|
I&D VULVA/PERINEAL ABSCESS
|
Facility
|
IP
|
$290.78
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
4505640501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.21 |
| Max. Negotiated Rate |
$276.24 |
| Rate for Payer: Aetna of VT Commercial |
$276.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$215.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$215.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$247.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$244.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$232.62
|
| Rate for Payer: Cash Price |
$145.39
|
| Rate for Payer: Cigna Commercial |
$232.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$232.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$232.62
|
| Rate for Payer: Multiplan Commercial |
$270.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$247.16
|
| Rate for Payer: United Healthcare Commercial |
$276.24
|
|
|
I&D VULVA/PERINEAL ABSCESS
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
9815640501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
I&D VULVA/PERINEAL ABSCESS
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
5105640501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.85 |
| Max. Negotiated Rate |
$273.54 |
| Rate for Payer: Aetna of VT Commercial |
$273.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$260.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$260.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$167.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$189.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$189.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$137.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$189.63
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cigna Commercial |
$212.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$225.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$225.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$136.88
|
| Rate for Payer: Multiplan Commercial |
$270.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$119.85
|
| Rate for Payer: United Healthcare Commercial |
$184.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.85
|
| Rate for Payer: United Healthcare VA CCN |
$119.85
|
|
|
I&D VULVA/PERINEAL ABSCESS
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
5105640501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.88 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Aetna of VT Commercial |
$276.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$260.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$128.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$260.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$175.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$247.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$235.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$130.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$231.34
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cigna Commercial |
$232.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$232.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$232.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$130.95
|
| Rate for Payer: Multiplan Commercial |
$270.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$247.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$130.95
|
| Rate for Payer: United Healthcare Commercial |
$276.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.95
|
| Rate for Payer: United Healthcare VA CCN |
$130.95
|
|
|
I&D VULVA/PERINEAL ABSCESS
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
9605640502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$130.66 |
| Max. Negotiated Rate |
$280.25 |
| Rate for Payer: Aetna of VT Commercial |
$280.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$264.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$130.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$264.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$177.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$250.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$238.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$132.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$234.53
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$236.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$132.75
|
| Rate for Payer: Multiplan Commercial |
$274.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$132.75
|
| Rate for Payer: United Healthcare Commercial |
$280.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.75
|
| Rate for Payer: United Healthcare VA CCN |
$132.75
|
|
|
I&D VULVA/PERINEAL ABSCESS
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
9605640502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$119.85 |
| Max. Negotiated Rate |
$277.30 |
| Rate for Payer: Aetna of VT Commercial |
$277.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$264.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$264.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$167.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$189.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$189.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$137.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$189.63
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$212.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$225.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$225.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$136.88
|
| Rate for Payer: Multiplan Commercial |
$274.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$119.85
|
| Rate for Payer: United Healthcare Commercial |
$184.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.85
|
| Rate for Payer: United Healthcare VA CCN |
$119.85
|
|
|
I&D VULVA/PERINEAL ABSCESS
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
9605640502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$218.33 |
| Max. Negotiated Rate |
$280.25 |
| Rate for Payer: Aetna of VT Commercial |
$280.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$218.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$218.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$250.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$247.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$236.00
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$236.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.00
|
| Rate for Payer: Multiplan Commercial |
$274.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.75
|
| Rate for Payer: United Healthcare Commercial |
$280.25
|
|
|
IGG 1 2 3 OR 4 EACH
|
Professional
|
Both
|
$322.61
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
3008278701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$303.25 |
| Rate for Payer: Aetna of VT Commercial |
$303.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.02
|
| Rate for Payer: Cash Price |
$161.30
|
| Rate for Payer: Cash Price |
$161.30
|
| Rate for Payer: Cigna Commercial |
$9.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.91
|
| Rate for Payer: Multiplan Commercial |
$300.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.02
|
| Rate for Payer: United Healthcare Commercial |
$12.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.02
|
| Rate for Payer: United Healthcare VA CCN |
$8.02
|
|
|
IGG 1 2 3 OR 4 EACH
|
Facility
|
IP
|
$322.61
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
3008278701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$238.76 |
| Max. Negotiated Rate |
$306.48 |
| Rate for Payer: Aetna of VT Commercial |
$306.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$238.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$238.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$274.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$270.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$258.09
|
| Rate for Payer: Cash Price |
$161.30
|
| Rate for Payer: Cigna Commercial |
