|
HEPATITIS B SURF ANTIBODY HBSA
|
Facility
|
IP
|
$155.10
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
3008670601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.79 |
| Max. Negotiated Rate |
$147.34 |
| Rate for Payer: Aetna of VT Commercial |
$147.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$114.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$114.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$131.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$130.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.08
|
| Rate for Payer: Cash Price |
$77.55
|
| Rate for Payer: Cigna Commercial |
$124.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$144.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.84
|
| Rate for Payer: United Healthcare Commercial |
$147.34
|
|
|
HEPATITIS C ANTIBODY
|
Facility
|
OP
|
$155.10
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
3008680301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$147.34 |
| Rate for Payer: Aetna of VT Commercial |
$147.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$131.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$125.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$123.30
|
| Rate for Payer: Cash Price |
$77.55
|
| Rate for Payer: Cash Price |
$77.55
|
| Rate for Payer: Cigna Commercial |
$124.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.80
|
| Rate for Payer: Multiplan Commercial |
$144.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.80
|
| Rate for Payer: United Healthcare Commercial |
$147.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.27
|
| Rate for Payer: United Healthcare VA CCN |
$69.80
|
|
|
HEPATITIS C ANTIBODY
|
Facility
|
IP
|
$155.10
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
3008680301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.79 |
| Max. Negotiated Rate |
$147.34 |
| Rate for Payer: Aetna of VT Commercial |
$147.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$114.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$114.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$131.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$130.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.08
|
| Rate for Payer: Cash Price |
$77.55
|
| Rate for Payer: Cigna Commercial |
$124.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$144.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.84
|
| Rate for Payer: United Healthcare Commercial |
$147.34
|
|
|
HEPATITIS C REVRS TRNSCRPJ
|
Professional
|
Both
|
$492.18
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
3008752201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Aetna of VT Commercial |
$462.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$211.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$44.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$211.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$59.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$73.22
|
| Rate for Payer: Cash Price |
$246.09
|
| Rate for Payer: Cash Price |
$246.09
|
| Rate for Payer: Cigna Commercial |
$51.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$42.24
|
| Rate for Payer: Multiplan Commercial |
$457.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare Commercial |
$65.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare VA CCN |
$42.84
|
|
|
HEPATITIS C REVRS TRNSCRPJ
|
Facility
|
IP
|
$492.18
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
3008752201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$364.26 |
| Max. Negotiated Rate |
$467.57 |
| Rate for Payer: Aetna of VT Commercial |
$467.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$364.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$364.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$418.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$413.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$393.74
|
| Rate for Payer: Cash Price |
$246.09
|
| Rate for Payer: Cigna Commercial |
$393.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$393.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$393.74
|
| Rate for Payer: Multiplan Commercial |
$457.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$418.35
|
| Rate for Payer: United Healthcare Commercial |
$467.57
|
|
|
HEPATITIS C REVRS TRNSCRPJ
|
Facility
|
OP
|
$492.18
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
3008752201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$467.57 |
| Rate for Payer: Aetna of VT Commercial |
$467.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$211.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$217.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$211.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$296.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$418.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$398.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$221.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.28
|
| Rate for Payer: Cash Price |
$246.09
|
| Rate for Payer: Cash Price |
$246.09
|
| Rate for Payer: Cigna Commercial |
$393.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$393.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$393.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$221.48
|
| Rate for Payer: Multiplan Commercial |
$457.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$418.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$221.48
|
| Rate for Payer: United Healthcare Commercial |
$467.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare VA CCN |
$221.48
|
|
|
HEPATITIS DELTA AGENT ANTBDY
|
Facility
|
IP
|
$255.60
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
3008669201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$189.17 |
| Max. Negotiated Rate |
$242.82 |
| Rate for Payer: Aetna of VT Commercial |
$242.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$189.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$189.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$217.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$214.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$204.48
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$204.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$204.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$204.48
|
| Rate for Payer: Multiplan Commercial |
$237.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.26
|
| Rate for Payer: United Healthcare Commercial |
$242.82
|
|
|
HEPATITIS DELTA AGENT ANTBDY
|
Facility
|
OP
|
$255.60
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
3008669201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$242.82 |
| Rate for Payer: Aetna of VT Commercial |
$242.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$84.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$113.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$84.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$153.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$217.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$207.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$115.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$203.20
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$204.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$204.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$204.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$115.02
|
| Rate for Payer: Multiplan Commercial |
$237.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$115.02
|
| Rate for Payer: United Healthcare Commercial |
$242.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.16
|
| Rate for Payer: United Healthcare VA CCN |
$115.02
|
|
|
HEP A VAC ADULT IM
|
Professional
|
Both
|
$337.55
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
6369063201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.16 |
| Max. Negotiated Rate |
$317.30 |
| Rate for Payer: Aetna of VT Commercial |
$317.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$198.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$198.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$103.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$84.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.47
