|
CULTURE ANAEROBE IDENT EACH
|
Professional
|
Both
|
$108.84
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
3008707601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$102.31 |
| Rate for Payer: Aetna of VT Commercial |
$102.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.81
|
| Rate for Payer: Cash Price |
$54.42
|
| Rate for Payer: Cash Price |
$54.42
|
| Rate for Payer: Cigna Commercial |
$9.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.97
|
| Rate for Payer: Multiplan Commercial |
$101.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.08
|
| Rate for Payer: United Healthcare Commercial |
$12.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.08
|
| Rate for Payer: United Healthcare VA CCN |
$8.08
|
|
|
CULTURE ANAEROBE IDENT EACH
|
Facility
|
OP
|
$108.84
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
3008707601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$103.40 |
| Rate for Payer: Aetna of VT Commercial |
$103.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$65.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$92.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$88.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$48.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$86.53
|
| Rate for Payer: Cash Price |
$54.42
|
| Rate for Payer: Cash Price |
$54.42
|
| Rate for Payer: Cigna Commercial |
$87.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$87.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$87.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$48.98
|
| Rate for Payer: Multiplan Commercial |
$101.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$92.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$48.98
|
| Rate for Payer: United Healthcare Commercial |
$103.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.08
|
| Rate for Payer: United Healthcare VA CCN |
$48.98
|
|
|
CULTURE ANAEROBE IDENT EACH
|
Facility
|
IP
|
$108.84
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
3008707601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.55 |
| Max. Negotiated Rate |
$103.40 |
| Rate for Payer: Aetna of VT Commercial |
$103.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$80.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$80.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$92.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$91.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.07
|
| Rate for Payer: Cash Price |
$54.42
|
| Rate for Payer: Cigna Commercial |
$87.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$87.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$87.07
|
| Rate for Payer: Multiplan Commercial |
$101.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$92.51
|
| Rate for Payer: United Healthcare Commercial |
$103.40
|
|
|
CULTURE OTHR SPECIMN AEROBIC
|
Professional
|
Both
|
$168.54
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
3008707001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$158.43 |
| Rate for Payer: Aetna of VT Commercial |
$158.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$42.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$42.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.73
|
| Rate for Payer: Cash Price |
$84.27
|
| Rate for Payer: Cash Price |
$84.27
|
| Rate for Payer: Cigna Commercial |
$10.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.50
|
| Rate for Payer: Multiplan Commercial |
$156.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare Commercial |
$13.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare VA CCN |
$8.62
|
|
|
CULTURE OTHR SPECIMN AEROBIC
|
Facility
|
OP
|
$168.54
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
300870700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$160.11 |
| Rate for Payer: Aetna of VT Commercial |
$160.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$42.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$74.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$42.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$101.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$143.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$136.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$75.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.99
|
| Rate for Payer: Cash Price |
$84.27
|
| Rate for Payer: Cash Price |
$84.27
|
| Rate for Payer: Cigna Commercial |
$134.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$75.84
|
| Rate for Payer: Multiplan Commercial |
$156.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$75.84
|
| Rate for Payer: United Healthcare Commercial |
$160.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare VA CCN |
$75.84
|
|
|
CULTURE OTHR SPECIMN AEROBIC
|
Facility
|
IP
|
$168.54
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
300870700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.74 |
| Max. Negotiated Rate |
$160.11 |
| Rate for Payer: Aetna of VT Commercial |
$160.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$143.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$141.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$134.83
|
| Rate for Payer: Cash Price |
$84.27
|
| Rate for Payer: Cigna Commercial |
$134.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.83
|
| Rate for Payer: Multiplan Commercial |
$156.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.26
|
| Rate for Payer: United Healthcare Commercial |
$160.11
|
|
|
CULTURE OTHR SPECIMN AEROBIC
|
Facility
|
IP
|
$168.54
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
3008707001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.74 |
| Max. Negotiated Rate |
$160.11 |
| Rate for Payer: Aetna of VT Commercial |
$160.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$143.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$141.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$134.83
|
| Rate for Payer: Cash Price |
$84.27
|
| Rate for Payer: Cigna Commercial |
$134.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.83
|
| Rate for Payer: Multiplan Commercial |
$156.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.26
|
| Rate for Payer: United Healthcare Commercial |
$160.11
|
|
|
CULTURE OTHR SPECIMN AEROBIC
|
Facility
|
OP
|
$168.54
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
3008707001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$160.11 |
| Rate for Payer: Aetna of VT Commercial |
$160.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$42.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$74.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$42.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$101.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$143.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$136.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$75.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.99
|
| Rate for Payer: Cash Price |
$84.27
|
| Rate for Payer: Cash Price |
$84.27
|
