|
ENDOMETR ABLATE THERMAL
|
Facility
|
IP
|
$2,067.00
|
|
|
Service Code
|
CPT 58353
|
| Hospital Charge Code |
9825835301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,529.79 |
| Max. Negotiated Rate |
$1,963.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,963.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,529.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,529.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,756.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,736.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,033.50
|
| Rate for Payer: Cigna Commercial |
$1,653.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,653.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,653.60
|
| Rate for Payer: Multiplan Commercial |
$1,922.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,756.95
|
| Rate for Payer: United Healthcare Commercial |
$1,963.65
|
|
|
ENDOMETR ABLATE THERMAL
|
Professional
|
Both
|
$2,067.00
|
|
|
Service Code
|
CPT 58353
|
| Hospital Charge Code |
9825835301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$214.83 |
| Max. Negotiated Rate |
$2,262.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,942.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,851.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$221.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,851.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$300.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,262.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,262.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$247.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,262.45
|
| Rate for Payer: Cash Price |
$1,033.50
|
| Rate for Payer: Cash Price |
$1,033.50
|
| Rate for Payer: Cigna Commercial |
$380.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,358.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,358.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$839.89
|
| Rate for Payer: Multiplan Commercial |
$1,922.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$305.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$214.83
|
| Rate for Payer: United Healthcare Commercial |
$330.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$214.83
|
| Rate for Payer: United Healthcare VA CCN |
$214.83
|
|
|
ENDOSCOPIC PLANTAR FASCIOTOMY
|
Facility
|
OP
|
$1,351.00
|
|
|
Service Code
|
CPT 29893
|
| Hospital Charge Code |
9822989301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$598.36 |
| Max. Negotiated Rate |
$1,283.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,283.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,210.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$598.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,210.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$813.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,148.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,094.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$607.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,074.05
|
| Rate for Payer: Cash Price |
$675.50
|
| Rate for Payer: Cigna Commercial |
$1,080.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,080.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,080.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$607.95
|
| Rate for Payer: Multiplan Commercial |
$1,256.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,148.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$607.95
|
| Rate for Payer: United Healthcare Commercial |
$1,283.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$607.95
|
| Rate for Payer: United Healthcare VA CCN |
$607.95
|
|
|
ENDOSCOPIC PLANTAR FASCIOTOMY
|
Facility
|
IP
|
$1,351.00
|
|
|
Service Code
|
CPT 29893
|
| Hospital Charge Code |
9822989301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$999.88 |
| Max. Negotiated Rate |
$1,283.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,283.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$999.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$999.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,148.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,134.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,080.80
|
| Rate for Payer: Cash Price |
$675.50
|
| Rate for Payer: Cigna Commercial |
$1,080.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,080.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,080.80
|
| Rate for Payer: Multiplan Commercial |
$1,256.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,148.35
|
| Rate for Payer: United Healthcare Commercial |
$1,283.45
|
|
|
ENDOSCOPIC PLANTAR FASCIOTOMY
|
Professional
|
Both
|
$1,351.00
|
|
|
Service Code
|
CPT 29893
|
| Hospital Charge Code |
9822989301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$1,269.94 |
| Rate for Payer: Aetna of VT Commercial |
$1,269.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,210.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$437.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,210.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$595.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$817.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$817.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$488.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$817.43
|
| Rate for Payer: Cash Price |
$675.50
|
| Rate for Payer: Cash Price |
$675.50
|
| Rate for Payer: Cigna Commercial |
$802.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,025.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,025.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$633.14
|
| Rate for Payer: Multiplan Commercial |
$1,256.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$603.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$425.00
|
| Rate for Payer: United Healthcare Commercial |
$653.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$425.00
|
| Rate for Payer: United Healthcare VA CCN |
$425.00
|
|
|
ENTEROVIRUS PROBE&REVRS TRNS
|
Professional
|
Both
|
$132.09
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
3008749801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$124.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$48.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$48.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$48.26
|
| Rate for Payer: Cash Price |
$66.04
|
| Rate for Payer: Cash Price |
