|
HALOPERIDOL INJECTION
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
637J163001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
HALOPERIDOL INJECTION
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
637J163001
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$2.15 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
HEART FIRST PASS ADD-ON
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 78496
|
| Hospital Charge Code |
9727849601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$40.71 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Aetna of VT Commercial |
$52.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$40.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$40.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$46.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$44.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$44.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$44.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$51.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.75
|
| Rate for Payer: United Healthcare Commercial |
$52.25
|
|
|
HEART FIRST PASS ADD-ON
|
Facility
|
OP
|
$1,485.86
|
|
|
Service Code
|
CPT 78496
|
| Hospital Charge Code |
3417849601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$82.15 |
| Max. Negotiated Rate |
$1,411.57 |
| Rate for Payer: Aetna of VT Commercial |
$1,411.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$82.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$658.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$82.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$894.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,262.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,203.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$668.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,181.26
|
| Rate for Payer: Cash Price |
$742.93
|
| Rate for Payer: Cash Price |
$742.93
|
| Rate for Payer: Cigna Commercial |
$1,188.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,188.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,188.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$668.64
|
| Rate for Payer: Multiplan Commercial |
$1,381.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,262.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$668.64
|
| Rate for Payer: United Healthcare Commercial |
$1,411.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.64
|
| Rate for Payer: United Healthcare VA CCN |
$668.64
|
|
|
HEART FIRST PASS ADD-ON
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
9727849601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$36.99 |
| Max. Negotiated Rate |
$131.31 |
| Rate for Payer: Aetna of VT Commercial |
$51.70
|
| 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 |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| 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 |
$51.15
|
| 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
|
|
|
HEART FIRST PASS ADD-ON
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 78496
|
| Hospital Charge Code |
9727849601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Aetna of VT Commercial |
$52.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$49.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$24.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$49.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$33.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$46.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.73
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$44.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$44.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$44.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$51.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$24.75
|
| Rate for Payer: United Healthcare Commercial |
$52.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.75
|
| Rate for Payer: United Healthcare VA CCN |
$24.75
|
|
|
HEART FIRST PASS ADD-ON
|
Facility
|
IP
|
$1,485.86
|
|
|
Service Code
|
CPT 78496
|
| Hospital Charge Code |
3417849601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,099.68 |
| Max. Negotiated Rate |
$1,411.57 |
| Rate for Payer: Aetna of VT Commercial |
$1,411.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,099.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,099.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,262.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,248.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,188.69
|
| Rate for Payer: Cash Price |
$742.93
|
| Rate for Payer: Cigna Commercial |
$1,188.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,188.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,188.69
|
| Rate for Payer: Multiplan Commercial |
$1,381.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,262.98
|
| Rate for Payer: United Healthcare Commercial |
$1,411.57
|
|
|
HEART/LUNG RESUSCITATION CPR
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
9819295002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$514.37 |
| Max. Negotiated Rate |
$660.25 |
| Rate for Payer: Aetna of VT Commercial |
$660.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$514.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$514.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$590.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$583.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$556.00
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cigna Commercial |
$556.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.00
|
| Rate for Payer: Multiplan Commercial |
$646.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$590.75
|
| Rate for Payer: United Healthcare Commercial |
$660.25
|
|
|
HEART/LUNG RESUSCITATION CPR
|
Facility
|
IP
|
$652.45
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
4509295001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$482.88 |
| Max. Negotiated Rate |
$619.83 |
| Rate for Payer: Aetna of VT Commercial |
$619.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$554.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$548.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$521.96
|
| Rate for Payer: Cash Price |
$326.22
|
| Rate for Payer: Cigna Commercial |
$521.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$521.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$521.96
|
| Rate for Payer: Multiplan Commercial |
$606.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$554.58
|
| Rate for Payer: United Healthcare Commercial |
$619.83
|
|
|
HEART/LUNG RESUSCITATION CPR
|
Facility
|
OP
|
$652.45
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
4509295001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.97 |
| Max. Negotiated Rate |
$619.83 |
| Rate for Payer: Aetna of VT Commercial |
$619.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$584.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$288.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$584.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$392.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$554.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$528.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$293.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$518.70