|
| Rate for Payer: Cash Price |
$168.78
|
| Rate for Payer: Cash Price |
$168.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$99.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$99.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$72.16
|
| Rate for Payer: Multiplan Commercial |
$313.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$73.79
|
| Rate for Payer: United Healthcare Commercial |
$113.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.79
|
| Rate for Payer: United Healthcare VA CCN |
$73.79
|
|
|
HEP A VAC ADULT IM
|
Professional
|
Both
|
$337.55
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
6369063201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.16 |
| Max. Negotiated Rate |
$317.30 |
| Rate for Payer: Aetna of VT Commercial |
$317.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$198.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$198.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$103.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$84.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.47
|
| Rate for Payer: Cash Price |
$168.78
|
| Rate for Payer: Cash Price |
$168.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$99.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$99.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$72.16
|
| Rate for Payer: Multiplan Commercial |
$313.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$73.79
|
| Rate for Payer: United Healthcare Commercial |
$113.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.79
|
| Rate for Payer: United Healthcare VA CCN |
$73.79
|
|
|
HEP A VAC ADULT IM
|
Facility
|
IP
|
$337.55
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
6369063201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$249.82 |
| Max. Negotiated Rate |
$320.67 |
| Rate for Payer: Aetna of VT Commercial |
$320.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$249.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$249.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$270.04
|
| Rate for Payer: Cash Price |
$168.78
|
| Rate for Payer: Cigna Commercial |
$270.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$270.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$270.04
|
| Rate for Payer: Multiplan Commercial |
$313.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.92
|
| Rate for Payer: United Healthcare Commercial |
$320.67
|
|
|
HEP A VAC ADULT IM
|
Facility
|
IP
|
$337.55
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
6369063201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$249.82 |
| Max. Negotiated Rate |
$320.67 |
| Rate for Payer: Aetna of VT Commercial |
$320.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$249.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$249.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$270.04
|
| Rate for Payer: Cash Price |
$168.78
|
| Rate for Payer: Cigna Commercial |
$270.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$270.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$270.04
|
| Rate for Payer: Multiplan Commercial |
$313.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.92
|
| Rate for Payer: United Healthcare Commercial |
$320.67
|
|
|
HEP A VAC ADULT IM
|
Facility
|
OP
|
$337.55
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
6369063201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$320.67 |
| Rate for Payer: Aetna of VT Commercial |
$320.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$198.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$198.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$203.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$273.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$151.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$268.35
|
| Rate for Payer: Cash Price |
$168.78
|
| Rate for Payer: Cash Price |
$168.78
|
| Rate for Payer: Cigna Commercial |
$270.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$270.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$270.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$151.90
|
| Rate for Payer: Multiplan Commercial |
$313.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$151.90
|
| Rate for Payer: United Healthcare Commercial |
$320.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.90
|
| Rate for Payer: United Healthcare VA CCN |
$151.90
|
|
|
HEP A VAC ADULT IM
|
Facility
|
OP
|
$337.55
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
6369063201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$320.67 |
| Rate for Payer: Aetna of VT Commercial |
$320.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$198.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$198.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$203.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$273.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$151.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$268.35
|
| Rate for Payer: Cash Price |
$168.78
|
| Rate for Payer: Cash Price |
$168.78
|
| Rate for Payer: Cigna Commercial |
$270.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$270.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$270.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$151.90
|
| Rate for Payer: Multiplan Commercial |
$313.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$151.90
|
| Rate for Payer: United Healthcare Commercial |
$320.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.90
|
| Rate for Payer: United Healthcare VA CCN |
$151.90
|
|
|
HEPA VACC PED/ADOL 2 DOSE IM
|
Professional
|
Both
|
$30.16
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
6369063302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$106.84 |
| Rate for Payer: Aetna of VT Commercial |
$28.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$44.67
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$53.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$53.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$41.33
|
| Rate for Payer: Multiplan Commercial |
$28.05
|
| Rate for Payer: United Healthcare Commercial |
$25.64
|
| Rate for Payer: United Healthcare VA CCN |
$56.00
|
|
|
HEPA VACC PED/ADOL 2 DOSE IM
|
Facility
|
IP
|
$30.16
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
6369063302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.32 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna of VT Commercial |
$28.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$22.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$22.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$25.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$25.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.13
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cigna Commercial |
$24.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$24.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$24.13
|
| Rate for Payer: Multiplan Commercial |
$28.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.64
|
| Rate for Payer: United Healthcare Commercial |
$28.65
|
|
|
HEPA VACC PED/ADOL 2 DOSE IM
|
Facility
|
OP
|
$30.16
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
6369063302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$106.84 |
| Rate for Payer: Aetna of VT Commercial |
$28.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$25.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$24.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$23.98
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cigna Commercial |
$24.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$24.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$24.13
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.57
|
| Rate for Payer: Multiplan Commercial |
$28.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.57
|
| Rate for Payer: United Healthcare Commercial |
$28.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.57
|
| Rate for Payer: United Healthcare VA CCN |
