|
DRILL, 1.3X100MM, SLD, AO
|
Facility
|
OP
|
$259.00
|
|
| Hospital Charge Code |
2720074181
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
DRILL, 1.3X100MM, SLD, AO
|
Facility
|
IP
|
$259.00
|
|
| Hospital Charge Code |
2720077181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.69 |
| 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 |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.20
|
| 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: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.15
|
| Rate for Payer: United Healthcare Commercial |
$246.05
|
|
|
DRILL, 1.3X100MM, SLD, AO
|
Facility
|
IP
|
$259.00
|
|
| Hospital Charge Code |
2720074181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.69 |
| 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 |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.20
|
| 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: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.15
|
| Rate for Payer: United Healthcare Commercial |
$246.05
|
|
|
DRILL, 2.3X120MM, CAN, AO
|
Facility
|
OP
|
$256.43
|
|
| Hospital Charge Code |
2720069511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.57 |
| Max. Negotiated Rate |
$243.61 |
| Rate for Payer: Aetna of VT Commercial |
$243.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$229.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$113.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$229.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$154.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$217.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$207.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$115.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$203.86
|
| Rate for Payer: Cash Price |
$128.22
|
| Rate for Payer: Cigna Commercial |
$205.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$205.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$205.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$115.39
|
| Rate for Payer: Multiplan Commercial |
$238.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$115.39
|
| Rate for Payer: United Healthcare Commercial |
$243.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.39
|
| Rate for Payer: United Healthcare VA CCN |
$115.39
|
|
|
DRILL, 2.3X120MM, CAN, AO
|
Facility
|
IP
|
$256.43
|
|
| Hospital Charge Code |
2720069511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.78 |
| Max. Negotiated Rate |
$243.61 |
| Rate for Payer: Aetna of VT Commercial |
$243.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$189.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$189.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$217.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$215.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$205.14
|
| Rate for Payer: Cash Price |
$128.22
|
| Rate for Payer: Cigna Commercial |
$205.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$205.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$205.14
|
| Rate for Payer: Multiplan Commercial |
$238.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.97
|
| Rate for Payer: United Healthcare Commercial |
$243.61
|
|
|
DRILL BIT 1.6X110MM, SLD, AO
|
Facility
|
IP
|
$259.16
|
|
| Hospital Charge Code |
2720073581
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$246.20 |
| Rate for Payer: Aetna of VT Commercial |
$246.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$191.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$191.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.33
|
| Rate for Payer: Cash Price |
$129.58
|
| Rate for Payer: Cigna Commercial |
$207.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.33
|
| Rate for Payer: Multiplan Commercial |
$241.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.29
|
| Rate for Payer: United Healthcare Commercial |
$246.20
|
|
|
DRILL BIT 1.6X110MM, SLD, AO
|
Facility
|
OP
|
$259.16
|
|
| Hospital Charge Code |
2720073581
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.78 |
| Max. Negotiated Rate |
$246.20 |
| Rate for Payer: Aetna of VT Commercial |
$246.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$232.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$114.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$232.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$156.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$209.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$206.03
|
| Rate for Payer: Cash Price |
$129.58
|
| Rate for Payer: Cigna Commercial |
$207.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$116.62
|
| Rate for Payer: Multiplan Commercial |
$241.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$116.62
|
| Rate for Payer: United Healthcare Commercial |
$246.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.62
|
| Rate for Payer: United Healthcare VA CCN |
$116.62
|
|
|
DRILL BIT 3.5X160MM
|
Facility
|
OP
|
$259.16
|
|
| Hospital Charge Code |
2720074221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.78 |
| Max. Negotiated Rate |
$246.20 |
| Rate for Payer: Aetna of VT Commercial |
$246.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$232.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$114.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$232.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$156.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$209.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$206.03
|
| Rate for Payer: Cash Price |
$129.58
|
| Rate for Payer: Cigna Commercial |
$207.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$116.62
|
| Rate for Payer: Multiplan Commercial |
$241.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$116.62
|
| Rate for Payer: United Healthcare Commercial |
$246.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.62
|
| Rate for Payer: United Healthcare VA CCN |
$116.62
|
|
|
DRILL BIT 3.5X160MM
|
Facility
|
IP
|
$259.16
|
|
| Hospital Charge Code |
2720074221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$246.20 |
| Rate for Payer: Aetna of VT Commercial |
$246.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$191.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$191.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.33
|
| Rate for Payer: Cash Price |
$129.58
|
| Rate for Payer: Cigna Commercial |
$207.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.33
|
| Rate for Payer: Multiplan Commercial |
$241.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.29
|
| Rate for Payer: United Healthcare Commercial |
$246.20
|
|
|
DRILL BIT 4.6X220MM
|
Facility
|
OP
|
$330.22
|
|
| Hospital Charge Code |
2720074211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$313.71 |
| Rate for Payer: Aetna of VT Commercial |
$313.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$295.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$146.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$295.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$198.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$280.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$267.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$148.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$262.52
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cigna Commercial |
$264.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$264.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$264.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$148.60
|
| Rate for Payer: Multiplan Commercial |
$307.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$280.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$148.60