|
| Rate for Payer: Cash Price |
$326.22
|
| Rate for Payer: Cigna Commercial |
$521.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$521.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$521.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$293.60
|
| Rate for Payer: Multiplan Commercial |
$606.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$554.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$293.60
|
| Rate for Payer: United Healthcare Commercial |
$619.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$293.60
|
| Rate for Payer: United Healthcare VA CCN |
$293.60
|
|
|
HEART/LUNG RESUSCITATION CPR
|
Professional
|
Both
|
$695.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
9819295002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$169.17 |
| Max. Negotiated Rate |
$653.30 |
| Rate for Payer: Aetna of VT Commercial |
$653.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$622.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$174.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$622.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$236.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$407.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$407.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$194.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$407.09
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cigna Commercial |
$389.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$493.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$493.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$302.79
|
| Rate for Payer: Multiplan Commercial |
$646.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$169.17
|
| Rate for Payer: United Healthcare Commercial |
$260.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.17
|
| Rate for Payer: United Healthcare VA CCN |
$169.17
|
|
|
HEART/LUNG RESUSCITATION CPR
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
9819295002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$307.82 |
| Max. Negotiated Rate |
$660.25 |
| Rate for Payer: Aetna of VT Commercial |
$660.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$622.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$307.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$622.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$590.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$562.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$312.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$552.52
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cigna Commercial |
$556.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$312.75
|
| Rate for Payer: Multiplan Commercial |
$646.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$590.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$312.75
|
| Rate for Payer: United Healthcare Commercial |
$660.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$312.75
|
| Rate for Payer: United Healthcare VA CCN |
$312.75
|
|
|
HEART/LUNG RESUSCITATION CPR
|
Facility
|
IP
|
$652.45
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
4809295001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$482.88 |
| Max. Negotiated Rate |
$619.83 |
| Rate for Payer: Aetna of VT Commercial |
$619.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$554.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$548.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$521.96
|
| Rate for Payer: Cash Price |
$326.22
|
| Rate for Payer: Cigna Commercial |
$521.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$521.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$521.96
|
| Rate for Payer: Multiplan Commercial |
$606.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$554.58
|
| Rate for Payer: United Healthcare Commercial |
$619.83
|
|
|
HEART/LUNG RESUSCITATION CPR
|
Facility
|
OP
|
$652.45
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
4809295001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$288.97 |
| Max. Negotiated Rate |
$619.83 |
| Rate for Payer: Aetna of VT Commercial |
$619.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$584.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$288.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$584.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$392.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$554.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$528.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$293.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$518.70
|
| Rate for Payer: Cash Price |
$326.22
|
| Rate for Payer: Cigna Commercial |
$521.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$521.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$521.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$293.60
|
| Rate for Payer: Multiplan Commercial |
$606.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$554.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$293.60
|
| Rate for Payer: United Healthcare Commercial |
$619.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$293.60
|
| Rate for Payer: United Healthcare VA CCN |
$293.60
|
|
|
HEAVY METAL QUANT EACH NES
|
Facility
|
OP
|
$376.63
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
3008301801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$357.80 |
| Rate for Payer: Aetna of VT Commercial |
$357.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$108.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$166.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$108.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$226.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$320.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$305.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$169.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$299.42
|
| Rate for Payer: Cash Price |
$188.32
|
| Rate for Payer: Cash Price |
$188.32
|
| Rate for Payer: Cigna Commercial |
$301.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$301.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$301.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$169.48
|
| Rate for Payer: Multiplan Commercial |
$350.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$320.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$169.48
|
| Rate for Payer: United Healthcare Commercial |
$357.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.96
|
| Rate for Payer: United Healthcare VA CCN |
$169.48
|
|
|
HEAVY METAL QUANT EACH NES
|
Professional
|
Both
|
$376.63
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
3008301801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.65 |
| Max. Negotiated Rate |
$354.03 |
| Rate for Payer: Aetna of VT Commercial |
$354.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$108.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$108.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$30.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$25.25
|
| Rate for Payer: Cash Price |
$188.32
|
| Rate for Payer: Cash Price |
$188.32
|
| Rate for Payer: Cigna Commercial |
$26.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$21.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$21.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$21.65
|
