|
HC INFLUENZA AND RSV BY PCR
|
Facility
|
IP
|
$227.81
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600213
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$170.86 |
| Max. Negotiated Rate |
$227.81 |
| Rate for Payer: Aetna Commercial |
$205.03
|
| Rate for Payer: ASR ASR |
$220.98
|
| Rate for Payer: BCBS Trust/PPO |
$187.08
|
| Rate for Payer: BCN Commercial |
$187.08
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cofinity Commercial |
$214.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.25
|
| Rate for Payer: Healthscope Commercial |
$220.98
|
| Rate for Payer: Healthscope Whirlpool |
$227.81
|
| Rate for Payer: Mclaren Commercial |
$205.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.64
|
| Rate for Payer: Nomi Health Commercial |
$186.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.47
|
|
|
HC INFLUENZA INJECTION
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
77100009
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.41 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: ASR ASR |
$30.27
|
| Rate for Payer: BCBS Trust/PPO |
$25.63
|
| Rate for Payer: BCN Commercial |
$25.63
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$30.27
|
| Rate for Payer: Healthscope Whirlpool |
$31.21
|
| Rate for Payer: Mclaren Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.46
|
|
|
HC INFLUENZA INJECTION
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
77100009
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$16.21 |
| Max. Negotiated Rate |
$72.32 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: Aetna Medicare |
$46.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.33
|
| Rate for Payer: ASR ASR |
$30.27
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS MAPPO |
$46.66
|
| Rate for Payer: BCBS Trust/PPO |
$25.73
|
| Rate for Payer: BCN Commercial |
$25.73
|
| Rate for Payer: BCN Medicare Advantage |
$46.66
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.66
|
| Rate for Payer: Healthscope Commercial |
$30.27
|
| Rate for Payer: Healthscope Whirlpool |
$31.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$46.66
|
| Rate for Payer: Mclaren Commercial |
$28.09
|
| Rate for Payer: Mclaren Medicaid |
$46.66
|
| Rate for Payer: Mclaren Medicare |
$46.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.99
|
| Rate for Payer: Meridian Medicaid |
$25.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: PACE Medicare |
$44.33
|
| Rate for Payer: PACE SWMI |
$46.66
|
| Rate for Payer: PHP Commercial |
$51.33
|
| Rate for Payer: PHP Medicaid |
$25.01
|
| Rate for Payer: PHP Medicare Advantage |
$46.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.27
|
| Rate for Payer: Priority Health Medicare |
$46.66
|
| Rate for Payer: Priority Health Narrow Network |
$16.21
|
| Rate for Payer: Railroad Medicare Medicare |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.66
|
| Rate for Payer: UHC Exchange |
$72.32
|
| Rate for Payer: UHC Medicaid |
$24.40
|
| Rate for Payer: UHCCP DNSP |
$46.66
|
| Rate for Payer: UHCCP Medicaid |
$24.40
|
| Rate for Payer: VA VA |
$46.66
|
|
|
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 |
$127.75 |
| Max. Negotiated Rate |
$170.34 |
| Rate for Payer: Aetna Commercial |
$153.31
|
| Rate for Payer: ASR ASR |
$165.23
|
| Rate for Payer: BCBS Trust/PPO |
$139.88
|
| Rate for Payer: BCN Commercial |
$139.88
|
| Rate for Payer: Cash Price |
$136.27
|
| Rate for Payer: Cofinity Commercial |
$160.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.27
|
| Rate for Payer: Healthscope Commercial |
$165.23
|
| Rate for Payer: Healthscope Whirlpool |
$170.34
|
| Rate for Payer: Mclaren Commercial |
$153.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.79
|
| Rate for Payer: Nomi Health Commercial |
$139.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.90
|
|
|
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 |
$0.01 |
| Max. Negotiated Rate |
$170.34 |
| Rate for Payer: Aetna Commercial |
$153.31
|
| Rate for Payer: Aetna Medicare |
$63.03
|
| Rate for Payer: ASR ASR |
$165.23
|
| Rate for Payer: BCBS Complete |
$68.14
|
| Rate for Payer: BCBS Trust/PPO |
$140.45
|
| Rate for Payer: BCN Commercial |
$140.45
|
| Rate for Payer: Cash Price |
$136.27
|
| Rate for Payer: Cash Price |
$136.27
|
| Rate for Payer: Cofinity Commercial |
$160.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.27
|
| Rate for Payer: Healthscope Commercial |
$165.23
|
| Rate for Payer: Healthscope Whirlpool |
$170.34
|
| Rate for Payer: Mclaren Commercial |
$153.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.79
|
| Rate for Payer: Nomi Health Commercial |
$139.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.90
|
|
|
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 |
$111.18 |
| Rate for Payer: Aetna Commercial |
$100.06
|
| Rate for Payer: Aetna Medicare |
$41.14
|
| Rate for Payer: ASR ASR |
$107.84
|
| Rate for Payer: BCBS Complete |
$44.47
|
| Rate for Payer: BCBS Trust/PPO |
$91.67
|
| Rate for Payer: BCN Commercial |
$91.67
|
| Rate for Payer: Cash Price |
$88.94
|
| Rate for Payer: Cash Price |
$88.94
|
| Rate for Payer: Cofinity Commercial |
$104.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.94
|
| Rate for Payer: Healthscope Commercial |
$107.84
|
| Rate for Payer: Healthscope Whirlpool |
$111.18
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$91.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$98.16
|
| Rate for Payer: Priority Health Narrow Network |
$78.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.84
|
|
|
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 |
$83.39 |
| Max. Negotiated Rate |
$111.18 |
| Rate for Payer: Aetna Commercial |
$100.06
|
| Rate for Payer: ASR ASR |
$107.84
|
| Rate for Payer: BCBS Trust/PPO |
$91.30
|
| Rate for Payer: BCN Commercial |
$91.30
|
| Rate for Payer: Cash Price |
$88.94
|
| Rate for Payer: Cofinity Commercial |
$104.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.94
|
| Rate for Payer: Healthscope Commercial |
$107.84
|
| Rate for Payer: Healthscope Whirlpool |
$111.18
|
| Rate for Payer: Mclaren Commercial |
$100.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.50
|
| Rate for Payer: Nomi Health Commercial |
$91.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.84
|
|
|
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 |
$19.90 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Trust/PPO |
$21.79
|
| Rate for Payer: BCN Commercial |
$21.79
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
|
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 |