$258.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$258.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$258.09
|
| Rate for Payer: Multiplan Commercial |
$300.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.22
|
| Rate for Payer: United Healthcare Commercial |
$306.48
|
|
|
IGG 1 2 3 OR 4 EACH
|
Facility
|
OP
|
$322.61
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
3008278701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$306.48 |
| Rate for Payer: Aetna of VT Commercial |
$306.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$142.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$194.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$274.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$261.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$145.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$256.47
|
| Rate for Payer: Cash Price |
$161.30
|
| Rate for Payer: Cash Price |
$161.30
|
| Rate for Payer: Cigna Commercial |
$258.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$258.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$258.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$145.17
|
| Rate for Payer: Multiplan Commercial |
$300.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$145.17
|
| Rate for Payer: United Healthcare Commercial |
$306.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.02
|
| Rate for Payer: United Healthcare VA CCN |
$145.17
|
|
|
IIV4 VACCINE SPLT 0.5 ML IM
|
Facility
|
OP
|
$26.16
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
6369068801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna of VT Commercial |
$24.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$50.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$50.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$21.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.80
|
| Rate for Payer: Cash Price |
$13.08
|
| Rate for Payer: Cash Price |
$13.08
|
| Rate for Payer: Cigna Commercial |
$20.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$20.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$20.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.77
|
| Rate for Payer: Multiplan Commercial |
$24.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.77
|
| Rate for Payer: United Healthcare Commercial |
$24.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.77
|
| Rate for Payer: United Healthcare VA CCN |
$11.77
|
|
|
IIV4 VACCINE SPLT 0.5 ML IM
|
Facility
|
IP
|
$26.16
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
6369068801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$24.85 |
| Rate for Payer: Aetna of VT Commercial |
$24.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$19.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$19.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$21.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.93
|
| Rate for Payer: Cash Price |
$13.08
|
| Rate for Payer: Cigna Commercial |
$20.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$20.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$20.93
|
| Rate for Payer: Multiplan Commercial |
$24.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.24
|
| Rate for Payer: United Healthcare Commercial |
$24.85
|
|
|
IIV4 VACCINE SPLT 0.5 ML IM
|
Professional
|
Both
|
$26.16
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
6369068801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna of VT Commercial |
$24.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$50.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$50.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$23.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$23.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$23.52
|
| Rate for Payer: Cash Price |
$13.08
|
| Rate for Payer: Cash Price |
$13.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$29.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$29.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$20.88
|
| Rate for Payer: Multiplan Commercial |
$24.33
|
| Rate for Payer: United Healthcare Commercial |
$22.24
|
| Rate for Payer: United Healthcare VA CCN |
$10.46
|
|
|
IIV4 VACC NO PRSV 0.5 ML IM
|
Facility
|
IP
|
$132.68
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
6369068601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.20 |
| Max. Negotiated Rate |
$126.05 |
| Rate for Payer: Aetna of VT Commercial |
$126.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$98.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$98.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$111.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$106.14
|
| Rate for Payer: Cash Price |
$66.34
|
| Rate for Payer: Cigna Commercial |
$106.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.14
|
| Rate for Payer: Multiplan Commercial |
$123.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.78
|
| Rate for Payer: United Healthcare Commercial |
$126.05
|
|
|
IIV4 VACC NO PRSV 0.5 ML IM
|
Professional
|
Both
|
$137.28
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
6369068601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$129.04 |
| Rate for Payer: Aetna of VT Commercial |
$129.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$25.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$25.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.64
|
| Rate for Payer: Cash Price |
$68.64
|
| Rate for Payer: Cash Price |
$68.64
|
| 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 |
$127.67
|
| Rate for Payer: United Healthcare Commercial |
$116.69
|
| Rate for Payer: United Healthcare VA CCN |
$54.91
|
|
|
IIV4 VACC NO PRSV 0.5 ML IM
|
Facility
|
OP
|
$132.68
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
6369068601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.26 |
| Max. Negotiated Rate |
$126.05 |
| Rate for Payer: Aetna of VT Commercial |
$126.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$107.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$105.48
|
| Rate for Payer: Cash Price |
$66.34
|
| Rate for Payer: Cash Price |
$66.34
|
| Rate for Payer: Cigna Commercial |
$106.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$59.71
|
| Rate for Payer: Multiplan Commercial |
$123.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.71
|
| Rate for Payer: United Healthcare Commercial |
$126.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.71
|
| Rate for Payer: United Healthcare VA CCN |
$59.71
|
|
|
IIV4 VACC NO PRSV 0.5 ML IM
|
Professional
|
Both
|
$137.28
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
6369068601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$129.04 |
| Rate for Payer: Aetna of VT Commercial |
$129.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$25.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$25.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.64
|
| Rate for Payer: Cash Price |
$68.64
|
| Rate for Payer: Cash Price |
$68.64
|
| 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 |
$127.67
|
| Rate for Payer: United Healthcare Commercial |
$116.69
|
| Rate for Payer: United Healthcare VA CCN |
$54.91
|
|
|
IIV4 VACC NO PRSV 0.5 ML IM
|
Facility
|
OP
|
$132.68
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
6369068601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.26 |
| Max. Negotiated Rate |
$126.05 |
| Rate for Payer: Aetna of VT Commercial |
$126.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$107.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$105.48
|
| Rate for Payer: Cash Price |
$66.34
|
| Rate for Payer: Cash Price |
$66.34
|
| Rate for Payer: Cigna Commercial |
$106.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$59.71
|
| Rate for Payer: Multiplan Commercial |
$123.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.71
|
| Rate for Payer: United Healthcare Commercial |
$126.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.71
|
| Rate for Payer: United Healthcare VA CCN |
$59.71
|
|
|
IIV4 VACC NO PRSV 0.5 ML IM
