|
FLUOROGUIDE FOR VEIN DEVICE
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
9727700101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$36.99 |
| Max. Negotiated Rate |
$209.62 |
| Rate for Payer: Aetna of VT Commercial |
$209.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$51.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$47.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$47.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$47.81
|
| Rate for Payer: Cash Price |
$111.50
|
| Rate for Payer: Cash Price |
$111.50
|
| Rate for Payer: Cigna Commercial |
$56.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.99
|
| Rate for Payer: Multiplan Commercial |
$207.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.99
|
| Rate for Payer: United Healthcare Commercial |
$56.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.99
|
| Rate for Payer: United Healthcare VA CCN |
$36.99
|
|
|
FLU VAC ADJUVANT IM
|
Professional
|
Both
|
$258.90
|
|
|
Service Code
|
CPT 90653
|
| Hospital Charge Code |
6369065301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.49 |
| Max. Negotiated Rate |
$243.37 |
| Rate for Payer: Aetna of VT Commercial |
$243.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$101.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$137.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$83.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$83.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$112.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.49
|
| Rate for Payer: Cash Price |
$129.45
|
| Rate for Payer: Cash Price |
$129.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.49
|
| Rate for Payer: Multiplan Commercial |
$240.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$98.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$98.16
|
| Rate for Payer: United Healthcare Commercial |
$151.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.16
|
| Rate for Payer: United Healthcare VA CCN |
$98.16
|
|
|
FLU VAC NO PRSV INCREASE AG IM
|
Facility
|
OP
|
$292.11
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
6369066201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.16 |
| Max. Negotiated Rate |
$277.50 |
| Rate for Payer: Aetna of VT Commercial |
$277.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$129.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$175.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$248.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$236.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$131.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$232.23
|
| Rate for Payer: Cash Price |
$146.06
|
| Rate for Payer: Cash Price |
$146.06
|
| Rate for Payer: Cigna Commercial |
$233.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$233.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$233.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$131.45
|
| Rate for Payer: Multiplan Commercial |
$271.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$248.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$131.45
|
| Rate for Payer: United Healthcare Commercial |
$277.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.16
|
| Rate for Payer: United Healthcare VA CCN |
$131.45
|
|
|
FLU VAC NO PRSV INCREASE AG IM
|
Facility
|
IP
|
$292.11
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
6369066201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$216.19 |
| Max. Negotiated Rate |
$277.50 |
| Rate for Payer: Aetna of VT Commercial |
$277.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$216.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$216.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$248.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$245.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$233.69
|
| Rate for Payer: Cash Price |
$146.06
|
| Rate for Payer: Cigna Commercial |
$233.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$233.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$233.69
|
| Rate for Payer: Multiplan Commercial |
$271.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$248.29
|
| Rate for Payer: United Healthcare Commercial |
$277.50
|
|
|
FLU VAC NO PRSV INCREASE AG IM
|
Facility
|
OP
|
$292.11
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
6369066201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.16 |
| Max. Negotiated Rate |
$277.50 |
| Rate for Payer: Aetna of VT Commercial |
$277.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$129.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$175.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$248.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$236.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$131.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$232.23
|
| Rate for Payer: Cash Price |
$146.06
|
| Rate for Payer: Cash Price |
$146.06
|
| Rate for Payer: Cigna Commercial |
$233.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$233.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$233.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$131.45
|
| Rate for Payer: Multiplan Commercial |
$271.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$248.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$131.45
|
| Rate for Payer: United Healthcare Commercial |
$277.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.16
|
| Rate for Payer: United Healthcare VA CCN |
$131.45
|
|
|
FLU VAC NO PRSV INCREASE AG IM
|
Professional
|
Both
|
$292.11
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
6369066201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.49 |
| Max. Negotiated Rate |
$274.58 |
| Rate for Payer: Aetna of VT Commercial |
$274.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$101.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$137.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$114.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$112.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.67
|
| Rate for Payer: Cash Price |
$146.06
|
| Rate for Payer: Cash Price |
$146.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.49
|
| Rate for Payer: Multiplan Commercial |
$271.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$98.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$98.16
|
| Rate for Payer: United Healthcare Commercial |
$151.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.16
|
| Rate for Payer: United Healthcare VA CCN |
$98.16
|
|
|
FLU VAC NO PRSV INCREASE AG IM
|
Professional
|
Both
|
$292.11
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
6369066201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.49 |
| Max. Negotiated Rate |
$274.58 |
| Rate for Payer: Aetna of VT Commercial |
$274.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$101.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$137.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$114.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$112.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.67
|
| Rate for Payer: Cash Price |
$146.06
|
| Rate for Payer: Cash Price |
$146.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.49
|
| Rate for Payer: Multiplan Commercial |
$271.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$98.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$98.16
|
| Rate for Payer: United Healthcare Commercial |
$151.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.16
|
| Rate for Payer: United Healthcare VA CCN |
$98.16
|
|
|
FLU VAC NO PRSV INCREASE AG IM
|
Facility
|
IP
|
$292.11
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
6369066201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$216.19 |
| Max. Negotiated Rate |
$277.50 |
| Rate for Payer: Aetna of VT Commercial |
$277.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$216.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$216.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$248.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$245.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$233.69
|
| Rate for Payer: Cash Price |
$146.06
|
