|
INFLIXIMAB-DYYB (INFLE)10 340B
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
636Q510302
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$43.75 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$43.75
|
| 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 |
$43.75
|
| 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
|
|
|
INFLIXIMAB-DYYB (INFLE)10 340B
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
636Q510302
|
|
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
|
|
|
INFLIXIMAB-DYYB (INFLECTRA) 10
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS Q5103 TB
|
| Hospital Charge Code |
636Q510302
|
|
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
|
|
|
INFLIXIMAB-DYYB (INFLECTRA) 10
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS Q5103 TB
|
| Hospital Charge Code |
636Q510302
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$43.75 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$43.75
|
| 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 |
$43.75
|
| 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
|
|
|
INFLIXIMAB(REMICADE)100MG 340B
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
636J174504
|
|
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
|
|
|
INFLIXIMAB(REMICADE)100MG 340B
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
636J174504
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$83.93 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.93
|
| 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 |
$83.93
|
| 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
|
|
|
INFLIXIMAB (REMICADE) 100 MG V
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J1745 TB
|
| Hospital Charge Code |
636J174504
|
|
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
|
|
|
INFLIXIMAB (REMICADE) 100 MG V
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J1745 TB
|
| Hospital Charge Code |
636J174504
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$83.93 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.93
|
| 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 |
$83.93
|
| 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
|
|
|
INFLUENZA DNA AMP PROBE
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
3008750201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$472.05 |
| Rate for Payer: Aetna of VT Commercial |
$233.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$472.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$108.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$472.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$148.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$199.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$110.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$195.57
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$196.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$110.70
|
| Rate for Payer: Multiplan Commercial |
$228.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$110.70
|
| Rate for Payer: United Healthcare Commercial |
$233.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.80
|
| Rate for Payer: United Healthcare VA CCN |
$110.70
|
|
|
INFLUENZA DNA AMP PROBE
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
3008750201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$182.06 |
| Max. Negotiated Rate |
$233.70 |
| Rate for Payer: Aetna of VT Commercial |
$233.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$182.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$182.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$206.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.80
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$196.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.80
|
| Rate for Payer: Multiplan Commercial |
$228.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.10
|
| Rate for Payer: United Healthcare Commercial |
$233.70
|
|
|
INFLUENZA DNA AMP PROBE
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
3008750201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$472.05 |
| Rate for Payer: Aetna of VT Commercial |
$231.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$472.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$98.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$472.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$134.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$124.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$124.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$110.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.22
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$116.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$95.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$95.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.46
|
| Rate for Payer: Multiplan Commercial |
$228.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$95.80
|
| Rate for Payer: United Healthcare Commercial |
$147.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.80
|
| Rate for Payer: United Healthcare VA CCN |
$95.80
|
|
|
INFLU VAC 2025-26(19-64) AFLUR
|
Facility
|
IP
|
$14.11
|
|
|
Service Code
|
NDC 3333202504
|
| Hospital Charge Code |
6369065604
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.44 |
| Max. Negotiated Rate |
$13.40 |
| Rate for Payer: Aetna of VT Commercial |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$10.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$10.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.29
|
| Rate for Payer: Cash Price |
$7.06
|
| Rate for Payer: Cigna Commercial |
$11.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.29
|
| Rate for Payer: Multiplan Commercial |
$13.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.99
|
| Rate for Payer: United Healthcare Commercial |
$13.40
|
|
|
INFLU VAC 2025-26(19-64) AFLUR
|
Professional
|
Both
|
$14.11
|
|
|
Service Code
|
NDC 3333202504
|
| Hospital Charge Code |
6369065604
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$13.26 |
| Rate for Payer: Aetna of VT Commercial |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$12.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$12.64
|
| Rate for Payer: Cash Price |
$7.06
|
| Rate for Payer: Multiplan Commercial |
$13.12
|
| Rate for Payer: United Healthcare Commercial |
$11.99
|
| Rate for Payer: United Healthcare VA CCN |
$5.64
|
|
|
INFLU VAC 2025-26(19-64) AFLUR
|
Facility
|
OP
|
$14.11
|
|
|
Service Code
|
NDC 3333202504
|
| Hospital Charge Code |
6369065604
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$13.40 |
| Rate for Payer: Aetna of VT Commercial |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$12.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$12.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$8.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.22
|
| Rate for Payer: Cash Price |
$7.06
|
| Rate for Payer: Cigna Commercial |
$11.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.35
|
| Rate for Payer: Multiplan Commercial |
$13.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.35
|
| Rate for Payer: United Healthcare Commercial |
$13.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.35
|
| Rate for Payer: United Healthcare VA CCN |
$6.35
|
|
|
INFLU VAC 2025-26(65+) FLUAD
|
Facility
|
OP
|
$52.53
|
|
|
Service Code
|
NDC 7046102504
|
| Hospital Charge Code |
6369065304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$49.90 |
| Rate for Payer: Aetna of VT Commercial |
$49.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$47.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$47.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$42.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$41.76
|
| Rate for Payer: Cash Price |
$26.26
|
| Rate for Payer: Cigna Commercial |
$42.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$23.64
|
| Rate for Payer: Multiplan Commercial |
$48.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.64
|
| Rate for Payer: United Healthcare Commercial |
$49.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.64
|
| Rate for Payer: United Healthcare VA CCN |
$23.64
|
|
|
INFLU VAC 2025-26(65+) FLUAD
|
Facility
|
IP
|
$52.53
|
|
|
Service Code
|
NDC 7046102504
|
| Hospital Charge Code |
6369065304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$49.90 |
| Rate for Payer: Aetna of VT Commercial |
$49.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.02
|
| Rate for Payer: Cash Price |
$26.26
|
| Rate for Payer: Cigna Commercial |
$42.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.02
|
| Rate for Payer: Multiplan Commercial |
$48.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.65
|
| Rate for Payer: United Healthcare Commercial |
$49.90
|
|
|
INFLU VAC 2025-26(65+) FLUAD
|
Professional
|
Both
|
$52.53
|
|
|
Service Code
|
NDC 7046102504
|
| Hospital Charge Code |
