|
DOPPLER ECHO EXAM HEART
|
Facility
|
IP
|
$757.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
5109332001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$560.26 |
| Max. Negotiated Rate |
$719.15 |
| Rate for Payer: Aetna of VT Commercial |
$719.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$560.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$560.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$643.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$635.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$605.60
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cigna Commercial |
$605.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$605.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$605.60
|
| Rate for Payer: Multiplan Commercial |
$704.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$643.45
|
| Rate for Payer: United Healthcare Commercial |
$719.15
|
|
|
DOPPLER ECHO EXAM HEART
|
Professional
|
Both
|
$757.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
5109332001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$711.58 |
| Rate for Payer: Aetna of VT Commercial |
$711.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$678.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$678.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$67.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$96.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$55.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$96.18
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cigna Commercial |
$112.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$77.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$77.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.96
|
| Rate for Payer: Multiplan Commercial |
$704.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.96
|
| Rate for Payer: United Healthcare Commercial |
$73.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.96
|
| Rate for Payer: United Healthcare VA CCN |
$47.96
|
|
|
DOPPLER ECHO EXAM HEART
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
9609332002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$243.46 |
| Rate for Payer: Aetna of VT Commercial |
$243.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$67.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$96.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$55.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$96.18
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$112.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$77.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$77.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.96
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.96
|
| Rate for Payer: United Healthcare Commercial |
$73.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.96
|
| Rate for Payer: United Healthcare VA CCN |
$47.96
|
|
|
DOPPLER ECHO EXAM HEART
|
Professional
|
Both
|
$1,016.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
9609332001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$955.04 |
| Rate for Payer: Aetna of VT Commercial |
$955.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$910.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$910.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$67.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$96.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$55.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$96.18
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cigna Commercial |
$112.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$77.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$77.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.96
|
| Rate for Payer: Multiplan Commercial |
$944.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.96
|
| Rate for Payer: United Healthcare Commercial |
$73.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.96
|
| Rate for Payer: United Healthcare VA CCN |
$47.96
|
|
|
DOPPLER ECHO EXAM HEART
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
9829332101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$31.82 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Aetna of VT Commercial |
$40.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$36.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.40
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cigna Commercial |
$34.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$34.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$34.40
|
| Rate for Payer: Multiplan Commercial |
$39.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.55
|
| Rate for Payer: United Healthcare Commercial |
$40.85
|
|
|
DOPPLER ECHO EXAM HEART
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
9609332002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$114.71 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Aetna of VT Commercial |
$246.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$114.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$155.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$209.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$205.91
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$116.55
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$116.55
|
| Rate for Payer: United Healthcare Commercial |
$246.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.55
|
| Rate for Payer: United Healthcare VA CCN |
$116.55
|
|
|
DOPPLER ECHO EXAM HEART
|
Facility
|
IP
|
$1,016.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
9609332001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$751.94 |
| Max. Negotiated Rate |
$965.20 |
| Rate for Payer: Aetna of VT Commercial |
$965.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$751.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$751.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$863.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$853.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$812.80
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cigna Commercial |
$812.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$812.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$812.80
|
| Rate for Payer: Multiplan Commercial |
$944.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$863.60
|
| Rate for Payer: United Healthcare Commercial |
$965.20
|
|
|
DOPPLER ECHO EXAM HEART
|
Facility
|
OP
|
$757.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
5109332001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$335.28 |
| Max. Negotiated Rate |
$719.15 |
| Rate for Payer: Aetna of VT Commercial |
$719.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$678.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$335.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$678.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$455.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$643.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$613.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$340.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$601.82
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cigna Commercial |
$605.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$605.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$605.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$340.65
|
| Rate for Payer: Multiplan Commercial |
$704.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$643.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$340.65
|
| Rate for Payer: United Healthcare Commercial |
$719.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$340.65
|
| Rate for Payer: United Healthcare VA CCN |
$340.65
|
|
|
DOPPLER ECHO EXAM HEART
|
Facility
|
OP
|
$1,016.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
9609332001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$449.99 |
| Max. Negotiated Rate |
$965.20 |
| Rate for Payer: Aetna of VT Commercial |
