|
HC INDWELLING PORT
|
Facility
|
IP
|
$1,361.50
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.98 |
| Max. Negotiated Rate |
$1,361.50 |
| Rate for Payer: Aetna Commercial |
$1,225.35
|
| Rate for Payer: ASR ASR |
$1,320.65
|
| Rate for Payer: ASR Commercial |
$1,320.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,109.49
|
| Rate for Payer: BCN Commercial |
$1,055.57
|
| Rate for Payer: Cash Price |
$1,089.20
|
| Rate for Payer: Cofinity Commercial |
$1,279.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.20
|
| Rate for Payer: Healthscope Commercial |
$1,361.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,320.65
|
| Rate for Payer: Mclaren Commercial |
$1,225.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.28
|
| Rate for Payer: Nomi Health Commercial |
$1,116.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,198.12
|
|
|
HC INDWELLING PORT
|
Facility
|
OP
|
$1,361.50
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.60 |
| Max. Negotiated Rate |
$1,361.50 |
| Rate for Payer: Aetna Commercial |
$1,225.35
|
| Rate for Payer: Aetna Medicare |
$680.75
|
| Rate for Payer: ASR ASR |
$1,320.65
|
| Rate for Payer: ASR Commercial |
$1,320.65
|
| Rate for Payer: BCBS Complete |
$544.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,114.93
|
| Rate for Payer: BCN Commercial |
$1,055.57
|
| Rate for Payer: Cash Price |
$1,089.20
|
| Rate for Payer: Cofinity Commercial |
$1,279.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.20
|
| Rate for Payer: Healthscope Commercial |
$1,361.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,320.65
|
| Rate for Payer: Mclaren Commercial |
$1,225.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.28
|
| Rate for Payer: Nomi Health Commercial |
$1,116.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,192.95
|
| Rate for Payer: Priority Health Narrow Network |
$954.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,198.12
|
|
|
HC INFANT COOLING SYSTEM
|
Facility
|
IP
|
$670.91
|
|
| Hospital Charge Code |
27000644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$436.09 |
| Max. Negotiated Rate |
$670.91 |
| Rate for Payer: Aetna Commercial |
$603.82
|
| Rate for Payer: ASR ASR |
$650.78
|
| Rate for Payer: ASR Commercial |
$650.78
|
| Rate for Payer: BCBS Trust/PPO |
$546.72
|
| Rate for Payer: BCN Commercial |
$520.16
|
| Rate for Payer: Cash Price |
$536.73
|
| Rate for Payer: Cofinity Commercial |
$630.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.73
|
| Rate for Payer: Healthscope Commercial |
$670.91
|
| Rate for Payer: Healthscope Whirlpool |
$650.78
|
| Rate for Payer: Mclaren Commercial |
$603.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.27
|
| Rate for Payer: Nomi Health Commercial |
$550.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$590.40
|
|
|
HC INFANT COOLING SYSTEM
|
Facility
|
OP
|
$670.91
|
|
| Hospital Charge Code |
27000644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$268.36 |
| Max. Negotiated Rate |
$670.91 |
| Rate for Payer: Aetna Commercial |
$603.82
|
| Rate for Payer: Aetna Medicare |
$335.45
|
| Rate for Payer: ASR ASR |
$650.78
|
| Rate for Payer: ASR Commercial |
$650.78
|
| Rate for Payer: BCBS Complete |
$268.36
|
| Rate for Payer: BCBS Trust/PPO |
$549.41
|
| Rate for Payer: BCN Commercial |
$520.16
|
| Rate for Payer: Cash Price |
$536.73
|
| Rate for Payer: Cofinity Commercial |
$630.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.73
|
| Rate for Payer: Healthscope Commercial |
$670.91
|
| Rate for Payer: Healthscope Whirlpool |
$650.78
|
| Rate for Payer: Mclaren Commercial |
$603.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.27
|
| Rate for Payer: Nomi Health Commercial |
$550.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$587.85
|
| Rate for Payer: Priority Health Narrow Network |
$470.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$590.40
|
|
|
HC INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: Aetna Medicare |
$95.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.75
|
| Rate for Payer: ASR ASR |
$151.38
|
| Rate for Payer: ASR Commercial |
$151.38
|
| Rate for Payer: BCBS Complete |
$53.92
|
| Rate for Payer: BCBS MAPPO |
$95.80
|
| Rate for Payer: BCBS Trust/PPO |
$127.80
|
| Rate for Payer: BCN Commercial |
