|
HC INFLUENZA AND RSV BY PCR
|
Facility
|
IP
|
$223.34
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600213
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$145.17 |
| Max. Negotiated Rate |
$223.34 |
| Rate for Payer: Aetna Commercial |
$201.01
|
| Rate for Payer: ASR ASR |
$216.64
|
| Rate for Payer: ASR Commercial |
$216.64
|
| Rate for Payer: BCBS Trust/PPO |
$182.00
|
| Rate for Payer: BCN Commercial |
$173.16
|
| Rate for Payer: Cash Price |
$178.67
|
| Rate for Payer: Cofinity Commercial |
$209.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.67
|
| Rate for Payer: Healthscope Commercial |
$223.34
|
| Rate for Payer: Healthscope Whirlpool |
$216.64
|
| Rate for Payer: Mclaren Commercial |
$201.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.84
|
| Rate for Payer: Nomi Health Commercial |
$183.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.54
|
|
|
HC INFLUENZA INJECTION
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
77100009
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: Aetna Medicare |
$45.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.51
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: ASR Commercial |
$29.68
|
| Rate for Payer: BCBS Complete |
$25.44
|
| Rate for Payer: BCBS MAPPO |
$45.21
|
| Rate for Payer: BCBS Trust/PPO |
$25.06
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: BCN Medicare Advantage |
$45.21
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.21
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$45.21
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$24.23
|
| Rate for Payer: Mclaren Medicare |
$45.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.47
|
| Rate for Payer: Meridian Medicaid |
$25.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: PACE Medicare |
$42.95
|
| Rate for Payer: PACE SWMI |
$45.21
|
| Rate for Payer: PHP Commercial |
$49.73
|
| Rate for Payer: PHP Medicaid |
$24.23
|
| Rate for Payer: PHP Medicare Advantage |
$45.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.38
|
| Rate for Payer: Priority Health Medicare |
$45.21
|
| Rate for Payer: Priority Health Narrow Network |
$14.70
|
| Rate for Payer: Railroad Medicare Medicare |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.21
|
| Rate for Payer: UHC Exchange |
$70.08
|
| Rate for Payer: UHC Medicare Advantage |
$45.21
|
| Rate for Payer: UHCCP DNSP |
$45.21
|
| Rate for Payer: UHCCP Medicaid |
$24.23
|
| Rate for Payer: VA VA |
$45.21
|
|
|
HC INFLUENZA INJECTION
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
77100009
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: ASR Commercial |
$29.68
|
| Rate for Payer: BCBS Trust/PPO |
$24.94
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
|
|
HC INFLUENZA VAC, INACTIV ADJUVANT IM
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 90653
|
| Hospital Charge Code |
63600251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.55 |
| Max. Negotiated Rate |
$167.00 |
| Rate for Payer: Aetna Commercial |
$150.30
|
| Rate for Payer: ASR ASR |
$161.99
|
| Rate for Payer: ASR Commercial |
$161.99
|
| Rate for Payer: BCBS Trust/PPO |
$136.09
|
| Rate for Payer: BCN Commercial |
$129.48
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$156.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.60
|
| Rate for Payer: Healthscope Commercial |
$167.00
|
| Rate for Payer: Healthscope Whirlpool |
$161.99
|
| Rate for Payer: Mclaren Commercial |
$150.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.95
|
| Rate for Payer: Nomi Health Commercial |
$136.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.96
|
|
|
HC INFLUENZA VAC, INACTIV ADJUVANT IM
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 90653
|
| Hospital Charge Code |
63600251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$167.00 |
| Rate for Payer: Aetna Commercial |
$150.30
|
| Rate for Payer: Aetna Medicare |
$83.50
|
| Rate for Payer: ASR ASR |
$161.99
|
| Rate for Payer: ASR Commercial |
$161.99
|
| Rate for Payer: BCBS Complete |
$66.80
|
| Rate for Payer: BCBS Trust/PPO |
$136.76
|
| Rate for Payer: BCN Commercial |
$129.48
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$156.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.60
|
| Rate for Payer: Healthscope Commercial |
$167.00
|
| Rate for Payer: Healthscope Whirlpool |
$161.99
|
| Rate for Payer: Mclaren Commercial |
$150.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.95
|
| Rate for Payer: Nomi Health Commercial |
$136.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: 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 |
$146.96
|
|
|
HC INFLUENZA VIRUS VACCINE (IIV), SPLIT VIRUS, PRESERVATIVE FREE IM
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
63600073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.85 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: ASR ASR |
$105.73
|
| Rate for Payer: ASR Commercial |
$105.73
|
| Rate for Payer: BCBS Trust/PPO |
$88.82
|
| Rate for Payer: BCN Commercial |
$84.51
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$102.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.20
|
| Rate for Payer: Healthscope Commercial |
$109.00
|