$965.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$910.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$449.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$910.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$611.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$863.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$822.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$457.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$807.72
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cigna Commercial |
$812.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$812.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$812.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$457.20
|
| Rate for Payer: Multiplan Commercial |
$944.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$863.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$457.20
|
| Rate for Payer: United Healthcare Commercial |
$965.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$457.20
|
| Rate for Payer: United Healthcare VA CCN |
$457.20
|
|
|
DOTAREM GATORATE MEGLUMI 20ML
|
Facility
|
OP
|
$140.29
|
|
|
Service Code
|
HCPCS A9575
|
| Hospital Charge Code |
636A957502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$133.28 |
| Rate for Payer: Aetna of VT Commercial |
$133.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$111.53
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cigna Commercial |
$112.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.13
|
| Rate for Payer: Multiplan Commercial |
$130.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$119.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.13
|
| Rate for Payer: United Healthcare Commercial |
$133.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.13
|
| Rate for Payer: United Healthcare VA CCN |
$63.13
|
|
|
DOTAREM GATORATE MEGLUMI 20ML
|
Facility
|
IP
|
$140.29
|
|
|
Service Code
|
HCPCS A9575
|
| Hospital Charge Code |
636A957502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.83 |
| Max. Negotiated Rate |
$133.28 |
| Rate for Payer: Aetna of VT Commercial |
$133.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$117.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.23
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cigna Commercial |
$112.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.23
|
| Rate for Payer: Multiplan Commercial |
$130.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$119.25
|
| Rate for Payer: United Healthcare Commercial |
$133.28
|
|
|
DOXAZOSIN 4MG TAB
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 1672921301
|
| Hospital Charge Code |
2500000591
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of VT Commercial |
$0.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.22
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna Commercial |
$0.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.23
|
| Rate for Payer: United Healthcare Commercial |
$0.26
|
|
|
DOXAZOSIN 4MG TAB
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 1672921301
|
| Hospital Charge Code |
2500000591
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of VT Commercial |
$0.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.21
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna Commercial |
$0.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.12
|
| Rate for Payer: United Healthcare Commercial |
$0.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.12
|
| Rate for Payer: United Healthcare VA CCN |
$0.12
|
|
|
DOXYCYCLINE 100MG VIAL
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
636J127101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.97 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna of VT Commercial |
$98.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$76.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$76.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$88.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.20
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$83.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$83.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$96.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$88.40
|
| Rate for Payer: United Healthcare Commercial |
$98.80
|
|
|
DOXYCYCLINE 100MG VIAL
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
636J127101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna of VT Commercial |
$98.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$46.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$88.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.68
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$83.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$83.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$83.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$96.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$88.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.80
|
| Rate for Payer: United Healthcare Commercial |
$98.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.80
|
| Rate for Payer: United Healthcare VA CCN |
$46.80
|
|
|
DOXYCYLINE 100 MG STARTER PACK
|
Facility
|
OP
|
$18.69
|
|
|
Service Code
|
NDC 999999930
|
| Hospital Charge Code |
2500000595
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Aetna of VT Commercial |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$15.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$15.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$8.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.86
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Cigna Commercial |
$14.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.95
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.95
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.41
|
| Rate for Payer: Multiplan Commercial |
$17.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.41
|
| Rate for Payer: United Healthcare Commercial |
$17.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.41
|
| Rate for Payer: United Healthcare VA CCN |
$8.41
|
|
|
DOXYCYLINE 100 MG STARTER PACK
|
Facility
|
IP
|
$18.69
|
|
|
Service Code
|
NDC 999999930
|
| Hospital Charge Code |
2500000595
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Aetna of VT Commercial |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$13.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$13.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$15.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$15.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.95
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Cigna Commercial |
$14.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.95
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.95
|
| Rate for Payer: Multiplan Commercial |
$17.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.89
|
| Rate for Payer: United Healthcare Commercial |
$17.76
|
|
|
DRAINAGE ABDOM ABSCESS OPEN
|
Facility
|
IP
|
$3,659.00
|
|
|
Service Code
|
CPT 49020
|
| Hospital Charge Code |
9824902001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,708.03 |
| Max. Negotiated Rate |
$3,476.05 |
| Rate for Payer: Aetna of VT Commercial |
$3,476.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,708.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,708.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,110.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,073.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,927.20
|
| Rate for Payer: Cash Price |
$1,829.50
|
| Rate for Payer: Cigna Commercial |
$2,927.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,927.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,927.20
|
| Rate for Payer: Multiplan Commercial |
$3,402.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,110.15
|
| Rate for Payer: United Healthcare Commercial |
$3,476.05
|
|
|
DRAINAGE ABDOM ABSCESS OPEN
|
Facility
|
OP
|
$3,659.00
|
|
|
Service Code
|
CPT 49020
|
| Hospital Charge Code |
9824902001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,620.57 |
