|
IVIG 10% 10 GRAMS/100 ML *340B
|
Facility
|
OP
|
$2,991.15
|
|
|
Service Code
|
NDC 4420643791
|
| Hospital Charge Code |
636J145908
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,324.78 |
| Max. Negotiated Rate |
$2,841.59 |
| Rate for Payer: Aetna of VT Commercial |
$2,841.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,679.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,324.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,679.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,800.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,542.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,422.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,346.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,377.96
|
| Rate for Payer: Cash Price |
$1,495.58
|
| Rate for Payer: Cigna Commercial |
$2,392.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,392.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,392.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,346.02
|
| Rate for Payer: Multiplan Commercial |
$2,781.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,542.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,346.02
|
| Rate for Payer: United Healthcare Commercial |
$2,841.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,346.02
|
| Rate for Payer: United Healthcare VA CCN |
$1,346.02
|
|
|
IVIG 10% 10 GRAMS/100 ML *340B
|
Facility
|
IP
|
$2,991.15
|
|
|
Service Code
|
NDC 4420643791
|
| Hospital Charge Code |
636J145908
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,213.75 |
| Max. Negotiated Rate |
$2,841.59 |
| Rate for Payer: Aetna of VT Commercial |
$2,841.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,213.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,213.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,542.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,512.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,392.92
|
| Rate for Payer: Cash Price |
$1,495.58
|
| Rate for Payer: Cigna Commercial |
$2,392.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,392.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,392.92
|
| Rate for Payer: Multiplan Commercial |
$2,781.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,542.48
|
| Rate for Payer: United Healthcare Commercial |
$2,841.59
|
|
|
IV INF HYDRATION EA ADDL HOUR
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
9819636102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$33.84 |
| Rate for Payer: Aetna of VT Commercial |
$33.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$23.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$23.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$23.54
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$14.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.43
|
| Rate for Payer: Multiplan Commercial |
$33.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.43
|
| Rate for Payer: United Healthcare Commercial |
$17.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.43
|
| Rate for Payer: United Healthcare VA CCN |
$11.43
|
|
|
IV INF HYDRATION EA ADDL HOUR
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
9819636102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of VT Commercial |
$34.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$21.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$29.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.62
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$28.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$33.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.20
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.20
|
| Rate for Payer: United Healthcare VA CCN |
$16.20
|
|
|
IV INF HYDRATION EA ADDL HOUR
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
9819636101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| 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 |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| 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: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
IV INF HYDRATION EA ADDL HOUR
|
Facility
|
OP
|
$170.61
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
4509636101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.56 |
| Max. Negotiated Rate |
$162.08 |
| Rate for Payer: Aetna of VT Commercial |
$162.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$152.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$75.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$152.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$102.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$138.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.63
|
| Rate for Payer: Cash Price |
$85.31
|
| Rate for Payer: Cigna Commercial |
$136.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.77
|
| Rate for Payer: Multiplan Commercial |
$158.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.77
|
| Rate for Payer: United Healthcare Commercial |
$162.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.77
|
| Rate for Payer: United Healthcare VA CCN |
$76.77
|
|
|
IV INF HYDRATION EA ADDL HOUR
|
Facility
|
OP
|
$170.61
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
2609636101
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$75.56 |
| Max. Negotiated Rate |
$162.08 |
| Rate for Payer: Aetna of VT Commercial |
$162.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$152.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$75.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$152.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$102.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$138.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.63
|
| Rate for Payer: Cash Price |
$85.31
|
| Rate for Payer: Cigna Commercial |
$136.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.77
|
| Rate for Payer: Multiplan Commercial |
$158.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.77
|
| Rate for Payer: United Healthcare Commercial |
$162.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.77
|
| Rate for Payer: United Healthcare VA CCN |
$76.77
|
|
|
IV INF HYDRATION EA ADDL HOUR
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
9819636102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$26.64 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of VT Commercial |
$34.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$26.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$26.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$28.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$33.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.60
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
|
|
IV INF HYDRATION EA ADDL HOUR
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
9819636101
|
|
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
|
|
|
IV INF HYDRATION EA ADDL HOUR
|
Facility
|
IP
|
$170.61
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
4509636101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$126.27 |
| Max. Negotiated Rate |
$162.08 |
| Rate for Payer: Aetna of VT Commercial |
$162.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$143.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$136.49
|
| Rate for Payer: Cash Price |
$85.31
|
| Rate for Payer: Cigna Commercial |
$136.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.49
|
| Rate for Payer: Multiplan Commercial |
$158.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.02
|
| Rate for Payer: United Healthcare Commercial |
$162.08
|
|
|
IV INF HYDRATION EA ADDL HOUR
|
Facility
|
IP
|
$170.61
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
2609636101
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$126.27 |
| Max. Negotiated Rate |
$162.08 |
| Rate for Payer: Aetna of VT Commercial |
$162.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$143.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$136.49
|
| Rate for Payer: Cash Price |
$85.31
|
| Rate for Payer: Cigna Commercial |
$136.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.49
|
| Rate for Payer: Multiplan Commercial |
$158.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.02
|
| Rate for Payer: United Healthcare Commercial |
$162.08
|
|
|
IV INF HYDRATION EA ADDL HOUR
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
9819636101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$23.54 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$23.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$23.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$23.54
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$14.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.43
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.43
|
| Rate for Payer: United Healthcare Commercial |
$17.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.43
|
| Rate for Payer: United Healthcare VA CCN |
$11.43
|
|
|
IV INF HYDRATION INIT 31-60MIN
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
9819636002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$144.32 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Aetna of VT Commercial |
$185.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$144.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$144.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$163.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$156.00
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$156.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$156.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$181.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.75
|
| Rate for Payer: United Healthcare Commercial |
$185.25
|
|
|
IV INF HYDRATION INIT 31-60MIN
|
Facility
|
OP
|
$342.46
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
4509636001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.68 |
| Max. Negotiated Rate |
$325.34 |
| Rate for Payer: Aetna of VT Commercial |
$325.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$306.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$151.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$306.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$206.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$291.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$277.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$154.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$272.26