$66.04
|
| Rate for Payer: Cigna Commercial |
$42.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$35.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$35.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.60
|
| Rate for Payer: Multiplan Commercial |
$122.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$53.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$35.09
|
|
|
ENTEROVIRUS PROBE&REVRS TRNS
|
Facility
|
OP
|
$132.09
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
3008749801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$125.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$105.01
|
| Rate for Payer: Cash Price |
$66.04
|
| Rate for Payer: Cash Price |
$66.04
|
| Rate for Payer: Cigna Commercial |
$105.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$59.44
|
| Rate for Payer: Multiplan Commercial |
$122.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.44
|
| Rate for Payer: United Healthcare Commercial |
$125.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$59.44
|
|
|
ENTEROVIRUS PROBE&REVRS TRNS
|
Facility
|
IP
|
$132.09
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
3008749801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.76 |
| Max. Negotiated Rate |
$125.49 |
| Rate for Payer: Aetna of VT Commercial |
$125.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$105.67
|
| Rate for Payer: Cash Price |
$66.04
|
| Rate for Payer: Cigna Commercial |
$105.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.67
|
| Rate for Payer: Multiplan Commercial |
$122.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.28
|
| Rate for Payer: United Healthcare Commercial |
$125.49
|
|
|
ENZYME CELL ACTIVITY
|
Facility
|
IP
|
$436.83
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
3008265701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$323.30 |
| Max. Negotiated Rate |
$414.99 |
| Rate for Payer: Aetna of VT Commercial |
$414.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$323.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$323.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$371.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$366.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$349.46
|
| Rate for Payer: Cash Price |
$218.42
|
| Rate for Payer: Cigna Commercial |
$349.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$349.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$349.46
|
| Rate for Payer: Multiplan Commercial |
$406.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$371.31
|
| Rate for Payer: United Healthcare Commercial |
$414.99
|
|
|
ENZYME CELL ACTIVITY
|
Professional
|
Both
|
$436.83
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
3008265701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.86 |
| Max. Negotiated Rate |
$410.62 |
| Rate for Payer: Aetna of VT Commercial |
$410.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$109.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$109.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$37.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$37.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$37.89
|
| Rate for Payer: Cash Price |
$218.42
|
| Rate for Payer: Cash Price |
$218.42
|
| Rate for Payer: Cigna Commercial |
$26.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$21.86
|
| Rate for Payer: Multiplan Commercial |
$406.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.17
|
| Rate for Payer: United Healthcare Commercial |
$34.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.17
|
| Rate for Payer: United Healthcare VA CCN |
$22.17
|
|
|
ENZYME CELL ACTIVITY
|
Facility
|
OP
|
$436.83
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
3008265701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$414.99 |
| Rate for Payer: Aetna of VT Commercial |
$414.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$109.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$193.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$109.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$262.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$371.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$353.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$196.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$347.28
|
| Rate for Payer: Cash Price |
$218.42
|
| Rate for Payer: Cash Price |
$218.42
|
| Rate for Payer: Cigna Commercial |
$349.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$349.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$349.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.57
|
| Rate for Payer: Multiplan Commercial |
$406.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$371.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$196.57
|
| Rate for Payer: United Healthcare Commercial |
$414.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.17
|
| Rate for Payer: United Healthcare VA CCN |
$196.57
|
|
|
ENZYME HISTOCHEMISTRY
|
Facility
|
IP
|
$744.48
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
3108831901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$550.99 |
| Max. Negotiated Rate |
$707.26 |
| Rate for Payer: Aetna of VT Commercial |
$707.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$550.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$550.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$632.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$625.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$595.58
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cigna Commercial |
$595.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$595.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$595.58
|
| Rate for Payer: Multiplan Commercial |
$692.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$632.81
|
| Rate for Payer: United Healthcare Commercial |
$707.26
|
|
|
ENZYME HISTOCHEMISTRY
|
Facility
|
OP
|
$744.48
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
3108831901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$130.07 |
| Max. Negotiated Rate |
$707.26 |
| Rate for Payer: Aetna of VT Commercial |
$707.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$535.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$329.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$535.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$448.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$632.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$603.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$335.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$591.86