$13.57
|
|
|
HEP B CORE ANTIBODY IGM
|
Facility
|
IP
|
$133.23
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
3008670501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$126.57 |
| Rate for Payer: Aetna of VT Commercial |
$126.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$98.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$98.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$111.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$106.58
|
| Rate for Payer: Cash Price |
$66.61
|
| Rate for Payer: Cigna Commercial |
$106.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.58
|
| Rate for Payer: Multiplan Commercial |
$123.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$113.25
|
| Rate for Payer: United Healthcare Commercial |
$126.57
|
|
|
HEP B CORE ANTIBODY IGM
|
Facility
|
OP
|
$133.23
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
3008670501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$126.57 |
| Rate for Payer: Aetna of VT Commercial |
$126.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$59.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$80.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$107.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$105.92
|
| Rate for Payer: Cash Price |
$66.61
|
| Rate for Payer: Cash Price |
$66.61
|
| Rate for Payer: Cigna Commercial |
$106.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$59.95
|
| Rate for Payer: Multiplan Commercial |
$123.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$113.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.95
|
| Rate for Payer: United Healthcare Commercial |
$126.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.77
|
| Rate for Payer: United Healthcare VA CCN |
$59.95
|
|
|
HEP B CORE ANTIBODY IGM
|
Professional
|
Both
|
$133.23
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
3008670501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$125.24 |
| Rate for Payer: Aetna of VT Commercial |
$125.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.12
|
| Rate for Payer: Cash Price |
$66.61
|
| Rate for Payer: Cash Price |
$66.61
|
| Rate for Payer: Cigna Commercial |
$14.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.77
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.61
|
| Rate for Payer: Multiplan Commercial |
$123.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.77
|
| Rate for Payer: United Healthcare Commercial |
$18.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.77
|
| Rate for Payer: United Healthcare VA CCN |
$11.77
|
|
|
HEP B SURFACE AG NEUTRLZJ IA
|
Professional
|
Both
|
$311.23
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
3008734101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$292.56 |
| Rate for Payer: Aetna of VT Commercial |
$292.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$50.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$50.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$14.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$17.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$17.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$17.66
|
| Rate for Payer: Cash Price |
$155.62
|
| Rate for Payer: Cash Price |
$155.62
|
| Rate for Payer: Cigna Commercial |
$12.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$10.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$10.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.19
|
| Rate for Payer: Multiplan Commercial |
$289.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.33
|
| Rate for Payer: United Healthcare Commercial |
$15.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.33
|
| Rate for Payer: United Healthcare VA CCN |
$10.33
|
|
|
HEP B SURFACE AG NEUTRLZJ IA
|
Facility
|
OP
|
$311.23
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
3008734101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$295.67 |
| Rate for Payer: Aetna of VT Commercial |
$295.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$50.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$137.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$50.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$187.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$264.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$252.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$140.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$247.43
|
| Rate for Payer: Cash Price |
$155.62
|
| Rate for Payer: Cash Price |
$155.62
|
| Rate for Payer: Cigna Commercial |
$248.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$248.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$248.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$140.05
|
| Rate for Payer: Multiplan Commercial |
$289.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$140.05
|
| Rate for Payer: United Healthcare Commercial |
$295.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.33
|
| Rate for Payer: United Healthcare VA CCN |
$140.05
|
|
|
HEP B SURFACE AG NEUTRLZJ IA
|
Facility
|
IP
|
$311.23
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
3008734101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$230.34 |
| Max. Negotiated Rate |
$295.67 |
| Rate for Payer: Aetna of VT Commercial |
$295.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$230.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$230.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$264.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$261.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$248.98
|
| Rate for Payer: Cash Price |
$155.62
|
| Rate for Payer: Cigna Commercial |
$248.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$248.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$248.98
|
| Rate for Payer: Multiplan Commercial |
$289.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.55
|
| Rate for Payer: United Healthcare Commercial |
$295.67
|
|
|
HERNIA REPAIR W/MESH
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
CPT 49568
|
| Hospital Charge Code |
9824956801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$345.46 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Aetna of VT Commercial |
$741.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$698.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$345.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$698.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$469.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$663.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$631.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$351.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$620.10
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$624.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$624.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$624.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$351.00
|
| Rate for Payer: Multiplan Commercial |
$725.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$663.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$351.00
|
| Rate for Payer: United Healthcare Commercial |
$741.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$351.00
|
| Rate for Payer: United Healthcare VA CCN |
$351.00
|
|
|
HERNIA REPAIR W/MESH
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
CPT 49568
|
| Hospital Charge Code |
9824956801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$577.28 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Aetna of VT Commercial |
$741.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$577.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$577.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$663.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$655.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$624.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$624.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$624.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$725.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$663.00
|
| Rate for Payer: United Healthcare Commercial |
$741.00
|
|