$120.99
|
| Rate for Payer: BCN Medicare Advantage |
$95.80
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$146.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.80
|
| Rate for Payer: Healthscope Commercial |
$156.06
|
| Rate for Payer: Healthscope Whirlpool |
$151.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$95.80
|
| Rate for Payer: Mclaren Commercial |
$140.45
|
| Rate for Payer: Mclaren Medicaid |
$51.35
|
| Rate for Payer: Mclaren Medicare |
$95.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.59
|
| Rate for Payer: Meridian Medicaid |
$53.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: PACE Medicare |
$91.01
|
| Rate for Payer: PACE SWMI |
$95.80
|
| Rate for Payer: PHP Commercial |
$105.38
|
| Rate for Payer: PHP Medicaid |
$51.35
|
| Rate for Payer: PHP Medicare Advantage |
$95.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$136.74
|
| Rate for Payer: Priority Health Medicare |
$95.80
|
| Rate for Payer: Priority Health Narrow Network |
$109.40
|
| Rate for Payer: Railroad Medicare Medicare |
$95.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.80
|
| Rate for Payer: UHC Exchange |
$148.49
|
| Rate for Payer: UHC Medicare Advantage |
$95.80
|
| Rate for Payer: UHCCP DNSP |
$95.80
|
| Rate for Payer: UHCCP Medicaid |
$51.35
|
| Rate for Payer: VA VA |
$95.80
|
|
|
HC INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.44 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: ASR ASR |
$151.38
|
| Rate for Payer: ASR Commercial |
$151.38
|
| Rate for Payer: BCBS Trust/PPO |
$127.17
|
| Rate for Payer: BCN Commercial |
$120.99
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$146.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$156.06
|
| Rate for Payer: Healthscope Whirlpool |
$151.38
|
| Rate for Payer: Mclaren Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.33
|
|
|
HC INFLIXIMAB AB
|
Facility
|
OP
|
$188.70
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$188.70 |
| Rate for Payer: Aetna Commercial |
$169.83
|
| Rate for Payer: Aetna Medicare |
$14.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.65
|
| Rate for Payer: ASR ASR |
$183.04
|
| Rate for Payer: ASR Commercial |
$183.04
|
| Rate for Payer: BCBS Complete |
$7.95
|
| Rate for Payer: BCBS MAPPO |
$14.12
|
| Rate for Payer: BCBS Trust/PPO |
$154.53
|
| Rate for Payer: BCN Commercial |
$146.30
|
| Rate for Payer: BCN Medicare Advantage |
$14.12
|
| Rate for Payer: Cash Price |
$150.96
|
| Rate for Payer: Cash Price |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$177.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.12
|
| Rate for Payer: Healthscope Commercial |
$188.70
|
| Rate for Payer: Healthscope Whirlpool |
$183.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.12
|
| Rate for Payer: Mclaren Commercial |
$169.83
|
| Rate for Payer: Mclaren Medicaid |
$7.57
|
| Rate for Payer: Mclaren Medicare |
$14.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.83
|
| Rate for Payer: Meridian Medicaid |
$7.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.40
|
| Rate for Payer: Nomi Health Commercial |
$154.73
|
| Rate for Payer: PACE Medicare |
$13.41
|
| Rate for Payer: PACE SWMI |
$14.12
|
| Rate for Payer: PHP Commercial |
$15.53
|
| Rate for Payer: PHP Medicaid |
$7.57
|
| Rate for Payer: PHP Medicare Advantage |
$14.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.34
|
| Rate for Payer: Priority Health Medicare |
$14.12
|
| Rate for Payer: Priority Health Narrow Network |
$132.28
|
| Rate for Payer: Railroad Medicare Medicare |
$14.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.12
|
| Rate for Payer: UHC Exchange |
$21.89
|
| Rate for Payer: UHC Medicare Advantage |
$14.12
|
| Rate for Payer: UHCCP DNSP |
$14.12
|
| Rate for Payer: UHCCP Medicaid |
$7.57
|
| Rate for Payer: VA VA |
$14.12
|
|
|
HC INFLIXIMAB AB
|
Facility
|
IP
|
$188.70
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$122.66 |
| Max. Negotiated Rate |
$188.70 |
| Rate for Payer: Aetna Commercial |
$169.83
|
| Rate for Payer: ASR ASR |
$183.04
|
| Rate for Payer: ASR Commercial |
$183.04
|
| Rate for Payer: BCBS Trust/PPO |
$153.77
|
| Rate for Payer: BCN Commercial |
$146.30
|
| Rate for Payer: Cash Price |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$177.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.96