| Rate for Payer: Cigna Commercial |
$233.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$233.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$233.69
|
| Rate for Payer: Multiplan Commercial |
$271.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$248.29
|
| Rate for Payer: United Healthcare Commercial |
$277.50
|
|
|
FLU VAC QUAD LIVE INTRANASAL
|
Professional
|
Both
|
$0.53
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
6369067201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$67.38 |
| Rate for Payer: Aetna of VT Commercial |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$34.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.99
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$38.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$38.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$27.79
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
| Rate for Payer: United Healthcare Commercial |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.21
|
|
|
FLU VAC TRIV NO PRSRV 0.5ML IM
|
Professional
|
Both
|
$13.96
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
6369065601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.98 |
| Max. Negotiated Rate |
$61.46 |
| Rate for Payer: Aetna of VT Commercial |
$13.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$24.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$24.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.46
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$31.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$31.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$22.35
|
| Rate for Payer: Multiplan Commercial |
$12.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.22
|
| Rate for Payer: United Healthcare Commercial |
$35.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.22
|
| Rate for Payer: United Healthcare VA CCN |
$23.22
|
|
|
FLU VAC TRIV NO PRSRV 0.5ML IM
|
Facility
|
IP
|
$13.96
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
6369065601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$13.26 |
| Rate for Payer: Aetna of VT Commercial |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$10.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$10.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.17
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cigna Commercial |
$11.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.17
|
| Rate for Payer: Multiplan Commercial |
$12.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.87
|
| Rate for Payer: United Healthcare Commercial |
$13.26
|
|
|
FLU VAC TRIV NO PRSRV 0.5ML IM
|
Facility
|
OP
|
$13.96
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
6369065601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$61.46 |
| Rate for Payer: Aetna of VT Commercial |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$6.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.10
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cigna Commercial |
$11.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$12.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.28
|
| Rate for Payer: United Healthcare Commercial |
$13.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.22
|
| Rate for Payer: United Healthcare VA CCN |
$6.28
|
|
|
FLU VAC TRIV SPLIT 0.5ML IM
|
Facility
|
IP
|
$42.08
|
|
|
Service Code
|
CPT 90658
|
| Hospital Charge Code |
6369065801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.14 |
| Max. Negotiated Rate |
$39.98 |
| Rate for Payer: Aetna of VT Commercial |
$39.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.66
|
| Rate for Payer: Cash Price |
$21.04
|
| Rate for Payer: Cigna Commercial |
$33.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.66
|
| Rate for Payer: Multiplan Commercial |
$39.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.77
|
| Rate for Payer: United Healthcare Commercial |
$39.98
|
|
|
FLU VAC TRIV SPLIT 0.5ML IM
|
Facility
|
OP
|
$42.08
|
|
|
Service Code
|
CPT 90658
|
| Hospital Charge Code |
6369065801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$60.12 |
| Rate for Payer: Aetna of VT Commercial |
$39.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$60.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$60.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.45
|
| Rate for Payer: Cash Price |
$21.04
|
| Rate for Payer: Cash Price |
$21.04
|
| Rate for Payer: Cigna Commercial |
$33.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.94
|
| Rate for Payer: Multiplan Commercial |
$39.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.94
|
| Rate for Payer: United Healthcare Commercial |
$39.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.94
|
| Rate for Payer: United Healthcare VA CCN |
$18.94
|
|
|
FLU VAC TRIV SPLIT 0.5ML IM
|
Professional
|
Both
|
$42.08
|
|
|
Service Code
|
CPT 90658
|
| Hospital Charge Code |
6369065801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.86 |
| Max. Negotiated Rate |
$60.12 |
| Rate for Payer: Aetna of VT Commercial |
$39.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$60.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$60.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$30.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$21.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$25.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$21.86
|
| Rate for Payer: Cash Price |
$21.04
|
| Rate for Payer: Cash Price |
$21.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$30.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$30.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$21.86
|
| Rate for Payer: Multiplan Commercial |
$39.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.07
|
| Rate for Payer: United Healthcare Commercial |
$33.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.07
|
| Rate for Payer: United Healthcare VA CCN |
$22.07
|
|
|
FMR1 GEN ALY DETC ABNL ALLEL
|
Professional
|
Both
|
$763.21
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
3008124301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.04 |
| Max. Negotiated Rate |
$717.42 |
| Rate for Payer: Aetna of VT Commercial |
$717.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$281.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$281.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.41
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Cigna Commercial |
$69.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$57.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$57.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$268.68
|
| Rate for Payer: Multiplan Commercial |
$709.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.04
|
| Rate for Payer: United Healthcare Commercial |
$87.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.04
|
| Rate for Payer: United Healthcare VA CCN |
$57.04
|
|
|
FMR1 GEN ALY DETC ABNL ALLEL
|
Facility
|
OP
|
$763.21
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
3008124301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.04 |
| Max. Negotiated Rate |
$725.05 |
| Rate for Payer: Aetna of VT Commercial |
$725.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$281.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$338.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$281.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$459.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$648.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$618.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$343.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$606.75
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Cigna Commercial |
$610.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$610.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$610.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$343.44
|
| Rate for Payer: Multiplan Commercial |
$709.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$648.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$343.44
|
| Rate for Payer: United Healthcare Commercial |
$725.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.04