| Max. Negotiated Rate |
$3,476.05 |
| Rate for Payer: Aetna of VT Commercial |
$3,476.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,278.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,620.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,278.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,202.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,110.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,963.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,646.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,908.91
|
| Rate for Payer: Cash Price |
$1,829.50
|
| Rate for Payer: Cigna Commercial |
$2,927.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,927.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,927.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,646.55
|
| Rate for Payer: Multiplan Commercial |
$3,402.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,110.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,646.55
|
| Rate for Payer: United Healthcare Commercial |
$3,476.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,646.55
|
| Rate for Payer: United Healthcare VA CCN |
$1,646.55
|
|
|
DRAINAGE ABDOM ABSCESS OPEN
|
Professional
|
Both
|
$3,659.00
|
|
|
Service Code
|
CPT 49020
|
| Hospital Charge Code |
9824902001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,452.86 |
| Max. Negotiated Rate |
$3,439.46 |
| Rate for Payer: Aetna of VT Commercial |
$3,439.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,278.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,496.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,278.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,034.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,296.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,296.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,670.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,296.52
|
| Rate for Payer: Cash Price |
$1,829.50
|
| Rate for Payer: Cash Price |
$1,829.50
|
| Rate for Payer: Cigna Commercial |
$2,658.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,469.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,469.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,452.87
|
| Rate for Payer: Multiplan Commercial |
$3,402.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,063.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,452.86
|
| Rate for Payer: United Healthcare Commercial |
$2,234.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,452.86
|
| Rate for Payer: United Healthcare VA CCN |
$1,452.86
|
|
|
DRAINAGE ABSCESS PALATE UVULA
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
CPT 42000
|
| Hospital Charge Code |
9814200002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$344.15 |
| Max. Negotiated Rate |
$441.75 |
| Rate for Payer: Aetna of VT Commercial |
$441.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$344.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$344.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$395.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$390.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$372.00
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cigna Commercial |
$372.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$372.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$372.00
|
| Rate for Payer: Multiplan Commercial |
$432.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$395.25
|
| Rate for Payer: United Healthcare Commercial |
$441.75
|
|
|
DRAINAGE ABSCESS PALATE UVULA
|
Facility
|
OP
|
$271.94
|
|
|
Service Code
|
CPT 42000
|
| Hospital Charge Code |
4504200001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.44 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna of VT Commercial |
$258.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$243.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$120.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$243.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$163.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$122.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.19
|
| Rate for Payer: Cash Price |
$135.97
|
| Rate for Payer: Cigna Commercial |
$217.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$122.37
|
| Rate for Payer: Multiplan Commercial |
$252.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$231.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$122.37
|
| Rate for Payer: United Healthcare Commercial |
$258.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.37
|
| Rate for Payer: United Healthcare VA CCN |
$122.37
|
|
|
DRAINAGE ABSCESS PALATE UVULA
|
Facility
|
IP
|
$271.94
|
|
|
Service Code
|
CPT 42000
|
| Hospital Charge Code |
4504200001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$201.26 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna of VT Commercial |
$258.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$201.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$201.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$228.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$217.55
|
| Rate for Payer: Cash Price |
$135.97
|
| Rate for Payer: Cigna Commercial |
$217.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.55
|
| Rate for Payer: Multiplan Commercial |
$252.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$231.15
|
| Rate for Payer: United Healthcare Commercial |
$258.34
|
|
|
DRAINAGE ABSCESS PALATE UVULA
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
CPT 42000
|
| Hospital Charge Code |
9814200001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$205.95 |
| Max. Negotiated Rate |
$441.75 |
| Rate for Payer: Aetna of VT Commercial |
$441.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$416.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$205.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$416.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$279.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$395.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$376.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$209.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$369.68
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cigna Commercial |
$372.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$372.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$372.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$209.25
|
| Rate for Payer: Multiplan Commercial |
$432.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$209.25
|
| Rate for Payer: United Healthcare Commercial |
$441.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$209.25
|
| Rate for Payer: United Healthcare VA CCN |
$209.25
|
|
|
DRAINAGE ABSCESS PALATE UVULA
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
CPT 42000
|
| Hospital Charge Code |
9814200002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$205.95 |
| Max. Negotiated Rate |
$441.75 |
| Rate for Payer: Aetna of VT Commercial |
$441.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$416.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$205.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$416.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$279.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$395.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$376.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$209.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$369.68
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cigna Commercial |
$372.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$372.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$372.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$209.25
|
| Rate for Payer: Multiplan Commercial |
$432.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$209.25
|
| Rate for Payer: United Healthcare Commercial |
$441.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$209.25
|
| Rate for Payer: United Healthcare VA CCN |
$209.25
|
|