|
| Rate for Payer: United Healthcare Commercial |
$313.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.60
|
| Rate for Payer: United Healthcare VA CCN |
$148.60
|
|
|
DRILL BIT 4.6X220MM
|
Facility
|
IP
|
$330.22
|
|
| Hospital Charge Code |
2720074211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.40 |
| Max. Negotiated Rate |
$313.71 |
| Rate for Payer: Aetna of VT Commercial |
$313.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$244.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$244.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$280.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$277.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$264.18
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cigna Commercial |
$264.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$264.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$264.18
|
| Rate for Payer: Multiplan Commercial |
$307.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$280.69
|
| Rate for Payer: United Healthcare Commercial |
$313.71
|
|
|
DRILL FLIP CUTTER III
|
Facility
|
OP
|
$2,468.72
|
|
| Hospital Charge Code |
2720072961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,093.40 |
| Max. Negotiated Rate |
$2,345.28 |
| Rate for Payer: Aetna of VT Commercial |
$2,345.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,211.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,093.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,211.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,486.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,098.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,999.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,110.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,962.63
|
| Rate for Payer: Cash Price |
$1,234.36
|
| Rate for Payer: Cigna Commercial |
$1,974.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,974.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,974.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,110.92
|
| Rate for Payer: Multiplan Commercial |
$2,295.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,098.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,110.92
|
| Rate for Payer: United Healthcare Commercial |
$2,345.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,110.92
|
| Rate for Payer: United Healthcare VA CCN |
$1,110.92
|
|
|
DRILL FLIP CUTTER III
|
Facility
|
IP
|
$2,468.72
|
|
| Hospital Charge Code |
2720072961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,827.10 |
| Max. Negotiated Rate |
$2,345.28 |
| Rate for Payer: Aetna of VT Commercial |
$2,345.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,827.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,827.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,098.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,073.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,974.98
|
| Rate for Payer: Cash Price |
$1,234.36
|
| Rate for Payer: Cigna Commercial |
$1,974.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,974.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,974.98
|
| Rate for Payer: Multiplan Commercial |
$2,295.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,098.41
|
| Rate for Payer: United Healthcare Commercial |
$2,345.28
|
|
|
DRUG ASSAY ADALIMUMAB
|
Professional
|
Both
|
$341.74
|
|
|
Service Code
|
CPT 80145
|
| Hospital Charge Code |
3008014501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.03 |
| Max. Negotiated Rate |
$321.24 |
| Rate for Payer: Aetna of VT Commercial |
$321.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$190.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$190.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$50.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$50.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$50.01
|
| Rate for Payer: Cash Price |
$170.87
|
| Rate for Payer: Cash Price |
$170.87
|
| Rate for Payer: Cigna Commercial |
$46.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$38.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$38.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$38.03
|
| Rate for Payer: Multiplan Commercial |
$317.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.57
|
| Rate for Payer: United Healthcare Commercial |
$59.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.57
|
| Rate for Payer: United Healthcare VA CCN |
$38.57
|
|
|
DRUG ASSAY ADALIMUMAB
|
Facility
|
OP
|
$341.74
|
|
|
Service Code
|
CPT 80145
|
| Hospital Charge Code |
3008014501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$324.65 |
| Rate for Payer: Aetna of VT Commercial |
$324.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$190.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$151.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$190.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$205.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$290.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$276.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$153.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$271.68
|
| Rate for Payer: Cash Price |
$170.87
|
| Rate for Payer: Cash Price |
$170.87
|
| Rate for Payer: Cigna Commercial |
$273.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$273.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$273.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$153.78
|
| Rate for Payer: Multiplan Commercial |
$317.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$290.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$153.78
|
| Rate for Payer: United Healthcare Commercial |
$324.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.57
|
| Rate for Payer: United Healthcare VA CCN |
$153.78
|
|
|
DRUG ASSAY ADALIMUMAB
|
Facility
|
IP
|
$341.74
|
|
|
Service Code
|
CPT 80145
|
| Hospital Charge Code |
3008014501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$252.92 |
| Max. Negotiated Rate |
$324.65 |
| Rate for Payer: Aetna of VT Commercial |
$324.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$252.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$252.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$290.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$287.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$273.39
|
| Rate for Payer: Cash Price |
$170.87
|
| Rate for Payer: Cigna Commercial |
$273.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$273.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$273.39
|
| Rate for Payer: Multiplan Commercial |
$317.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$290.48
|
| Rate for Payer: United Healthcare Commercial |
$324.65
|
|
|
DRUG ASSAY CARBAMAZEPINE TOTAL
|
Facility
|
IP
|
$196.98
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
3008015601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.78 |
| Max. Negotiated Rate |
$187.13 |
| Rate for Payer: Aetna of VT Commercial |
$187.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$145.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$145.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$167.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$165.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$157.58
|
| Rate for Payer: Cash Price |
$98.49
|
| Rate for Payer: Cigna Commercial |
$157.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$157.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$157.58
|
| Rate for Payer: Multiplan Commercial |
$183.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$167.43
|