|
Facility
|
IP
|
$132.68
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
6369068601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.20 |
| Max. Negotiated Rate |
$126.05 |
| Rate for Payer: Aetna of VT Commercial |
$126.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$98.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$98.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$111.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$106.14
|
| Rate for Payer: Cash Price |
$66.34
|
| Rate for Payer: Cigna Commercial |
$106.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.14
|
| Rate for Payer: Multiplan Commercial |
$123.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.78
|
| Rate for Payer: United Healthcare Commercial |
$126.05
|
|
|
ILEOSTOMY/JEJUNOSTOMY
|
Facility
|
OP
|
$2,400.00
|
|
|
Service Code
|
CPT 44310
|
| Hospital Charge Code |
9824431001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,062.96 |
| Max. Negotiated Rate |
$2,280.00 |
| Rate for Payer: Aetna of VT Commercial |
$2,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,150.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,062.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,150.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,444.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,040.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,944.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,080.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,908.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,920.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,920.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,920.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,080.00
|
| Rate for Payer: Multiplan Commercial |
$2,232.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,040.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,080.00
|
| Rate for Payer: United Healthcare Commercial |
$2,280.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,080.00
|
| Rate for Payer: United Healthcare VA CCN |
$1,080.00
|
|
|
ILEOSTOMY/JEJUNOSTOMY
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
CPT 44310
|
| Hospital Charge Code |
9824431001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,776.24 |
| Max. Negotiated Rate |
$2,280.00 |
| Rate for Payer: Aetna of VT Commercial |
$2,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,776.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,776.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,040.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,016.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,920.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,920.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,920.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,920.00
|
| Rate for Payer: Multiplan Commercial |
$2,232.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,040.00
|
| Rate for Payer: United Healthcare Commercial |
$2,280.00
|
|
|
ILEOSTOMY/JEJUNOSTOMY
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
CPT 44310
|
| Hospital Charge Code |
9824431001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$950.28 |
| Max. Negotiated Rate |
$2,256.00 |
| Rate for Payer: Aetna of VT Commercial |
$2,256.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,150.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$978.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,150.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,330.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,577.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,577.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,092.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,577.31
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,738.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,607.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,607.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$950.28
|
| Rate for Payer: Multiplan Commercial |
$2,232.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,349.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$950.29
|
| Rate for Payer: United Healthcare Commercial |
$1,461.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$950.29
|
| Rate for Payer: United Healthcare VA CCN |
$950.29
|
|
|
IMFLUOR 1ST 1ANTB STAIN PX
|
Professional
|
Both
|
$231.79
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
3008834601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.79 |
| Max. Negotiated Rate |
$558.24 |
| Rate for Payer: Aetna of VT Commercial |
$217.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$558.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$142.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$558.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$194.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$186.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$186.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$159.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$186.93
|
| Rate for Payer: Cash Price |
$115.89
|
| Rate for Payer: Cash Price |
$115.89
|
| Rate for Payer: Cigna Commercial |
$192.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$222.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$222.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$138.79
|
| Rate for Payer: Multiplan Commercial |
$215.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$138.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$138.79
|
| Rate for Payer: United Healthcare Commercial |
$213.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.79
|
| Rate for Payer: United Healthcare VA CCN |
$138.79
|
|
|
IMFLUOR 1ST 1ANTB STAIN PX
|
Facility
|
IP
|
$231.79
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
3008834601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$171.55 |
| Max. Negotiated Rate |
$220.20 |
| Rate for Payer: Aetna of VT Commercial |
$220.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$171.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$171.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$197.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$194.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$185.43
|
| Rate for Payer: Cash Price |
$115.89
|
| Rate for Payer: Cigna Commercial |
$185.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$185.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$185.43
|
| Rate for Payer: Multiplan Commercial |
$215.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$197.02
|
| Rate for Payer: United Healthcare Commercial |
$220.20
|
|
|
IMFLUOR 1ST 1ANTB STAIN PX
|
Facility
|
OP
|
$231.79
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
3008834601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.66 |
| Max. Negotiated Rate |
$558.24 |
| Rate for Payer: Aetna of VT Commercial |
$220.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$558.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$102.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$558.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$139.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$197.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$187.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$104.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$184.27
|
| Rate for Payer: Cash Price |
$115.89
|
| Rate for Payer: Cash Price |
$115.89
|
| Rate for Payer: Cigna Commercial |
$185.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$185.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$185.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$104.31
|
| Rate for Payer: Multiplan Commercial |
$215.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$197.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$104.31
|
| Rate for Payer: United Healthcare Commercial |
$220.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.79
|
| Rate for Payer: United Healthcare VA CCN |
$104.31
|
|
