|
INJECTION,FULPHILA .5MG*340B*
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
HCPCS Q5108 TB
|
| Hospital Charge Code |
636Q510802
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.13 |
| Max. Negotiated Rate |
$5,715.20 |
| Rate for Payer: Aetna of VT Commercial |
$5,715.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$310.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$310.48
|
| Rate for Payer: Cash Price |
$3,040.00
|
| Rate for Payer: Cash Price |
$3,040.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$125.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$125.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$112.90
|
| Rate for Payer: Multiplan Commercial |
$5,654.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.13
|
| Rate for Payer: United Healthcare Commercial |
$5,168.00
|
| Rate for Payer: United Healthcare VA CCN |
$2,432.00
|
|
|
INJECTION, FULVESTRANT 25 MG
|
Facility
|
IP
|
$199.56
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
636J939501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$147.69 |
| Max. Negotiated Rate |
$189.58 |
| Rate for Payer: Aetna of VT Commercial |
$189.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$169.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$167.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.65
|
| Rate for Payer: Cash Price |
$99.78
|
| Rate for Payer: Cigna Commercial |
$159.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$159.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$159.65
|
| Rate for Payer: Multiplan Commercial |
$185.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$169.63
|
| Rate for Payer: United Healthcare Commercial |
$189.58
|
|
|
INJECTION, FULVESTRANT 25 MG
|
Professional
|
Both
|
$199.56
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
636J939501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$187.59 |
| Rate for Payer: Aetna of VT Commercial |
$187.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$18.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$6.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$18.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$9.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$7.74
|
| Rate for Payer: Cash Price |
$99.78
|
| Rate for Payer: Cash Price |
$99.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.90
|
| Rate for Payer: Multiplan Commercial |
$185.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.73
|
| Rate for Payer: United Healthcare Commercial |
$10.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.73
|
| Rate for Payer: United Healthcare VA CCN |
$6.73
|
|
|
INJECTION, FULVESTRANT 25 MG
|
Facility
|
OP
|
$199.56
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
636J939501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.98 |
| Max. Negotiated Rate |
$189.58 |
| Rate for Payer: Aetna of VT Commercial |
$189.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$18.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$88.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$18.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$120.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$169.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$161.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$89.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$158.65
|
| Rate for Payer: Cash Price |
$99.78
|
| Rate for Payer: Cash Price |
$99.78
|
| Rate for Payer: Cigna Commercial |
$159.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$159.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$159.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$89.80
|
| Rate for Payer: Multiplan Commercial |
$185.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$169.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$89.80
|
| Rate for Payer: United Healthcare Commercial |
$189.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.80
|
| Rate for Payer: United Healthcare VA CCN |
$89.80
|
|
|
INJECTION, INCLISIRAN, 1 MG
|
Facility
|
IP
|
$12.23
|
|
|
Service Code
|
HCPCS J1306
|
| Hospital Charge Code |
636J130601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: Aetna of VT Commercial |
$11.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$9.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$9.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$10.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$10.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9.78
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cigna Commercial |
$9.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$9.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$9.78
|
| Rate for Payer: Multiplan Commercial |
$11.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.40
|
| Rate for Payer: United Healthcare Commercial |
$11.62
|
|
|
INJECTION, INCLISIRAN, 1 MG
|
Facility
|
OP
|
$12.23
|
|
|
Service Code
|
HCPCS J1306
|
| Hospital Charge Code |
636J130601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$33.74 |
| Rate for Payer: Aetna of VT Commercial |
$11.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$33.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$33.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$10.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$5.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9.72
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cigna Commercial |
$9.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$9.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$9.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.50
|
| Rate for Payer: Multiplan Commercial |
$11.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.50
|
| Rate for Payer: United Healthcare Commercial |
$11.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.50
|
| Rate for Payer: United Healthcare VA CCN |
$5.50
|
|
|
INJECTION, MEPOLIZUMAB, 1MG
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
637J218201
|
|
Hospital Revenue Code
|
637
|
| 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
|
|
|
INJECTION, MEPOLIZUMAB, 1MG
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
637J218201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$83.99 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$30.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$30.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$30.54
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.27
|
| Rate for Payer: United Healthcare Commercial |
$48.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.27
|
| Rate for Payer: United Healthcare VA CCN |
$31.27
|
|
|
INJECTION, MEPOLIZUMAB, 1MG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
637J218201
|
|
Hospital Revenue Code
|
637
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
INJECT SACROILIAC JOINT
|
Facility
|
OP
|
$885.10
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
3202709601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$392.01 |
| Max. Negotiated Rate |
$840.85 |
| Rate for Payer: Aetna of VT Commercial |
$840.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$792.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$392.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$792.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$532.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$752.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$716.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$398.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$703.65