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cigna Commercial |
$595.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$595.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$595.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$335.02
|
| Rate for Payer: Multiplan Commercial |
$692.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$632.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$335.02
|
| Rate for Payer: United Healthcare Commercial |
$707.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.07
|
| Rate for Payer: United Healthcare VA CCN |
$335.02
|
|
|
EPIFIX 18MM DISK
|
Facility
|
IP
|
$664.86
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
2780048801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$492.06 |
| Max. Negotiated Rate |
$631.62 |
| Rate for Payer: Aetna of VT Commercial |
$631.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$492.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$492.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$565.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$558.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$531.89
|
| Rate for Payer: Cash Price |
$332.43
|
| Rate for Payer: Cigna Commercial |
$531.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$531.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$531.89
|
| Rate for Payer: Multiplan Commercial |
$618.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$565.13
|
| Rate for Payer: United Healthcare Commercial |
$631.62
|
|
|
EPIFIX 18MM DISK
|
Facility
|
OP
|
$664.86
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
2780048801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$294.47 |
| Max. Negotiated Rate |
$631.62 |
| Rate for Payer: Aetna of VT Commercial |
$631.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$595.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$294.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$595.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$400.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$565.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$538.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$299.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$528.56
|
| Rate for Payer: Cash Price |
$332.43
|
| Rate for Payer: Cigna Commercial |
$531.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$531.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$531.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$299.19
|
| Rate for Payer: Multiplan Commercial |
$618.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$565.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$299.19
|
| Rate for Payer: United Healthcare Commercial |
$631.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$299.19
|
| Rate for Payer: United Healthcare VA CCN |
$299.19
|
|
|
EPIFIX 2x3CM
|
Facility
|
IP
|
$1,218.05
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
2780048021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$901.48 |
| Max. Negotiated Rate |
$1,157.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,157.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$901.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$901.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,035.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,023.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$974.44
|
| Rate for Payer: Cash Price |
$609.02
|
| Rate for Payer: Cigna Commercial |
$974.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$974.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$974.44
|
| Rate for Payer: Multiplan Commercial |
$1,132.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,035.34
|
| Rate for Payer: United Healthcare Commercial |
$1,157.15
|
|
|
EPIFIX 2x3CM
|
Facility
|
OP
|
$1,218.05
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
2780048021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$539.47 |
| Max. Negotiated Rate |
$1,157.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,157.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,091.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$539.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,091.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$733.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,035.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$986.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$548.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$968.35
|
| Rate for Payer: Cash Price |
$609.02
|
| Rate for Payer: Cigna Commercial |
$974.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$974.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$974.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$548.12
|
| Rate for Payer: Multiplan Commercial |
$1,132.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,035.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$548.12
|
| Rate for Payer: United Healthcare Commercial |
$1,157.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$548.12
|
| Rate for Payer: United Healthcare VA CCN |
$548.12
|
|
|
EPIFIX 4X4CM
|
Facility
|
OP
|
$3,083.39
|
|
| Hospital Charge Code |
2720046881
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,365.63 |
| Max. Negotiated Rate |
$2,929.22 |
| Rate for Payer: Aetna of VT Commercial |
$2,929.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,762.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,365.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,762.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,856.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,620.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,497.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,387.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,451.30
|
| Rate for Payer: Cash Price |
$1,541.69
|
| Rate for Payer: Cigna Commercial |
$2,466.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,466.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,466.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,387.53
|
| Rate for Payer: Multiplan Commercial |
$2,867.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,620.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,387.53