| Rate for Payer: Cigna Commercial |
$134.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$75.84
|
| Rate for Payer: Multiplan Commercial |
$156.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$75.84
|
| Rate for Payer: United Healthcare Commercial |
$160.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare VA CCN |
$75.84
|
|
|
CULTURE SCREEN ONLY
|
Facility
|
IP
|
$77.55
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
300870810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.39 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna of VT Commercial |
$73.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$57.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$57.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$65.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.04
|
| Rate for Payer: Cash Price |
$38.77
|
| Rate for Payer: Cigna Commercial |
$62.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.04
|
| Rate for Payer: Multiplan Commercial |
$72.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.92
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
|
|
CULTURE SCREEN ONLY
|
Facility
|
OP
|
$77.55
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
300870810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna of VT Commercial |
$73.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$32.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$32.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$65.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$34.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$61.65
|
| Rate for Payer: Cash Price |
$38.77
|
| Rate for Payer: Cash Price |
$38.77
|
| Rate for Payer: Cigna Commercial |
$62.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.90
|
| Rate for Payer: Multiplan Commercial |
$72.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.90
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.63
|
| Rate for Payer: United Healthcare VA CCN |
$34.90
|
|
|
CUL TYP ID BLD PTHGN 6+ TRGT
|
Facility
|
IP
|
$611.09
|
|
|
Service Code
|
CPT 87154
|
| Hospital Charge Code |
3008715401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$452.27 |
| Max. Negotiated Rate |
$580.54 |
| Rate for Payer: Aetna of VT Commercial |
$580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$452.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$452.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$519.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$513.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$488.87
|
| Rate for Payer: Cash Price |
$305.54
|
| Rate for Payer: Cigna Commercial |
$488.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.87
|
| Rate for Payer: Multiplan Commercial |
$568.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$519.43
|
| Rate for Payer: United Healthcare Commercial |
$580.54
|
|
|
CUL TYP ID BLD PTHGN 6+ TRGT
|
Facility
|
OP
|
$611.09
|
|
|
Service Code
|
CPT 87154
|
| Hospital Charge Code |
3008715401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$218.06 |
| Max. Negotiated Rate |
$1,074.49 |
| Rate for Payer: Aetna of VT Commercial |
$580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,074.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$270.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,074.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$367.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$519.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$494.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$274.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$485.82
|
| Rate for Payer: Cash Price |
$305.54
|
| Rate for Payer: Cash Price |
$305.54
|
| Rate for Payer: Cigna Commercial |
$488.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$274.99
|
| Rate for Payer: Multiplan Commercial |
$568.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$519.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$274.99
|
| Rate for Payer: United Healthcare Commercial |
$580.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$218.06
|
| Rate for Payer: United Healthcare VA CCN |
$274.99
|
|
|
CUL TYP ID BLD PTHGN 6+ TRGT
|
Professional
|
Both
|
$611.09
|
|
|
Service Code
|
CPT 87154
|
| Hospital Charge Code |
3008715401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$215.01 |
| Max. Negotiated Rate |
$1,074.49 |
| Rate for Payer: Aetna of VT Commercial |
$574.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,074.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$224.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,074.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$305.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$250.77
|
| Rate for Payer: Cash Price |
$305.54
|
| Rate for Payer: Cash Price |
$305.54
|
| Rate for Payer: Cigna Commercial |
$264.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$218.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$218.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$215.01
|
| Rate for Payer: Multiplan Commercial |
$568.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$218.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$218.06
|
| Rate for Payer: United Healthcare Commercial |
$335.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$218.06
|
| Rate for Payer: United Healthcare VA CCN |
$218.06
|
|
|
CUSHION, PRE-INF BUBBLE 18X18
|
Facility
|
OP
|
$66.00
|
|
| Hospital Charge Code |
2700074891
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.23 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Aetna of VT Commercial |
$62.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$29.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$39.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$56.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$53.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.47
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$52.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$52.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$52.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.70
|
| Rate for Payer: Multiplan Commercial |
$61.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$29.70
|
| Rate for Payer: United Healthcare Commercial |
$62.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.70
|
| Rate for Payer: United Healthcare VA CCN |
$29.70
|
|
|
CUSHION, PRE-INF BUBBLE 18X18
|
Facility
|
IP
|
$66.00
|
|
| Hospital Charge Code |
2700074891
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.85 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Aetna of VT Commercial |
$62.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$56.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$55.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.80
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$52.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$52.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$52.80
|
| Rate for Payer: Multiplan Commercial |