|
| Rate for Payer: Healthscope Commercial |
$188.70
|
| Rate for Payer: Healthscope Whirlpool |
$183.04
|
| Rate for Payer: Mclaren Commercial |
$169.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.40
|
| Rate for Payer: Nomi Health Commercial |
$154.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.06
|
|
|
HC INFLIXIMAB, S
|
Facility
|
IP
|
$249.90
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
30100705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$162.44 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Aetna Commercial |
$224.91
|
| Rate for Payer: ASR ASR |
$242.40
|
| Rate for Payer: ASR Commercial |
$242.40
|
| Rate for Payer: BCBS Trust/PPO |
$203.64
|
| Rate for Payer: BCN Commercial |
$193.75
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$234.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Healthscope Commercial |
$249.90
|
| Rate for Payer: Healthscope Whirlpool |
$242.40
|
| Rate for Payer: Mclaren Commercial |
$224.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.91
|
|
|
HC INFLIXIMAB, S
|
Facility
|
OP
|
$249.90
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
30100705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.67 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Aetna Commercial |
$224.91
|
| Rate for Payer: Aetna Medicare |
$38.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.21
|
| Rate for Payer: ASR ASR |
$242.40
|
| Rate for Payer: ASR Commercial |
$242.40
|
| Rate for Payer: BCBS Complete |
$21.71
|
| Rate for Payer: BCBS MAPPO |
$38.57
|
| Rate for Payer: BCBS Trust/PPO |
$204.64
|
| Rate for Payer: BCN Commercial |
$193.75
|
| Rate for Payer: BCN Medicare Advantage |
$38.57
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$234.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.57
|
| Rate for Payer: Healthscope Commercial |
$249.90
|
| Rate for Payer: Healthscope Whirlpool |
$242.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.57
|
| Rate for Payer: Mclaren Commercial |
$224.91
|
| Rate for Payer: Mclaren Medicaid |
$20.67
|
| Rate for Payer: Mclaren Medicare |
$38.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.50
|
| Rate for Payer: Meridian Medicaid |
$21.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: PACE Medicare |
$36.64
|
| Rate for Payer: PACE SWMI |
$38.57
|
| Rate for Payer: PHP Commercial |
$42.43
|
| Rate for Payer: PHP Medicaid |
$20.67
|
| Rate for Payer: PHP Medicare Advantage |
$38.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.96
|
| Rate for Payer: Priority Health Medicare |
$38.57
|
| Rate for Payer: Priority Health Narrow Network |
$175.18
|
| Rate for Payer: Railroad Medicare Medicare |
$38.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.57
|
| Rate for Payer: UHC Exchange |
$59.78
|
| Rate for Payer: UHC Medicare Advantage |
$38.57
|
| Rate for Payer: UHCCP DNSP |
$38.57
|
| Rate for Payer: UHCCP Medicaid |
$20.67
|
| Rate for Payer: VA VA |
$38.57
|
|
|
HC INFLUENZA A AND B PCR
|
Facility
|
OP
|
$216.95
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600207
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.45 |
| Max. Negotiated Rate |
$221.08 |
| Rate for Payer: Aetna Commercial |
$195.25
|
| Rate for Payer: Aetna Medicare |
$142.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: ASR ASR |
$210.44
|
| Rate for Payer: ASR Commercial |
$210.44
|
| Rate for Payer: BCBS Complete |
$80.27
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$177.66
|
| Rate for Payer: BCN Commercial |
$168.20
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$173.56
|
| Rate for Payer: Cash Price |
$173.56
|
| Rate for Payer: Cofinity Commercial |
$203.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$216.95
|
| Rate for Payer: Healthscope Whirlpool |
$210.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$142.63
|
| Rate for Payer: Mclaren Commercial |
$195.25
|
| Rate for Payer: Mclaren Medicaid |
$76.45
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: Meridian Medicaid |
$80.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.41
|
| Rate for Payer: Nomi Health Commercial |
$177.90
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$156.89
|
| Rate for Payer: PHP Medicaid |
$76.45
