|
DARBEPOETIN A 500MCG SYR*340B*
|
Facility
|
IP
|
$164.10
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
636J088108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.45 |
| Max. Negotiated Rate |
$155.90 |
| Rate for Payer: Aetna of VT Commercial |
$155.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$121.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$121.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$139.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$137.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$131.28
|
| Rate for Payer: Cash Price |
$82.05
|
| Rate for Payer: Cigna Commercial |
$131.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$131.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$131.28
|
| Rate for Payer: Multiplan Commercial |
$152.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$139.49
|
| Rate for Payer: United Healthcare Commercial |
$155.90
|
|
|
DARBEPOETIN A 500MCG SYR*340B*
|
Facility
|
OP
|
$164.10
|
|
|
Service Code
|
HCPCS J0881 TB
|
| Hospital Charge Code |
636J088108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.03 |
| Max. Negotiated Rate |
$155.90 |
| Rate for Payer: Aetna of VT Commercial |
$155.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$98.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$139.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$132.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$73.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$130.46
|
| Rate for Payer: Cash Price |
$82.05
|
| Rate for Payer: Cash Price |
$82.05
|
| Rate for Payer: Cigna Commercial |
$131.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$131.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$131.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$73.84
|
| Rate for Payer: Multiplan Commercial |
$152.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$139.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$73.84
|
| Rate for Payer: United Healthcare Commercial |
$155.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.84
|
| Rate for Payer: United Healthcare VA CCN |
$73.84
|
|
|
DBRDMT OPN WND ADDL 20CM/<
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
9609759801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$103.64 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna of VT Commercial |
$222.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$209.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$209.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$140.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$189.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$105.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$186.03
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$187.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$105.30
|
| Rate for Payer: Multiplan Commercial |
$217.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.30
|
| Rate for Payer: United Healthcare Commercial |
$222.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.30
|
| Rate for Payer: United Healthcare VA CCN |
$105.30
|
|
|
DBRDMT OPN WND ADDL 20CM/<
|
Facility
|
OP
|
$93.60
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
5109759801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.46 |
| Max. Negotiated Rate |
$88.92 |
| Rate for Payer: Aetna of VT Commercial |
$88.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$41.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$56.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$75.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$74.41
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$74.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$74.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$74.88
|
| Rate for Payer: Martins Point Health Care Commercial |
$42.12
|
| Rate for Payer: Multiplan Commercial |
$87.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$42.12
|
| Rate for Payer: United Healthcare Commercial |
$88.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.12
|
| Rate for Payer: United Healthcare VA CCN |
$42.12
|
|
|
DBRDMT OPN WND ADDL 20CM/<
|
Professional
|
Both
|
$93.60
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
5109759801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.47 |
| Max. Negotiated Rate |
$87.98 |
| Rate for Payer: Aetna of VT Commercial |
$87.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$53.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$53.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$25.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$53.03
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$27.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$68.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$68.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$42.38
|
| Rate for Payer: Multiplan Commercial |
$87.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.47
|
| Rate for Payer: United Healthcare Commercial |
$34.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.47
|
| Rate for Payer: United Healthcare VA CCN |
$22.47
|
|
|
DBRDMT OPN WND ADDL 20CM/<
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
9609759801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$173.18 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna of VT Commercial |
$222.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$173.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$173.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$187.20
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$217.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.90
|
| Rate for Payer: United Healthcare Commercial |
$222.30
|
|
|
DBRDMT OPN WND ADDL 20CM/<
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
9609759801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$22.47 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna of VT Commercial |
$219.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$209.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$209.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$53.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$53.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$25.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$53.03
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$27.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$68.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$68.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$42.38
|
| Rate for Payer: Multiplan Commercial |
$217.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.47
|
| Rate for Payer: United Healthcare Commercial |
$34.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.47
|
| Rate for Payer: United Healthcare VA CCN |
$22.47
|
|
|
DBRDMT OPN WND ADDL 20CM/<
|
Facility
|
OP
|
$140.40
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
9609759802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$62.18 |
| Max. Negotiated Rate |
$133.38 |
| Rate for Payer: Aetna of VT Commercial |
$133.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$119.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$111.62
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$112.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.18
|
| Rate for Payer: Multiplan Commercial |
$130.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$119.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.18
|
| Rate for Payer: United Healthcare Commercial |
$133.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.18
|
| Rate for Payer: United Healthcare VA CCN |
$63.18
|
|
|
DBRDMT OPN WND ADDL 20CM/<
|
Facility
|
IP
|
$93.60
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
5109759801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.27 |
| Max. Negotiated Rate |
$88.92 |
| Rate for Payer: Aetna of VT Commercial |
$88.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$74.88
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$74.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$74.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$74.88
|
| Rate for Payer: Multiplan Commercial |
$87.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.56
|
| Rate for Payer: United Healthcare Commercial |
$88.92
|
|
|
DBRDMT OPN WND ADDL 20CM/<
|
Facility
|
IP
|
$140.40
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
9609759802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$103.91 |
| Max. Negotiated Rate |
$133.38 |
| Rate for Payer: Aetna of VT Commercial |
$133.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$119.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$117.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.32
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$112.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.32