| Rate for Payer: Multiplan Commercial |
$350.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.96
|
| Rate for Payer: United Healthcare Commercial |
$33.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.96
|
| Rate for Payer: United Healthcare VA CCN |
$21.96
|
|
|
HEAVY METAL QUANT EACH NES
|
Facility
|
IP
|
$376.63
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
3008301801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$278.74 |
| Max. Negotiated Rate |
$357.80 |
| Rate for Payer: Aetna of VT Commercial |
$357.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$278.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$278.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$320.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$316.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$301.30
|
| Rate for Payer: Cash Price |
$188.32
|
| Rate for Payer: Cigna Commercial |
$301.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$301.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$301.30
|
| Rate for Payer: Multiplan Commercial |
$350.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$320.14
|
| Rate for Payer: United Healthcare Commercial |
$357.80
|
|
|
HEMIARTHROPLASTY HIP PARTIAL
|
Facility
|
OP
|
$4,277.00
|
|
|
Service Code
|
CPT 27125
|
| Hospital Charge Code |
9822712501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,894.28 |
| Max. Negotiated Rate |
$4,063.15 |
| Rate for Payer: Aetna of VT Commercial |
$4,063.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,831.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,894.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,831.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,574.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,635.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,464.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,924.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,400.22
|
| Rate for Payer: Cash Price |
$2,138.50
|
| Rate for Payer: Cigna Commercial |
$3,421.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,421.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,421.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,924.65
|
| Rate for Payer: Multiplan Commercial |
$3,977.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,635.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,924.65
|
| Rate for Payer: United Healthcare Commercial |
$4,063.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,924.65
|
| Rate for Payer: United Healthcare VA CCN |
$1,924.65
|
|
|
HEMIARTHROPLASTY HIP PARTIAL
|
Professional
|
Both
|
$4,277.00
|
|
|
Service Code
|
CPT 27125
|
| Hospital Charge Code |
9822712501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,057.08 |
| Max. Negotiated Rate |
$4,020.38 |
| Rate for Payer: Aetna of VT Commercial |
$4,020.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,831.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,088.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,831.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,479.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,120.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,120.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,215.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,120.45
|
| Rate for Payer: Cash Price |
$2,138.50
|
| Rate for Payer: Cash Price |
$2,138.50
|
| Rate for Payer: Cigna Commercial |
$2,002.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,769.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,769.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,057.08
|
| Rate for Payer: Multiplan Commercial |
$3,977.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,501.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,057.09
|
| Rate for Payer: United Healthcare Commercial |
$1,626.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,057.09
|
| Rate for Payer: United Healthcare VA CCN |
$1,057.09
|
|
|
HEMIARTHROPLASTY HIP PARTIAL
|
Facility
|
IP
|
$4,277.00
|
|
|
Service Code
|
CPT 27125
|
| Hospital Charge Code |
9822712501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$3,165.41 |
| Max. Negotiated Rate |
$4,063.15 |
| Rate for Payer: Aetna of VT Commercial |
$4,063.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,165.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,165.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,635.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,592.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,421.60
|
| Rate for Payer: Cash Price |
$2,138.50
|
| Rate for Payer: Cigna Commercial |
$3,421.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,421.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,421.60
|
| Rate for Payer: Multiplan Commercial |
$3,977.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,635.45
|
| Rate for Payer: United Healthcare Commercial |
$4,063.15
|
|
|
HEMOGLOBIN A1C LEVEL >9.0%
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 3046F
|
| Hospital Charge Code |
3003046F01
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
HEMOGLOBIN A1C LEVEL >9.0%
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 3046F
|
| Hospital Charge Code |
3003046F01
|
|
Hospital Revenue Code
|
300
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
HEMOGLOBIN A1C LEVEL >9.0%
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
CPT 3046F
|
| Hospital Charge Code |
3003046F01
|
|
Hospital Revenue Code
|
300
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
IP
|
$348.20
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
3008302001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$257.70 |
| Max. Negotiated Rate |
$330.79 |
| Rate for Payer: Aetna of VT Commercial |
$330.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$257.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$257.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$295.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$292.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$278.56
|
| Rate for Payer: Cash Price |
$174.10
|
| Rate for Payer: Cigna Commercial |
$278.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$278.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$278.56
|
| Rate for Payer: Multiplan Commercial |
$323.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$295.97
|
| Rate for Payer: United Healthcare Commercial |
$330.79
|
|
|
HEMOGLOBIN ELECTROPHORESIS
|
Professional
|
Both
|
$348.20
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
3008302001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.69 |
| Max. Negotiated Rate |
$327.31 |
| Rate for Payer: Aetna of VT Commercial |
$327.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$33.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$33.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.52
|
| Rate for Payer: Cash Price |
$174.10
|
| Rate for Payer: Cash Price |
$174.10
|
| Rate for Payer: Cigna Commercial |
$36.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.69
|
| Rate for Payer: Multiplan Commercial |
$323.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.87
|
| Rate for Payer: United Healthcare Commercial |
$19.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.87
|
| Rate for Payer: United Healthcare VA CCN |
$12.87
|
|