6369065304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$49.38 |
| Rate for Payer: Aetna of VT Commercial |
$49.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$47.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$47.06
|
| Rate for Payer: Cash Price |
$26.26
|
| Rate for Payer: Multiplan Commercial |
$48.85
|
| Rate for Payer: United Healthcare Commercial |
$44.65
|
| Rate for Payer: United Healthcare VA CCN |
$21.01
|
|
|
INGEST CHALLENGE INI 120 MIN
|
Professional
|
Both
|
$709.00
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
5109507601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.91 |
| Max. Negotiated Rate |
$666.46 |
| Rate for Payer: Aetna of VT Commercial |
$666.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$635.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$635.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$97.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$169.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.43
|
| Rate for Payer: Cash Price |
$354.50
|
| Rate for Payer: Cash Price |
$354.50
|
| Rate for Payer: Cigna Commercial |
$83.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$192.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$192.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$119.70
|
| Rate for Payer: Multiplan Commercial |
$659.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.91
|
| Rate for Payer: United Healthcare Commercial |
$107.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.91
|
| Rate for Payer: United Healthcare VA CCN |
$69.91
|
|
|
INGEST CHALLENGE INI 120 MIN
|
Professional
|
Both
|
$976.00
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
9609507601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$69.91 |
| Max. Negotiated Rate |
$917.44 |
| Rate for Payer: Aetna of VT Commercial |
$917.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$874.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$874.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$97.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$169.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.43
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cigna Commercial |
$83.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$192.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$192.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$119.70
|
| Rate for Payer: Multiplan Commercial |
$907.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.91
|
| Rate for Payer: United Healthcare Commercial |
$107.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.91
|
| Rate for Payer: United Healthcare VA CCN |
$69.91
|
|
|
INGEST CHALLENGE INI 120 MIN
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
5109507601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$524.73 |
| Max. Negotiated Rate |
$673.55 |
| Rate for Payer: Aetna of VT Commercial |
$673.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$524.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$524.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$602.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$595.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$567.20
|
| Rate for Payer: Cash Price |
$354.50
|
| Rate for Payer: Cigna Commercial |
$567.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$567.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$567.20
|
| Rate for Payer: Multiplan Commercial |
$659.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$602.65
|
| Rate for Payer: United Healthcare Commercial |
$673.55
|
|
|
INGEST CHALLENGE INI 120 MIN
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
5109507601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$314.02 |
| Max. Negotiated Rate |
$673.55 |
| Rate for Payer: Aetna of VT Commercial |
$673.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$635.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$314.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$635.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$426.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$602.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$574.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$319.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$563.65
|
| Rate for Payer: Cash Price |
$354.50
|
| Rate for Payer: Cigna Commercial |
$567.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$567.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$567.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$319.05
|
| Rate for Payer: Multiplan Commercial |
$659.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$602.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$319.05
|
| Rate for Payer: United Healthcare Commercial |
$673.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$319.05
|
| Rate for Payer: United Healthcare VA CCN |
$319.05
|
|
|
INGEST CHALLENGE INI 120 MIN
|
Facility
|
IP
|
$976.00
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
9609507601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$722.34 |
| Max. Negotiated Rate |
$927.20 |
| Rate for Payer: Aetna of VT Commercial |
$927.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$722.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$722.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$829.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$780.80
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cigna Commercial |
$780.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$780.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$780.80
|
| Rate for Payer: Multiplan Commercial |
$907.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$829.60
|
| Rate for Payer: United Healthcare Commercial |
$927.20
|
|
|
INGEST CHALLENGE INI 120 MIN
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
9609507602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$69.91 |
| Max. Negotiated Rate |
$250.98 |
| Rate for Payer: Aetna of VT Commercial |
$250.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$239.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$239.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$97.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$169.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.43
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$83.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$192.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$192.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$119.70
|
| Rate for Payer: Multiplan Commercial |
$248.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.91
|
| Rate for Payer: United Healthcare Commercial |
$107.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.91
|
| Rate for Payer: United Healthcare VA CCN |
$69.91
|
|
|
INGEST CHALLENGE INI 120 MIN
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
9609507602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$118.25 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Aetna of VT Commercial |
$253.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$239.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$118.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$239.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$160.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$226.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$216.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$120.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$212.26
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$213.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$213.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$213.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.15
|
| Rate for Payer: Multiplan Commercial |
$248.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$226.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$120.15
|
| Rate for Payer: United Healthcare Commercial |
$253.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.15
|
| Rate for Payer: United Healthcare VA CCN |
$120.15
|
|
|
INGEST CHALLENGE INI 120 MIN
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
9609507602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$197.61 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Aetna of VT Commercial |
$253.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$197.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$197.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$226.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$224.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$213.60
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$213.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$213.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$213.60
|
| Rate for Payer: Multiplan Commercial |
$248.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$226.95
|
| Rate for Payer: United Healthcare Commercial |
$253.65
|
|
