.96
|
| Rate for Payer: Aetna Medicare |
$16.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.39
|
| Rate for Payer: BCBS Complete |
$13.16
|
| Rate for Payer: BCBS Trust/PPO |
$77.97
|
| Rate for Payer: BCN Commercial |
$77.97
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cofinity Advantage |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$28.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$29.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.68
|
| Rate for Payer: PHP Commercial |
$27.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27.79
|
| Rate for Payer: Priority Health SBD |
$20.73
|
| Rate for Payer: Priority Health Tiered Network |
$22.23
|
| Rate for Payer: UMR Bronson Commercial |
$12.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.68
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT, LIVE (LAIV4) INTRANASAL
|
Facility
|
IP
|
$32.90
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
63600075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$29.61 |
| Rate for Payer: Aetna American Axle |
$21.39
|
| Rate for Payer: Aetna Commercial |
$27.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.39
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cofinity Advantage |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$28.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$29.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.68
|
| Rate for Payer: PHP Commercial |
$27.96
|
| Rate for Payer: Priority Health SBD |
$20.73
|
| Rate for Payer: UMR Bronson Commercial |
$14.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.68
|
|
|
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 |
$29.34 |
| Rate for Payer: Aetna American Axle |
$17.24
|
| 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 |
$29.34
|
| Rate for Payer: BCN Commercial |
$29.34
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$18.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.90
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$9.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.90
|
|
|
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 |
$11.67 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna American Axle |
$17.24
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$18.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.90
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$11.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.90
|
|
|
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 |
$9.82 |
| Max. Negotiated Rate |
$62.79 |
| Rate for Payer: Aetna American Axle |
$17.24
|
| 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 |
$62.79
|
| Rate for Payer: BCN Commercial |
$62.79
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$18.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.90
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$9.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.90
|
|
|
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 |
$11.67 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna American Axle |
$17.24
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$18.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.90
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$11.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.90
|
|
|
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 |
$11.67 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna American Axle |
$17.24
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$18.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.90
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$11.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.90
|
|
|
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 |
$9.82 |
| Max. Negotiated Rate |
$70.18 |
| Rate for Payer: Aetna American Axle |
$17.24
|
| 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 |
$70.18
|
| Rate for Payer: BCN Commercial |
$70.18
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$18.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.90
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$9.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.90
|
|
|
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 |
$18.85 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna American Axle |
$27.85
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$29.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$18.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
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 |
$15.85 |
| Max. Negotiated Rate |
$138.57 |
| Rate for Payer: Aetna American Axle |
$27.85
|
| 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 |
$138.57
|
| Rate for Payer: BCN Commercial |
$138.57
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$29.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$15.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
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 |
$65.21 |
| Rate for Payer: Aetna American Axle |
$27.85
|
| 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 |
$65.21
|
| Rate for Payer: BCN Commercial |
$65.21
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$29.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$15.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
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 |
$18.85 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna American Axle |
$27.85
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$29.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$18.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
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 |
$18.85 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna American Axle |
$27.85
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$29.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$18.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
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 |
$15.85 |
| Max. Negotiated Rate |
$65.21 |
| Rate for Payer: Aetna American Axle |
$27.85
|
| 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 |
$65.21
|
| Rate for Payer: BCN Commercial |
$65.21
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$29.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$15.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
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 |
$18.85 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna American Axle |
$27.85
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$29.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$18.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
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 |
$15.85 |
| Max. Negotiated Rate |
$65.21 |
| Rate for Payer: Aetna American Axle |
$27.85
|
| 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 |
$65.21
|
| Rate for Payer: BCN Commercial |
$65.21
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$29.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$15.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
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 |
$30.52 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna American Axle |
$45.08
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$48.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.02
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$30.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.02
|
|
|
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 |
$83.35 |
| Rate for Payer: Aetna American Axle |
$45.08
|
| 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 |
$83.35
|
| Rate for Payer: BCN Commercial |
$83.35
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$48.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.02
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$25.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.02
|
|
|
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 |
$41.14 |
| Max. Negotiated Rate |
$274.44 |
| Rate for Payer: Aetna American Axle |
$72.27
|
| 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 |
$274.44
|
| Rate for Payer: BCN Commercial |
$274.44
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$77.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.39
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$41.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.39
|
|