|
| Rate for Payer: Cash Price |
$442.55
|
| Rate for Payer: Cigna Commercial |
$708.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$708.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$708.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$398.30
|
| Rate for Payer: Multiplan Commercial |
$823.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$752.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$398.30
|
| Rate for Payer: United Healthcare Commercial |
$840.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$398.30
|
| Rate for Payer: United Healthcare VA CCN |
$398.30
|
|
|
INJECT SACROILIAC JOINT
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
9822709601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$258.29 |
| Max. Negotiated Rate |
$331.55 |
| Rate for Payer: Aetna of VT Commercial |
$331.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$296.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$293.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$279.20
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna Commercial |
$279.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$279.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$279.20
|
| Rate for Payer: Multiplan Commercial |
$324.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$296.65
|
| Rate for Payer: United Healthcare Commercial |
$331.55
|
|
|
INJECT SACROILIAC JOINT
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
9822709601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$154.57 |
| Max. Negotiated Rate |
$331.55 |
| Rate for Payer: Aetna of VT Commercial |
$331.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$312.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$154.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$312.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$210.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$296.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$282.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$157.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$277.45
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna Commercial |
$279.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$279.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$279.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$157.05
|
| Rate for Payer: Multiplan Commercial |
$324.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$296.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$157.05
|
| Rate for Payer: United Healthcare Commercial |
$331.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.05
|
| Rate for Payer: United Healthcare VA CCN |
$157.05
|
|
|
INJECT SACROILIAC JOINT
|
Facility
|
IP
|
$885.10
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
3202709601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$655.06 |
| Max. Negotiated Rate |
$840.85 |
| Rate for Payer: Aetna of VT Commercial |
$840.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$655.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$655.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$752.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$743.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$708.08
|
| Rate for Payer: Cash Price |
$442.55
|
| Rate for Payer: Cigna Commercial |
$708.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$708.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$708.08
|
| Rate for Payer: Multiplan Commercial |
$823.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$752.34
|
| Rate for Payer: United Healthcare Commercial |
$840.85
|
|
|
INJECT SACROILIAC JOINT
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
9822709601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$78.33 |
| Max. Negotiated Rate |
$409.35 |
| Rate for Payer: Aetna of VT Commercial |
$328.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$312.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$80.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$312.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$109.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$409.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$409.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$90.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$409.35
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna Commercial |
$148.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$253.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$253.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$156.06
|
| Rate for Payer: Multiplan Commercial |
$324.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$111.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$78.33
|
| Rate for Payer: United Healthcare Commercial |
$120.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.33
|
| Rate for Payer: United Healthcare VA CCN |
$78.33
|
|
|
INJECT SKIN LESIONS </W 7
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
9601190002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$27.62 |
| Max. Negotiated Rate |
$149.46 |
| Rate for Payer: Aetna of VT Commercial |
$149.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$142.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$142.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$38.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$74.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$74.64
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$31.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$147.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$27.62
|
| Rate for Payer: United Healthcare Commercial |
$42.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.62
|
| Rate for Payer: United Healthcare VA CCN |
$27.62
|
|
|
INJECT SKIN LESIONS </W 7
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
5101190001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.62 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna of VT Commercial |
$76.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$38.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$74.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$74.64
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$31.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$75.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$27.62
|
| Rate for Payer: United Healthcare Commercial |
$42.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.62
|
| Rate for Payer: United Healthcare VA CCN |
$27.62
|
|
|
INJECT SKIN LESIONS </W 7
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
9601190002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$117.68 |
| Max. Negotiated Rate |
$151.05 |
| Rate for Payer: Aetna of VT Commercial |
$151.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$117.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$117.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$133.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$127.20
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$127.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$127.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$127.20