$0.01 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Complete |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$21.87
|
| Rate for Payer: BCN Commercial |
$21.87
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
|
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 |
$0.01 |
| Max. Negotiated Rate |
$32.90 |
| Rate for Payer: Aetna Commercial |
$29.61
|
| Rate for Payer: Aetna Medicare |
$12.17
|
| Rate for Payer: ASR ASR |
$31.91
|
| Rate for Payer: BCBS Complete |
$13.16
|
| Rate for Payer: BCBS Trust/PPO |
$27.13
|
| Rate for Payer: BCN Commercial |
$27.13
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$30.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$31.91
|
| Rate for Payer: Healthscope Whirlpool |
$32.90
|
| Rate for Payer: Mclaren Commercial |
$29.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.96
|
| Rate for Payer: Nomi Health Commercial |
$26.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.95
|
|
|
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 |
$24.68 |
| Max. Negotiated Rate |
$32.90 |
| Rate for Payer: Aetna Commercial |
$29.61
|
| Rate for Payer: ASR ASR |
$31.91
|
| Rate for Payer: BCBS Trust/PPO |
$27.02
|
| Rate for Payer: BCN Commercial |
$27.02
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$30.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$31.91
|
| Rate for Payer: Healthscope Whirlpool |
$32.90
|
| Rate for Payer: Mclaren Commercial |
$29.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.96
|
| Rate for Payer: Nomi Health Commercial |
$26.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.95
|
|
|
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 |
$19.90 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Trust/PPO |
$21.79
|
| Rate for Payer: BCN Commercial |
$21.79
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
|
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 |
$0.01 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Complete |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$21.87
|
| Rate for Payer: BCN Commercial |
$21.87
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
|
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 |
$19.90 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Trust/PPO |
$21.79
|
| Rate for Payer: BCN Commercial |
$21.79
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
|
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 |
$0.01 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Complete |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$21.87
|
| Rate for Payer: BCN Commercial |
$21.87
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
|
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 |
$19.90 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Trust/PPO |
$21.79
|
| Rate for Payer: BCN Commercial |
$21.79
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
|
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 |
$0.01 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Complete |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$21.87
|
| Rate for Payer: BCN Commercial |
$21.87
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
|
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 |
$32.13 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: BCBS Trust/PPO |
$35.18
|
| Rate for Payer: BCN Commercial |
$35.18
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$41.55
|
| Rate for Payer: Healthscope Whirlpool |
$42.84
|
| Rate for Payer: Mclaren Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
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 |
$49.50 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: Aetna Medicare |
$15.85
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$35.32
|
| Rate for Payer: BCN Commercial |
$35.32
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$41.55
|
| Rate for Payer: Healthscope Whirlpool |
$42.84
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$49.50
|
| Rate for Payer: Priority Health Narrow Network |
$39.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
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 |
$8.83 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: Aetna Medicare |
$15.85
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$35.32
|
| Rate for Payer: BCN Commercial |
$35.32
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$41.55
|
| Rate for Payer: Healthscope Whirlpool |
$42.84
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.04
|
| Rate for Payer: Priority Health Narrow Network |
$8.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
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 |
$32.13 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: BCBS Trust/PPO |
$35.18
|
| Rate for Payer: BCN Commercial |
$35.18
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$41.55
|
| Rate for Payer: Healthscope Whirlpool |
$42.84
|
| Rate for Payer: Mclaren Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
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 |
$32.13 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: BCBS Trust/PPO |
$35.18
|
| Rate for Payer: BCN Commercial |
$35.18
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$41.55
|
| Rate for Payer: Healthscope Whirlpool |
$42.84
|
| Rate for Payer: Mclaren Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
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 |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: Aetna Medicare |
$15.85
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$35.32
|
| Rate for Payer: BCN Commercial |
$35.32
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$41.55
|
| Rate for Payer: Healthscope Whirlpool |
$42.84
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.07
|
| Rate for Payer: Priority Health Narrow Network |
$17.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
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 |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: Aetna Medicare |
$15.85
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$35.32
|
| Rate for Payer: BCN Commercial |
$35.32
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$41.55
|
| Rate for Payer: Healthscope Whirlpool |
$42.84
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
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 |
$32.13 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: BCBS Trust/PPO |
$35.18
|
| Rate for Payer: BCN Commercial |
$35.18
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$41.55
|
| Rate for Payer: Healthscope Whirlpool |
$42.84
|
| Rate for Payer: Mclaren Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