| Rate for Payer: United Healthcare Commercial |
$187.13
|
|
|
DRUG ASSAY CARBAMAZEPINE TOTAL
|
Facility
|
OP
|
$196.98
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
3008015601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$187.13 |
| Rate for Payer: Aetna of VT Commercial |
$187.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$118.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$167.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$156.60
|
| Rate for Payer: Cash Price |
$98.49
|
| Rate for Payer: Cash Price |
$98.49
|
| Rate for Payer: Cigna Commercial |
$157.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$157.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$157.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$88.64
|
| Rate for Payer: Multiplan Commercial |
$183.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$167.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$88.64
|
| Rate for Payer: United Healthcare Commercial |
$187.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.57
|
| Rate for Payer: United Healthcare VA CCN |
$88.64
|
|
|
DRUG ASSAY CARBAMAZEPINE TOTAL
|
Professional
|
Both
|
$196.98
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
3008015601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.37 |
| Max. Negotiated Rate |
$185.16 |
| Rate for Payer: Aetna of VT Commercial |
$185.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$24.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$24.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.90
|
| Rate for Payer: Cash Price |
$98.49
|
| Rate for Payer: Cash Price |
$98.49
|
| Rate for Payer: Cigna Commercial |
$17.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.37
|
| Rate for Payer: Multiplan Commercial |
$183.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.57
|
| Rate for Payer: United Healthcare Commercial |
$22.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.57
|
| Rate for Payer: United Healthcare VA CCN |
$14.57
|
|
|
DRUG ASSAY CLOZAPINE
|
Facility
|
IP
|
$104.95
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
3008015901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.67 |
| Max. Negotiated Rate |
$99.70 |
| Rate for Payer: Aetna of VT Commercial |
$99.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$77.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$77.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$88.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.96
|
| Rate for Payer: Cash Price |
$52.48
|
| Rate for Payer: Cigna Commercial |
$83.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$83.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$83.96
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.21
|
| Rate for Payer: United Healthcare Commercial |
$99.70
|
|
|
DRUG ASSAY CLOZAPINE
|
Professional
|
Both
|
$104.95
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
3008015901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.87 |
| Max. Negotiated Rate |
$99.29 |
| Rate for Payer: Aetna of VT Commercial |
$98.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$28.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$34.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.44
|
| Rate for Payer: Cash Price |
$52.48
|
| Rate for Payer: Cash Price |
$52.48
|
| Rate for Payer: Cigna Commercial |
$24.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$20.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$20.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.87
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.15
|
| Rate for Payer: United Healthcare Commercial |
$31.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.15
|
| Rate for Payer: United Healthcare VA CCN |
$20.15
|
|
|
DRUG ASSAY CLOZAPINE
|
Facility
|
OP
|
$104.95
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
3008015901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$99.70 |
| Rate for Payer: Aetna of VT Commercial |
$99.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$46.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$63.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$47.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.44
|
| Rate for Payer: Cash Price |
$52.48
|
| Rate for Payer: Cash Price |
$52.48
|
| Rate for Payer: Cigna Commercial |
$83.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$83.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$83.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.23
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.23
|
| Rate for Payer: United Healthcare Commercial |
$99.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.15
|
| Rate for Payer: United Healthcare VA CCN |
$47.23
|
|
|
DRUG ASSAY CYCLOSPORINE
|
Facility
|
IP
|
$237.33
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
3008015801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.65 |
| Max. Negotiated Rate |
$225.46 |
| Rate for Payer: Aetna of VT Commercial |
$225.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$175.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$175.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$201.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$199.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$189.86
|
| Rate for Payer: Cash Price |
$118.67
|
| Rate for Payer: Cigna Commercial |
$189.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$189.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$189.86
|
| Rate for Payer: Multiplan Commercial |
$220.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$201.73
|
| Rate for Payer: United Healthcare Commercial |
$225.46
|
|
|
DRUG ASSAY CYCLOSPORINE
|
Professional
|
Both
|
$237.33
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
3008015801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$223.09 |
| Rate for Payer: Aetna of VT Commercial |
$223.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$30.86
|
| Rate for Payer: Cash Price |
$118.67
|
| Rate for Payer: Cash Price |
$118.67
|
| Rate for Payer: Cigna Commercial |
$21.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.80
|
| Rate for Payer: Multiplan Commercial |
$220.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.05
|
| Rate for Payer: United Healthcare Commercial |
$27.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.05
|
| Rate for Payer: United Healthcare VA CCN |
$18.05
|
|
|
DRUG ASSAY CYCLOSPORINE
|
Facility
|
OP
|
$237.33
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
3008015801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$225.46 |
| Rate for Payer: Aetna of VT Commercial |
$225.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$105.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$142.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$201.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$192.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$106.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$188.68
|
| Rate for Payer: Cash Price |
$118.67
|
| Rate for Payer: Cash Price |
$118.67
|
| Rate for Payer: Cigna Commercial |
$189.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$189.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$189.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$106.80
|
| Rate for Payer: Multiplan Commercial |
$220.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$201.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$106.80
|
| Rate for Payer: United Healthcare Commercial |
$225.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.05
|
| Rate for Payer: United Healthcare VA CCN |
$106.80
|
|