| Rate for Payer: Healthscope Whirlpool |
$105.73
|
| Rate for Payer: Mclaren Commercial |
$98.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.65
|
| Rate for Payer: Nomi Health Commercial |
$89.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.92
|
|
|
HC INFLUENZA VIRUS VACCINE (IIV), SPLIT VIRUS, PRESERVATIVE FREE IM
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
63600073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Aetna Medicare |
$54.50
|
| Rate for Payer: ASR ASR |
$105.73
|
| Rate for Payer: ASR Commercial |
$105.73
|
| Rate for Payer: BCBS Complete |
$43.60
|
| Rate for Payer: BCBS Trust/PPO |
$89.26
|
| Rate for Payer: BCN Commercial |
$84.51
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$102.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.20
|
| Rate for Payer: Healthscope Commercial |
$109.00
|
| Rate for Payer: Healthscope Whirlpool |
$105.73
|
| Rate for Payer: Mclaren Commercial |
$98.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.65
|
| Rate for Payer: Nomi Health Commercial |
$89.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.50
|
| Rate for Payer: Priority Health Narrow Network |
$66.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.92
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (IIV4), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
63600079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: 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 |
$22.89
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (IIV4), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
63600079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Trust/PPO |
$21.20
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT, LIVE (LAIV4) INTRANASAL
|
Facility
|
OP
|
$32.25
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
63600075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Medicare |
$16.12
|
| Rate for Payer: ASR ASR |
$31.28
|
| Rate for Payer: ASR Commercial |
$31.28
|
| Rate for Payer: BCBS Complete |
$12.90
|
| Rate for Payer: BCBS Trust/PPO |
$26.41
|
| Rate for Payer: BCN Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$32.25
|
| Rate for Payer: Healthscope Whirlpool |
$31.28
|
| Rate for Payer: Mclaren Commercial |
$29.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.96
|
| Rate for Payer: 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 |
$28.38
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT, LIVE (LAIV4) INTRANASAL
|
Facility
|
IP
|
$32.25
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
63600075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.96 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: ASR ASR |
$31.28
|
| Rate for Payer: ASR Commercial |
$31.28
|
| Rate for Payer: BCBS Trust/PPO |
$26.28
|
| Rate for Payer: BCN Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$32.25
|
| Rate for Payer: Healthscope Whirlpool |
$31.28
|
| Rate for Payer: Mclaren Commercial |
$29.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.38
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, 0.25 ML IM
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 90687
|
| Hospital Charge Code |
63600126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Trust/PPO |
$21.20
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, 0.25 ML IM
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 90687
|
| Hospital Charge Code |
63600126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: 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 |
$22.89
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, 0.5 ML IM
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
63600078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: 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 |
$22.89
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, 0.5 ML IM
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
63600078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Trust/PPO |
$21.20
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, CHILD 6-35 MONTHS, IM
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 90685
|
| Hospital Charge Code |
63600077
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Trust/PPO |
$21.20
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, CHILD 6-35 MONTHS, IM
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 90685
|
| Hospital Charge Code |
63600077
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: 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 |
$22.89
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (CCIIV3) 0.5 ML IM
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 90661
|
| Hospital Charge Code |
63600250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: ASR ASR |
$40.74
|
| Rate for Payer: ASR Commercial |
$40.74
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$34.39
|
| Rate for Payer: BCN Commercial |
$32.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$39.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$42.00
|
| Rate for Payer: Healthscope Whirlpool |
$40.74
|
| Rate for Payer: Mclaren Commercial |
$37.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Nomi Health Commercial |
$34.44
|