|
| Rate for Payer: United Healthcare Commercial |
$2,929.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,387.53
|
| Rate for Payer: United Healthcare VA CCN |
$1,387.53
|
|
|
EPIFIX 4X4CM
|
Facility
|
IP
|
$3,083.39
|
|
| Hospital Charge Code |
2720046881
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,282.02 |
| Max. Negotiated Rate |
$2,929.22 |
| Rate for Payer: Aetna of VT Commercial |
$2,929.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,282.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,282.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,620.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,590.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,466.71
|
| Rate for Payer: Cash Price |
$1,541.69
|
| Rate for Payer: Cigna Commercial |
$2,466.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,466.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,466.71
|
| Rate for Payer: Multiplan Commercial |
$2,867.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,620.88
|
| Rate for Payer: United Healthcare Commercial |
$2,929.22
|
|
|
EPIFIX 5X6CM
|
Facility
|
OP
|
$5,852.44
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
2780046891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,592.05 |
| Max. Negotiated Rate |
$5,559.82 |
| Rate for Payer: Aetna of VT Commercial |
$5,559.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,243.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,592.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,243.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,523.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,974.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,740.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,633.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,652.69
|
| Rate for Payer: Cash Price |
$2,926.22
|
| Rate for Payer: Cigna Commercial |
$4,681.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,681.95
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,681.95
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,633.60
|
| Rate for Payer: Multiplan Commercial |
$5,442.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,974.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,633.60
|
| Rate for Payer: United Healthcare Commercial |
$5,559.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,633.60
|
| Rate for Payer: United Healthcare VA CCN |
$2,633.60
|
|
|
EPIFIX 5X6CM
|
Facility
|
IP
|
$5,852.44
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
2780046891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,331.39 |
| Max. Negotiated Rate |
$5,559.82 |
| Rate for Payer: Aetna of VT Commercial |
$5,559.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,331.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,331.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,974.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,916.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,681.95
|
| Rate for Payer: Cash Price |
$2,926.22
|
| Rate for Payer: Cigna Commercial |
$4,681.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,681.95
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,681.95
|
| Rate for Payer: Multiplan Commercial |
$5,442.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,974.57
|
| Rate for Payer: United Healthcare Commercial |
$5,559.82
|
|
|
EPIFIX 7X7CM
|
Facility
|
OP
|
$9,793.01
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
2780048191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,337.32 |
| Max. Negotiated Rate |
$9,303.36 |
| Rate for Payer: Aetna of VT Commercial |
$9,303.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8,773.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4,337.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8,773.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5,895.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8,324.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7,932.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4,406.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,785.44
|
| Rate for Payer: Cash Price |
$4,896.50
|
| Rate for Payer: Cigna Commercial |
$7,834.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,834.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,834.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$4,406.85
|
| Rate for Payer: Multiplan Commercial |
$9,107.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,324.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4,406.85
|
| Rate for Payer: United Healthcare Commercial |
$9,303.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,406.85
|
| Rate for Payer: United Healthcare VA CCN |
$4,406.85
|
|
|
EPIFIX 7X7CM
|
Facility
|
IP
|
$9,793.01
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
2780048191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,247.81 |
| Max. Negotiated Rate |
$9,303.36 |
| Rate for Payer: Aetna of VT Commercial |
$9,303.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7,247.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7,247.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8,324.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8,226.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,834.41
|
| Rate for Payer: Cash Price |
$4,896.50
|
| Rate for Payer: Cigna Commercial |
$7,834.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,834.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,834.41
|
| Rate for Payer: Multiplan Commercial |
$9,107.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,324.06
|
| Rate for Payer: United Healthcare Commercial |
$9,303.36
|
|
|
EPINEPHRINE 0.3 MG AUTO-INJECT
|
Facility
|
OP
|
$2.01
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
636J017101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.01
|
|
|
EPINEPHRINE 0.3 MG AUTO-INJECT
|
Professional
|
Both
|
$1,062.19
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
636J017101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$998.46 |
| Rate for Payer: Aetna of VT Commercial |
$998.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.01
|
| Rate for Payer: Cash Price |
$531.10
|
| Rate for Payer: Cash Price |
$531.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$987.84
|
| Rate for Payer: United Healthcare Commercial |
$902.86
|
| Rate for Payer: United Healthcare VA CCN |
$424.88
|
|