|
| Rate for Payer: Multiplan Commercial |
$130.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$119.34
|
| Rate for Payer: United Healthcare Commercial |
$133.38
|
|
|
DBRDMT OPN WND ADDL 20CM/<
|
Professional
|
Both
|
$140.40
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
9609759802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$22.47 |
| Max. Negotiated Rate |
$131.98 |
| Rate for Payer: Aetna of VT Commercial |
$131.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$53.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$53.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$25.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$53.03
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$27.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$68.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$68.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$42.38
|
| Rate for Payer: Multiplan Commercial |
$130.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.47
|
| Rate for Payer: United Healthcare Commercial |
$34.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.47
|
| Rate for Payer: United Healthcare VA CCN |
$22.47
|
|
|
D & C AFTER DELIVERY
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
CPT 59160
|
| Hospital Charge Code |
9825916001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$169.99 |
| Max. Negotiated Rate |
$606.30 |
| Rate for Payer: Aetna of VT Commercial |
$606.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$577.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$175.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$577.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$237.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$395.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$395.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$195.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$395.77
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$187.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$417.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$417.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$248.37
|
| Rate for Payer: Multiplan Commercial |
$599.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$241.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$169.99
|
| Rate for Payer: United Healthcare Commercial |
$261.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.99
|
| Rate for Payer: United Healthcare VA CCN |
$169.99
|
|
|
D & C AFTER DELIVERY
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
CPT 59160
|
| Hospital Charge Code |
9825916001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$477.36 |
| Max. Negotiated Rate |
$612.75 |
| Rate for Payer: Aetna of VT Commercial |
$612.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$477.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$477.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$548.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$541.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$516.00
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$516.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$516.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$516.00
|
| Rate for Payer: Multiplan Commercial |
$599.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$548.25
|
| Rate for Payer: United Healthcare Commercial |
$612.75
|
|
|
D & C AFTER DELIVERY
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
CPT 59160
|
| Hospital Charge Code |
9825916001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$285.67 |
| Max. Negotiated Rate |
$612.75 |
| Rate for Payer: Aetna of VT Commercial |
$612.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$577.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$285.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$577.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$388.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$548.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$522.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$290.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$512.77
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$516.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$516.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$516.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$290.25
|
| Rate for Payer: Multiplan Commercial |
$599.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$548.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$290.25
|
| Rate for Payer: United Healthcare Commercial |
$612.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$290.25
|
| Rate for Payer: United Healthcare VA CCN |
$290.25
|
|
|
DEB BONE 20 SQ CM/<
|
Facility
|
IP
|
$5,404.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
9601104401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,999.50 |
| Max. Negotiated Rate |
$5,133.80 |
| Rate for Payer: Aetna of VT Commercial |
$5,133.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,999.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,999.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,593.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,539.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,323.20
|
| Rate for Payer: Cash Price |
$2,702.00
|
| Rate for Payer: Cigna Commercial |
$4,323.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,323.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,323.20
|
| Rate for Payer: Multiplan Commercial |
$5,025.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,593.40
|
| Rate for Payer: United Healthcare Commercial |
$5,133.80
|
|
|
DEB BONE 20 SQ CM/<
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
9811104401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$460.62 |
| Max. Negotiated Rate |
$988.00 |
| Rate for Payer: Aetna of VT Commercial |
$988.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$931.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$460.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$931.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$626.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$884.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$842.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$468.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$826.80
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$832.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$832.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$832.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$967.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$884.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$468.00
|
| Rate for Payer: United Healthcare Commercial |
$988.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$468.00
|
| Rate for Payer: United Healthcare VA CCN |
$468.00
|
|
|
DEB BONE 20 SQ CM/<
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
9601104402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$207.26 |
| Max. Negotiated Rate |
$977.60 |
| Rate for Payer: Aetna of VT Commercial |
$977.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$931.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$213.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$931.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$290.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$466.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$466.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$238.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$466.57
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$233.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$478.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$478.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$290.14
|
| Rate for Payer: Multiplan Commercial |
$967.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$207.26
|
| Rate for Payer: United Healthcare Commercial |
$318.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$207.26
|
| Rate for Payer: United Healthcare VA CCN |
$207.26
|
|
|
DEB BONE 20 SQ CM/<
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
9601104402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$460.62 |
| Max. Negotiated Rate |
$988.00 |
| Rate for Payer: Aetna of VT Commercial |
$988.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$931.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$460.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$931.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$626.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$884.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$842.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$468.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$826.80