| 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: UHC All Payor (Choice/PPO) + Core |
$36.96
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (CCIIV3) 0.5 ML IM
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 90661
|
| Hospital Charge Code |
63600250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: ASR ASR |
$40.74
|
| Rate for Payer: ASR Commercial |
$40.74
|
| Rate for Payer: BCBS Trust/PPO |
$34.23
|
| Rate for Payer: BCN Commercial |
$32.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$39.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$42.00
|
| Rate for Payer: Healthscope Whirlpool |
$40.74
|
| Rate for Payer: Mclaren Commercial |
$37.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Nomi Health Commercial |
$34.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.96
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS, 0.25 ML IM
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 90657
|
| Hospital Charge Code |
63600248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: ASR ASR |
$40.74
|
| Rate for Payer: ASR Commercial |
$40.74
|
| Rate for Payer: BCBS Trust/PPO |
$34.23
|
| Rate for Payer: BCN Commercial |
$32.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$39.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$42.00
|
| Rate for Payer: Healthscope Whirlpool |
$40.74
|
| Rate for Payer: Mclaren Commercial |
$37.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Nomi Health Commercial |
$34.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.96
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS, 0.25 ML IM
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 90657
|
| Hospital Charge Code |
63600248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: ASR ASR |
$40.74
|
| Rate for Payer: ASR Commercial |
$40.74
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$34.39
|
| Rate for Payer: BCN Commercial |
$32.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$39.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$42.00
|
| Rate for Payer: Healthscope Whirlpool |
$40.74
|
| Rate for Payer: Mclaren Commercial |
$37.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Nomi Health Commercial |
$34.44
|
| 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: UHC All Payor (Choice/PPO) + Core |
$36.96
|
|
|
HC INFLUENZA VIRUS VAC TRIVALENT (IIV3), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 90658
|
| Hospital Charge Code |
63600247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: ASR ASR |
$40.74
|
| Rate for Payer: ASR Commercial |
$40.74
|
| Rate for Payer: BCBS Trust/PPO |
$34.23
|
| Rate for Payer: BCN Commercial |
$32.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$39.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$42.00
|
| Rate for Payer: Healthscope Whirlpool |
$40.74
|
| Rate for Payer: Mclaren Commercial |
$37.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Nomi Health Commercial |
$34.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.96
|
|
|
HC INFLUENZA VIRUS VAC TRIVALENT (IIV3), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 90658
|
| Hospital Charge Code |
63600247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: ASR ASR |
$40.74
|
| Rate for Payer: ASR Commercial |
$40.74
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$34.39
|
| Rate for Payer: BCN Commercial |
$32.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$39.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$42.00
|
| Rate for Payer: Healthscope Whirlpool |
$40.74
|
| Rate for Payer: Mclaren Commercial |
$37.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Nomi Health Commercial |
$34.44
|
| 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: UHC All Payor (Choice/PPO) + Core |
$36.96
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS PF, 0.5 ML IM
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
63600072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: ASR ASR |
$40.74
|
| Rate for Payer: ASR Commercial |
$40.74
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$34.39
|
| Rate for Payer: BCN Commercial |
$32.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$39.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$42.00
|
| Rate for Payer: Healthscope Whirlpool |
$40.74
|
| Rate for Payer: Mclaren Commercial |
$37.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Nomi Health Commercial |
$34.44
|
| 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: UHC All Payor (Choice/PPO) + Core |
$36.96
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS PF, 0.5 ML IM
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
63600072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: ASR ASR |
$40.74
|
| Rate for Payer: ASR Commercial |
$40.74
|
| Rate for Payer: BCBS Trust/PPO |
$34.23
|
| Rate for Payer: BCN Commercial |
$32.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$39.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$42.00
|
| Rate for Payer: Healthscope Whirlpool |
$40.74
|
| Rate for Payer: Mclaren Commercial |
$37.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Nomi Health Commercial |
$34.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.96
|
|