$61.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.10
|
| Rate for Payer: United Healthcare Commercial |
$62.70
|
|
|
CUTIMED SILTEC SORBACT 3X3
|
Facility
|
IP
|
$5.80
|
|
| Hospital Charge Code |
2720061541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$5.51 |
| Rate for Payer: Aetna of VT Commercial |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.64
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cigna Commercial |
$4.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.64
|
| Rate for Payer: Multiplan Commercial |
$5.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.93
|
| Rate for Payer: United Healthcare Commercial |
$5.51
|
|
|
CUTIMED SILTEC SORBACT 3X3
|
Facility
|
OP
|
$5.80
|
|
| Hospital Charge Code |
2720061541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$5.51 |
| Rate for Payer: Aetna of VT Commercial |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.61
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cigna Commercial |
$4.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$5.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.61
|
| Rate for Payer: United Healthcare Commercial |
$5.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.61
|
| Rate for Payer: United Healthcare VA CCN |
$2.61
|
|
|
CUTIMED SILTEC SORBACT 5X5
|
Facility
|
IP
|
$10.39
|
|
| Hospital Charge Code |
2720060791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Aetna of VT Commercial |
$9.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.31
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Cigna Commercial |
$8.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.31
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.31
|
| Rate for Payer: Multiplan Commercial |
$9.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.83
|
| Rate for Payer: United Healthcare Commercial |
$9.87
|
|
|
CUTIMED SILTEC SORBACT 5X5
|
Facility
|
OP
|
$10.39
|
|
| Hospital Charge Code |
2720060791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Aetna of VT Commercial |
$9.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$9.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$9.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.26
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Cigna Commercial |
$8.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.31
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.31
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$9.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.68
|
| Rate for Payer: United Healthcare Commercial |
$9.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.68
|
| Rate for Payer: United Healthcare VA CCN |
$4.68
|
|
|
CYANOCOBALAMIN VITAMIN B-12
|
Facility
|
IP
|
$112.71
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
3008260701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.42 |
| Max. Negotiated Rate |
$107.07 |
| Rate for Payer: Aetna of VT Commercial |
$107.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$95.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$90.17
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cigna Commercial |
$90.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$90.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$90.17
|
| Rate for Payer: Multiplan Commercial |
$104.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.80
|
| Rate for Payer: United Healthcare Commercial |
$107.07
|
|
|
CYANOCOBALAMIN VITAMIN B-12
|
Facility
|
OP
|
$112.71
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
3008260701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$107.07 |
| Rate for Payer: Aetna of VT Commercial |
$107.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$67.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$95.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$91.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$50.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.60
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cigna Commercial |
$90.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$90.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$90.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$50.72
|
| Rate for Payer: Multiplan Commercial |
$104.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$50.72
|
| Rate for Payer: United Healthcare Commercial |
$107.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.08
|
| Rate for Payer: United Healthcare VA CCN |
$50.72
|
|
|
CYANOCOBALAMIN (VIT B-12) 1000
|
Professional
|
Both
|
$13.82
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
636J342001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$12.99 |
| Rate for Payer: Aetna of VT Commercial |
$12.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.16
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$12.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.01
|
| Rate for Payer: United Healthcare Commercial |
$1.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.01
|
| Rate for Payer: United Healthcare VA CCN |
$1.01
|
|
|
CYANOCOBALAMIN (VIT B-12) 1000
|
Facility
|
OP
|
$1.84
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
636J342001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.84
|
|
|
CYSTATIN C
|
Facility
|
OP
|
$74.45
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
3008261001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$91.26 |
| Rate for Payer: Aetna of VT Commercial |
$70.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$91.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$91.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$44.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$60.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$33.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.19
|
| Rate for Payer: Cash Price |
$37.23
|
| Rate for Payer: Cash Price |
$37.23
|
| Rate for Payer: Cigna Commercial |
$59.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.56
|
| Rate for Payer: Martins Point Health Care Commercial |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$69.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.50
|
| Rate for Payer: United Healthcare Commercial |
$70.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.52
|
| Rate for Payer: United Healthcare VA CCN |
$33.50
|
|
|
CYSTATIN C
|
Facility
|
IP
|
$74.45
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
3008261001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$70.73 |
| Rate for Payer: Aetna of VT Commercial |
$70.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$55.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$55.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.56
|
| Rate for Payer: Cash Price |
$37.23
|
| Rate for Payer: Cigna Commercial |
$59.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.56
|
| Rate for Payer: Multiplan Commercial |
$69.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.28
|
| Rate for Payer: United Healthcare Commercial |
$70.73
|
|