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$832.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$832.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$832.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$967.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$884.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$468.00
|
| Rate for Payer: United Healthcare Commercial |
$988.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$468.00
|
| Rate for Payer: United Healthcare VA CCN |
$468.00
|
|
|
DEB BONE 20 SQ CM/<
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
9601104402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$769.70 |
| Max. Negotiated Rate |
$988.00 |
| Rate for Payer: Aetna of VT Commercial |
$988.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$769.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$769.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$884.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$873.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$832.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$832.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$832.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$832.00
|
| Rate for Payer: Multiplan Commercial |
$967.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$884.00
|
| Rate for Payer: United Healthcare Commercial |
$988.00
|
|
|
DEB BONE 20 SQ CM/<
|
Facility
|
OP
|
$4,365.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
5101104401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,933.26 |
| Max. Negotiated Rate |
$4,146.75 |
| Rate for Payer: Aetna of VT Commercial |
$4,146.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,910.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,933.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,910.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,627.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,710.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,535.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,964.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,470.18
|
| Rate for Payer: Cash Price |
$2,182.50
|
| Rate for Payer: Cigna Commercial |
$3,492.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,492.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,492.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,964.25
|
| Rate for Payer: Multiplan Commercial |
$4,059.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,710.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,964.25
|
| Rate for Payer: United Healthcare Commercial |
$4,146.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,964.25
|
| Rate for Payer: United Healthcare VA CCN |
$1,964.25
|
|
|
DEB BONE 20 SQ CM/<
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
9821104401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$207.26 |
| Max. Negotiated Rate |
$977.60 |
| Rate for Payer: Aetna of VT Commercial |
$977.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$931.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$213.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$931.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$290.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$466.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$466.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$238.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$466.57
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$233.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$478.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$478.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$290.14
|
| Rate for Payer: Multiplan Commercial |
$967.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$207.26
|
| Rate for Payer: United Healthcare Commercial |
$318.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$207.26
|
| Rate for Payer: United Healthcare VA CCN |
$207.26
|
|
|
DEB BONE 20 SQ CM/<
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
9821104401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$460.62 |
| Max. Negotiated Rate |
$988.00 |
| Rate for Payer: Aetna of VT Commercial |
$988.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$931.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$460.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$931.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$626.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$884.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$842.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$468.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$826.80
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$832.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$832.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$832.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$967.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$884.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$468.00
|
| Rate for Payer: United Healthcare Commercial |
$988.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$468.00
|
| Rate for Payer: United Healthcare VA CCN |
$468.00
|
|
|
DEB BONE 20 SQ CM/<
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
9811104402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$769.70 |
| Max. Negotiated Rate |
$988.00 |
| Rate for Payer: Aetna of VT Commercial |
$988.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$769.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$769.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$884.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$873.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$832.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$832.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$832.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$832.00
|
| Rate for Payer: Multiplan Commercial |
$967.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$884.00
|
| Rate for Payer: United Healthcare Commercial |
$988.00
|
|
|
DEB BONE 20 SQ CM/<
|
Facility
|
OP
|
$4,364.51
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
4501104401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,933.04 |
| Max. Negotiated Rate |
$4,146.28 |
| Rate for Payer: Aetna of VT Commercial |
$4,146.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,910.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,933.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,910.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,627.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,709.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,535.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,964.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,469.79
|
| Rate for Payer: Cash Price |
$2,182.26
|
| Rate for Payer: Cigna Commercial |
$3,491.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,491.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,491.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,964.03
|
| Rate for Payer: Multiplan Commercial |
$4,058.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,709.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,964.03
|
| Rate for Payer: United Healthcare Commercial |
$4,146.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,964.03
|
| Rate for Payer: United Healthcare VA CCN |
$1,964.03
|
|
|
DEB BONE 20 SQ CM/<
|
Professional
|
Both
|
$5,404.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
9601104401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$207.26 |
| Max. Negotiated Rate |
$5,079.76 |
| Rate for Payer: Aetna of VT Commercial |
$5,079.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,841.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$213.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,841.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$290.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$466.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$466.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$238.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$466.57
|
| Rate for Payer: Cash Price |
$2,702.00
|
| Rate for Payer: Cash Price |
$2,702.00
|
| Rate for Payer: Cigna Commercial |
$233.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$478.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$478.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$290.14
|
| Rate for Payer: Multiplan Commercial |
$5,025.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$207.26
|
| Rate for Payer: United Healthcare Commercial |
$318.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$207.26
|
| Rate for Payer: United Healthcare VA CCN |
$207.26
|
|