|
| Rate for Payer: Cash Price |
$171.23
|
| Rate for Payer: Cigna Commercial |
$273.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$273.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$273.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$154.11
|
| Rate for Payer: Multiplan Commercial |
$318.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$291.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$154.11
|
| Rate for Payer: United Healthcare Commercial |
$325.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.11
|
| Rate for Payer: United Healthcare VA CCN |
$154.11
|
|
|
IV INF HYDRATION INIT 31-60MIN
|
Facility
|
IP
|
$342.46
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
2609636001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$253.45 |
| Max. Negotiated Rate |
$325.34 |
| Rate for Payer: Aetna of VT Commercial |
$325.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$253.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$253.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$291.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$287.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$273.97
|
| Rate for Payer: Cash Price |
$171.23
|
| Rate for Payer: Cigna Commercial |
$273.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$273.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$273.97
|
| Rate for Payer: Multiplan Commercial |
$318.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$291.09
|
| Rate for Payer: United Healthcare Commercial |
$325.34
|
|
|
IV INF HYDRATION INIT 31-60MIN
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
9819636001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| 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 |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| 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: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
IV INF HYDRATION INIT 31-60MIN
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
9819636001
|
|
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
|
|
|
IV INF HYDRATION INIT 31-60MIN
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
9819636002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$86.37 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Aetna of VT Commercial |
$185.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$174.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$86.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$174.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$117.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$157.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$87.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.03
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$156.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$156.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$156.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$87.75
|
| Rate for Payer: Multiplan Commercial |
$181.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$87.75
|
| Rate for Payer: United Healthcare Commercial |
$185.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.75
|
| Rate for Payer: United Healthcare VA CCN |
$87.75
|
|
|
IV INF HYDRATION INIT 31-60MIN
|
Facility
|
OP
|
$342.46
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
2609636001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$151.68 |
| Max. Negotiated Rate |
$325.34 |
| Rate for Payer: Aetna of VT Commercial |
$325.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$306.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$151.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$306.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$206.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$291.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$277.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$154.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$272.26
|
| Rate for Payer: Cash Price |
$171.23
|
| Rate for Payer: Cigna Commercial |
$273.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$273.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$273.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$154.11
|
| Rate for Payer: Multiplan Commercial |
$318.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$291.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$154.11
|
| Rate for Payer: United Healthcare Commercial |
$325.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.11
|
| Rate for Payer: United Healthcare VA CCN |
$154.11
|
|
|
IV INF HYDRATION INIT 31-60MIN
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
9819636001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$61.02 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$30.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$41.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$61.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$61.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$34.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$61.02
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$37.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$47.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$47.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.75
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$29.76
|
| Rate for Payer: United Healthcare Commercial |
$45.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.76
|
| Rate for Payer: United Healthcare VA CCN |
$29.76
|
|
|
IV INF HYDRATION INIT 31-60MIN
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
9819636002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$183.30 |
| Rate for Payer: Aetna of VT Commercial |
$183.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$174.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$30.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$174.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$41.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$61.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$61.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$34.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$61.02
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$37.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$47.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$47.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.75
|
| Rate for Payer: Multiplan Commercial |
$181.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$29.76
|
| Rate for Payer: United Healthcare Commercial |
$45.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.76
|
| Rate for Payer: United Healthcare VA CCN |
$29.76
|
|
|
IV INF HYDRATION INIT 31-60MIN
|
Facility
|
IP
|
$342.46
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
4509636001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$253.45 |
| Max. Negotiated Rate |
$325.34 |
| Rate for Payer: Aetna of VT Commercial |
$325.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$253.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$253.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$291.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$287.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$273.97
|
| Rate for Payer: Cash Price |
$171.23
|
| Rate for Payer: Cigna Commercial |
$273.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$273.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$273.97
|
| Rate for Payer: Multiplan Commercial |
$318.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$291.09
|
| Rate for Payer: United Healthcare Commercial |
$325.34
|
|
|
IV INF THERAP/PROPH EA ADDL HR
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
9819636601
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| 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 |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| 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: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
IV INF THERAP/PROPH EA ADDL HR
|
Facility
|
OP
|
$224.38
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
2609636601
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$99.38 |
| Max. Negotiated Rate |
$213.16 |
| Rate for Payer: Aetna of VT Commercial |
$213.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$201.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$99.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$201.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$135.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$190.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$181.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$100.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$178.38
|
| Rate for Payer: Cash Price |
$112.19
|
| Rate for Payer: Cigna Commercial |
$179.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$179.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$179.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$100.97
|
| Rate for Payer: Multiplan Commercial |
$208.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$190.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.97
|
| Rate for Payer: United Healthcare Commercial |
$213.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Healthcare VA CCN |
$100.97
|
|
|
IV INF THERAP/PROPH EA ADDL HR
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
9819636602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$107.16 |
| Rate for Payer: Aetna of VT Commercial |
$107.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$26.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$31.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$31.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$22.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$31.90
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$23.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$30.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$30.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.16
|
| Rate for Payer: Multiplan Commercial |
$106.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.16
|
| Rate for Payer: United Healthcare Commercial |
$29.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.16
|
| Rate for Payer: United Healthcare VA CCN |
$19.16
|
|