|
| Rate for Payer: Multiplan Commercial |
$147.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.15
|
| Rate for Payer: United Healthcare Commercial |
$151.05
|
|
|
INJECT SKIN LESIONS </W 7
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
9601190001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$27.62 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna of VT Commercial |
$225.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$215.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$215.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$38.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$74.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$74.64
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$31.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$27.62
|
| Rate for Payer: United Healthcare Commercial |
$42.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.62
|
| Rate for Payer: United Healthcare VA CCN |
$27.62
|
|
|
INJECT SKIN LESIONS </W 7
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
9601190001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$106.30 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna of VT Commercial |
$228.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$215.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$106.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$215.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$144.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$194.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$108.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$190.80
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$192.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$192.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$192.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$204.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$108.00
|
| Rate for Payer: United Healthcare Commercial |
$228.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.00
|
| Rate for Payer: United Healthcare VA CCN |
$108.00
|
|
|
INJECT SKIN LESIONS </W 7
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
9601190001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$177.62 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna of VT Commercial |
$228.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$177.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$177.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$201.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$192.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$192.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$192.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$192.00
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$204.00
|
| Rate for Payer: United Healthcare Commercial |
$228.00
|
|
|
INJECT SKIN LESIONS </W 7
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
5101190001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.87 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Aetna of VT Commercial |
$76.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$48.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.39
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$64.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.45
|
| Rate for Payer: Multiplan Commercial |
$75.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.45
|
| Rate for Payer: United Healthcare Commercial |
$76.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.45
|
| Rate for Payer: United Healthcare VA CCN |
$36.45
|
|
|
INJECT SKIN LESIONS </W 7
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
5101190001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.95 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Aetna of VT Commercial |
$76.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.80
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$64.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$75.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.85
|
| Rate for Payer: United Healthcare Commercial |
$76.95
|
|
|
INJECT SKIN LESIONS </W 7
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
9601190002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$70.42 |
| Max. Negotiated Rate |
$151.05 |
| Rate for Payer: Aetna of VT Commercial |
$151.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$142.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$70.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$142.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$95.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$128.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$126.41
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$127.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$127.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$127.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$71.55
|
| Rate for Payer: Multiplan Commercial |
$147.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$71.55
|
| Rate for Payer: United Healthcare Commercial |
$151.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.55
|
| Rate for Payer: United Healthcare VA CCN |
$71.55
|
|
|
INJECT TRIGGER POINTS 3/>
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
9822055301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$38.77 |
| Max. Negotiated Rate |
$194.58 |
| Rate for Payer: Aetna of VT Commercial |
$194.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$185.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$185.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$91.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$91.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$91.07
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$74.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$93.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$93.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$57.08
|
| Rate for Payer: Multiplan Commercial |
$192.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.77
|
| Rate for Payer: United Healthcare Commercial |
$59.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.77
|
| Rate for Payer: United Healthcare VA CCN |
$38.77
|
|
|
INJECT TRIGGER POINTS 3/>
|
Professional
|
Both
|
$561.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
9602055301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$38.77 |
| Max. Negotiated Rate |
$527.34 |
| Rate for Payer: Aetna of VT Commercial |
$527.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$502.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$502.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$91.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$91.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$91.07
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cigna Commercial |
$74.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$93.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$93.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$57.08
|
| Rate for Payer: Multiplan Commercial |
$521.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.77
|
| Rate for Payer: United Healthcare Commercial |
$59.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.77
|
| Rate for Payer: United Healthcare VA CCN |
$38.77
|
|