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health Narrow Network |
$152.08
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.63
|
| Rate for Payer: UHC Exchange |
$221.08
|
| Rate for Payer: UHC Medicare Advantage |
$142.63
|
| Rate for Payer: UHCCP DNSP |
$142.63
|
| Rate for Payer: UHCCP Medicaid |
$76.45
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC INFLUENZA A AND B PCR
|
Facility
|
IP
|
$216.95
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600207
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$141.02 |
| Max. Negotiated Rate |
$216.95 |
| Rate for Payer: Aetna Commercial |
$195.25
|
| Rate for Payer: ASR ASR |
$210.44
|
| Rate for Payer: ASR Commercial |
$210.44
|
| Rate for Payer: BCBS Trust/PPO |
$176.79
|
| Rate for Payer: BCN Commercial |
$168.20
|
| Rate for Payer: Cash Price |
$173.56
|
| Rate for Payer: Cofinity Commercial |
$203.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.56
|
| Rate for Payer: Healthscope Commercial |
$216.95
|
| Rate for Payer: Healthscope Whirlpool |
$210.44
|
| Rate for Payer: Mclaren Commercial |
$195.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.41
|
| Rate for Payer: Nomi Health Commercial |
$177.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.92
|
|
|
HC INFLUENZA A/B DNA AMP PROBE
|
Facility
|
IP
|
$145.73
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30600314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$94.72 |
| Max. Negotiated Rate |
$145.73 |
| Rate for Payer: Aetna Commercial |
$131.16
|
| Rate for Payer: ASR ASR |
$141.36
|
| Rate for Payer: ASR Commercial |
$141.36
|
| Rate for Payer: BCBS Trust/PPO |
$118.76
|
| Rate for Payer: BCN Commercial |
$112.98
|
| Rate for Payer: Cash Price |
$116.58
|
| Rate for Payer: Cofinity Commercial |
$136.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.58
|
| Rate for Payer: Healthscope Commercial |
$145.73
|
| Rate for Payer: Healthscope Whirlpool |
$141.36
|
| Rate for Payer: Mclaren Commercial |
$131.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.87
|
| Rate for Payer: Nomi Health Commercial |
$119.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.24
|
|
|
HC INFLUENZA A/B DNA AMP PROBE
|
Facility
|
OP
|
$145.73
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30600314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$148.49 |
| Rate for Payer: Aetna Commercial |
$131.16
|
| Rate for Payer: Aetna Medicare |
$95.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.75
|
| Rate for Payer: ASR ASR |
$141.36
|
| Rate for Payer: ASR Commercial |
$141.36
|
| Rate for Payer: BCBS Complete |
$53.92
|
| Rate for Payer: BCBS MAPPO |
$95.80
|
| Rate for Payer: BCBS Trust/PPO |
$119.34
|
| Rate for Payer: BCN Commercial |
$112.98
|
| Rate for Payer: BCN Medicare Advantage |
$95.80
|
| Rate for Payer: Cash Price |
$116.58
|
| Rate for Payer: Cash Price |
$116.58
|
| Rate for Payer: Cofinity Commercial |
$136.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.80
|
| Rate for Payer: Healthscope Commercial |
$145.73
|
| Rate for Payer: Healthscope Whirlpool |
$141.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$95.80
|
| Rate for Payer: Mclaren Commercial |
$131.16
|
| Rate for Payer: Mclaren Medicaid |
$51.35
|
| Rate for Payer: Mclaren Medicare |
$95.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.59
|
| Rate for Payer: Meridian Medicaid |
$53.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.87
|
| Rate for Payer: Nomi Health Commercial |
$119.50
|
| Rate for Payer: PACE Medicare |
$91.01
|
| Rate for Payer: PACE SWMI |
$95.80
|
| Rate for Payer: PHP Commercial |
$105.38
|
| Rate for Payer: PHP Medicaid |
$51.35
|
| Rate for Payer: PHP Medicare Advantage |
$95.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.69
|
| Rate for Payer: Priority Health Medicare |
$95.80
|
| Rate for Payer: Priority Health Narrow Network |
$102.16
|
| Rate for Payer: Railroad Medicare Medicare |
$95.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.80
|
| Rate for Payer: UHC Exchange |
$148.49
|
| Rate for Payer: UHC Medicare Advantage |
$95.80
|
| Rate for Payer: UHCCP DNSP |
$95.80
|
| Rate for Payer: UHCCP Medicaid |
$51.35
|
| Rate for Payer: VA VA |
$95.80
|
|
|
HC INFLUENZA AND RSV BY PCR
|
Facility
|
OP
|
$223.34
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600213