|
| Rate for Payer: United Healthcare VA CCN |
$343.44
|
|
|
FMR1 GEN ALY DETC ABNL ALLEL
|
Facility
|
IP
|
$763.21
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
3008124301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$564.85 |
| Max. Negotiated Rate |
$725.05 |
| Rate for Payer: Aetna of VT Commercial |
$725.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$564.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$564.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$648.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$641.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$610.57
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Cigna Commercial |
$610.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$610.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$610.57
|
| Rate for Payer: Multiplan Commercial |
$709.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$648.73
|
| Rate for Payer: United Healthcare Commercial |
$725.05
|
|
|
FNA BX W/O IMG GDN 1ST LES
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
9601002102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$50.93 |
| Max. Negotiated Rate |
$209.62 |
| Rate for Payer: Aetna of VT Commercial |
$209.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$199.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$52.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$199.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$71.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$140.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$140.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$58.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.06
|
| Rate for Payer: Cash Price |
$111.50
|
| Rate for Payer: Cash Price |
$111.50
|
| Rate for Payer: Cigna Commercial |
$92.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.93
|
| Rate for Payer: Multiplan Commercial |
$207.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$72.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$50.93
|
| Rate for Payer: United Healthcare Commercial |
$78.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.93
|
| Rate for Payer: United Healthcare VA CCN |
$50.93
|
|
|
FNA BX W/O IMG GDN 1ST LES
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
9601002101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$290.86 |
| Max. Negotiated Rate |
$373.35 |
| Rate for Payer: Aetna of VT Commercial |
$373.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$290.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$290.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$334.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$330.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$314.40
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$314.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$314.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$314.40
|
| Rate for Payer: Multiplan Commercial |
$365.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$334.05
|
| Rate for Payer: United Healthcare Commercial |
$373.35
|
|
|
FNA BX W/O IMG GDN 1ST LES
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
9601002101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$174.06 |
| Max. Negotiated Rate |
$373.35 |
| Rate for Payer: Aetna of VT Commercial |
$373.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$352.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$174.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$352.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$236.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$334.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$318.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$176.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$312.44
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$314.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$314.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$314.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$176.85
|
| Rate for Payer: Multiplan Commercial |
$365.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$334.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$176.85
|
| Rate for Payer: United Healthcare Commercial |
$373.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$176.85
|
| Rate for Payer: United Healthcare VA CCN |
$176.85
|
|
|
FNA BX W/O IMG GDN 1ST LES
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
9821002101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$50.93 |
| Max. Negotiated Rate |
$347.80 |
| Rate for Payer: Aetna of VT Commercial |
$347.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$331.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$52.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$331.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$71.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$140.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$140.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$58.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.06
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$92.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.93
|
| Rate for Payer: Multiplan Commercial |
$344.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$72.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$50.93
|
| Rate for Payer: United Healthcare Commercial |
$78.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.93
|
| Rate for Payer: United Healthcare VA CCN |
$50.93
|
|
|
FNA BX W/O IMG GDN 1ST LES
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
9601002101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$50.93 |
| Max. Negotiated Rate |
$369.42 |
| Rate for Payer: Aetna of VT Commercial |
$369.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$352.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$52.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$352.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$71.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$140.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$140.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$58.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.06
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$92.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.93
|
| Rate for Payer: Multiplan Commercial |
$365.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$72.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$50.93
|
| Rate for Payer: United Healthcare Commercial |
$78.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.93
|
| Rate for Payer: United Healthcare VA CCN |
$50.93
|
|
|
FNA BX W/O IMG GDN 1ST LES
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
5101002101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.56 |
| Max. Negotiated Rate |
$162.45 |
| Rate for Payer: Aetna of VT Commercial |
$162.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$143.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$136.80
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$136.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$159.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.35
|
| Rate for Payer: United Healthcare Commercial |
$162.45
|
|
|
FNA BX W/O IMG GDN 1ST LES
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
9821002101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$273.84 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Aetna of VT Commercial |
$351.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$273.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$273.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$314.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$310.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$296.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$296.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$296.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$296.00
|
| Rate for Payer: Multiplan Commercial |
$344.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$314.50
|
| Rate for Payer: United Healthcare Commercial |
$351.50
|
|