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.45 |
| Max. Negotiated Rate |
$223.34 |
| Rate for Payer: Aetna Commercial |
$201.01
|
| Rate for Payer: Aetna Medicare |
$142.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: ASR ASR |
$216.64
|
| Rate for Payer: ASR Commercial |
$216.64
|
| Rate for Payer: BCBS Complete |
$80.27
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$182.89
|
| Rate for Payer: BCN Commercial |
$173.16
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$178.67
|
| 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: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$223.34
|
| Rate for Payer: Healthscope Whirlpool |
$216.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$142.63
|
| Rate for Payer: Mclaren Commercial |
$201.01
|
| Rate for Payer: Mclaren Medicaid |
$76.45
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: Meridian Medicaid |
$80.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.84
|
| Rate for Payer: Nomi Health Commercial |
$183.14
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$156.89
|
| Rate for Payer: PHP Medicaid |
$76.45
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.69
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health Narrow Network |
$156.56
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.63
|
| Rate for Payer: UHC Exchange |
$221.08
|
| Rate for Payer: UHC Medicare Advantage |
$142.63
|
| Rate for Payer: UHCCP DNSP |
$142.63
|
| Rate for Payer: UHCCP Medicaid |
$76.45
|
| Rate for Payer: VA VA |
$142.63
|
|
|
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 |
$19.89 |
| Max. Negotiated Rate |
$69.75 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: Aetna Medicare |
$45.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.25
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: ASR Commercial |
$29.68
|
| Rate for Payer: BCBS Complete |
$25.33
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCBS Trust/PPO |
$25.06
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| 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 |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$45.00
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$24.12
|
| Rate for Payer: Mclaren Medicare |
$45.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.25
|
| Rate for Payer: Meridian Medicaid |
$25.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: PACE Medicare |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.00
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: PHP Medicaid |
$24.12
|
| Rate for Payer: PHP Medicare Advantage |
$45.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.81
|
| Rate for Payer: Priority Health Medicare |
$45.00
|
| Rate for Payer: Priority Health Narrow Network |
$21.45
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.00
|
| Rate for Payer: UHC Exchange |
$69.75
|
| Rate for Payer: UHC Medicare Advantage |
$45.00
|
| Rate for Payer: UHCCP DNSP |
$45.00
|
| Rate for Payer: UHCCP Medicaid |
$24.12
|
| Rate for Payer: VA VA |
$45.00
|
|
|
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 |
$66.80 |
| 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: 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 |
$146.33
|
| Rate for Payer: Priority Health Narrow Network |
$117.07
|
| 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: 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 |
$95.51
|
| Rate for Payer: Priority Health Narrow Network |
$76.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.92
|
|
|
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 (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 |
$10.40 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$13.01
|
| 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: 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 |
$22.79
|
| Rate for Payer: Priority Health Narrow Network |
$18.23
|
| 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 |
$12.90 |
| 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: 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 |
$26.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.26
|
| Rate for Payer: Priority Health Narrow Network |
$22.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.38
|
|
