|
IV INF THERAP/PROPH EA ADDL HR
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
9819636602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$50.49 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Aetna of VT Commercial |
$108.30
|
| 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 |
$50.49
|
| 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 |
$68.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$90.63
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$91.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$51.30
|
| Rate for Payer: Multiplan Commercial |
$106.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.30
|
| Rate for Payer: United Healthcare Commercial |
$108.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.30
|
| Rate for Payer: United Healthcare VA CCN |
$51.30
|
|
|
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
|
|
|
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
|
$1.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
9819636601
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$31.90 |
| 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 |
$19.73
|
| 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 |
$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 |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| 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 |
$0.93
|
| 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
|
|
|
IV INF THERAP/PROPH EA ADDL HR
|
Facility
|
IP
|
$224.38
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
2609636601
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$166.06 |
| 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 |
$166.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$166.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$190.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$188.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$179.50
|
| 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: Multiplan Commercial |
$208.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$190.72
|
| Rate for Payer: United Healthcare Commercial |
$213.16
|
|
|
IV INF THERAPY ADDL SEQ =<1HR
|
Facility
|
OP
|
$233.68
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
2609636701
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Aetna of VT Commercial |
$222.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$209.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$209.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$140.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$189.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$105.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$185.78
|
| Rate for Payer: Cash Price |
$116.84
|
| Rate for Payer: Cigna Commercial |
$186.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$186.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$186.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$105.16
|
| Rate for Payer: Multiplan Commercial |
$217.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.16
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.16
|
| Rate for Payer: United Healthcare VA CCN |
$105.16
|
|
|
IV INF THERAPY ADDL SEQ =<1HR
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
9819636702
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$97.69 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna of VT Commercial |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$105.60
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.60
|
| Rate for Payer: Multiplan Commercial |
$122.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.20
|
| Rate for Payer: United Healthcare Commercial |
$125.40
|
|
|
IV INF THERAPY ADDL SEQ =<1HR
|
Facility
|
IP
|
$233.68
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
2609636701
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$172.95 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Aetna of VT Commercial |
$222.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$186.94
|
| Rate for Payer: Cash Price |
$116.84
|
| Rate for Payer: Cigna Commercial |
$186.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$186.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$186.94
|
| Rate for Payer: Multiplan Commercial |
$217.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.63
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
IV INF THERAPY ADDL SEQ =<1HR
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
9819636701
|
|
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 THERAPY ADDL SEQ =<1HR
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
9819636701
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$49.27 |
| 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 |
$27.02
|
| 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 |
$36.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$49.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$49.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$49.27
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$32.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.22
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.23
|
| Rate for Payer: United Healthcare Commercial |
$40.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.23
|
| Rate for Payer: United Healthcare VA CCN |
$26.23
|
|
|
IV INF THERAPY ADDL SEQ =<1HR
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
9819636702
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$124.08 |
| Rate for Payer: Aetna of VT Commercial |
$124.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$36.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$49.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$49.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$49.27
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$32.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.22
|
| Rate for Payer: Multiplan Commercial |
$122.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.23
|
| Rate for Payer: United Healthcare Commercial |
$40.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.23
|
| Rate for Payer: United Healthcare VA CCN |
$26.23
|
|
|
IV INF THERAPY ADDL SEQ =<1HR
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
9819636701
|
|
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 THERAPY ADDL SEQ =<1HR
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
9819636702
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$58.46 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna of VT Commercial |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.94
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$59.40
|
| Rate for Payer: Multiplan Commercial |
$122.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.40
|
| Rate for Payer: United Healthcare Commercial |
$125.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.40
|
| Rate for Payer: United Healthcare VA CCN |
$59.40
|
|
|
IV INF THERAPY CONCURRENT INF
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
9819636801
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$29.32 |
| 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 |
$18.74
|
| 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 |
$25.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$20.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.88
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$22.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$29.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$29.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.19
|
| Rate for Payer: United Healthcare Commercial |
$27.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.19
|
| Rate for Payer: United Healthcare VA CCN |
$18.19
|
|
|
IV INF THERAPY CONCURRENT INF
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
9819636801
|
|
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 THERAPY CONCURRENT INF
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
9819636802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$73.32 |
| Rate for Payer: Aetna of VT Commercial |
$73.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$20.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.88
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$22.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$29.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$29.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.19
|
| Rate for Payer: United Healthcare Commercial |
$27.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.19
|
| Rate for Payer: United Healthcare VA CCN |
$18.19
|
|
|
IV INF THERAPY CONCURRENT INF
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
9819636801
|
|
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 THERAPY CONCURRENT INF
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
9819636802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$34.55 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.01
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.10
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare VA CCN |
$35.10
|
|
|
IV INF THERAPY CONCURRENT INF
|
Facility
|
OP
|
$316.40
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
2609636801
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$300.58 |
| Rate for Payer: Aetna of VT Commercial |
$300.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$283.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$140.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$283.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$190.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$268.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$256.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$251.54
|
| Rate for Payer: Cash Price |
$158.20
|
| Rate for Payer: Cigna Commercial |
$253.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$253.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$253.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.38
|
| Rate for Payer: Multiplan Commercial |
$294.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$268.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$142.38
|
| Rate for Payer: United Healthcare Commercial |
$300.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.38
|
| Rate for Payer: United Healthcare VA CCN |
$142.38
|
|
|
IV INF THERAPY CONCURRENT INF
|
Facility
|
IP
|
$316.40
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
2609636801
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$234.17 |
| Max. Negotiated Rate |
$300.58 |
| Rate for Payer: Aetna of VT Commercial |
$300.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$234.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$234.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$268.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$265.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$253.12
|
| Rate for Payer: Cash Price |
$158.20
|
| Rate for Payer: Cigna Commercial |
$253.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$253.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$253.12
|
| Rate for Payer: Multiplan Commercial |
$294.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$268.94
|
| Rate for Payer: United Healthcare Commercial |
$300.58
|
|
|
IV INF THERAPY CONCURRENT INF
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
9819636802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$57.73 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$57.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$57.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.40
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
|
|
IV INF THERAPY/PROPH DX =<1 HR
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
9819636502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$56.93 |
| Max. Negotiated Rate |
$299.86 |
| Rate for Payer: Aetna of VT Commercial |
$299.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$285.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$285.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$100.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$100.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$100.70
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna Commercial |
$71.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.93
|
| Rate for Payer: Multiplan Commercial |
$296.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.93
|
| Rate for Payer: United Healthcare Commercial |
$87.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.93
|
| Rate for Payer: United Healthcare VA CCN |
$56.93
|
|
|
IV INF THERAPY/PROPH DX =<1 HR
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
9819636502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$236.09 |
| Max. Negotiated Rate |
$303.05 |
| Rate for Payer: Aetna of VT Commercial |
$303.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$236.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$236.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$271.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$267.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$255.20
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna Commercial |
$255.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$255.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$255.20
|
| Rate for Payer: Multiplan Commercial |
$296.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$271.15
|
| Rate for Payer: United Healthcare Commercial |
$303.05
|
|
|
IV INF THERAPY/PROPH DX =<1 HR
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
9819636501
|
|
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 THERAPY/PROPH DX =<1 HR
|
Facility
|
IP
|
$649.35
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
2609636501
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$480.58 |
| Max. Negotiated Rate |
$616.88 |
| Rate for Payer: Aetna of VT Commercial |
$616.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$480.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$480.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$551.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$545.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$519.48
|
| Rate for Payer: Cash Price |
$324.68
|
| Rate for Payer: Cigna Commercial |
$519.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$519.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$519.48
|
| Rate for Payer: Multiplan Commercial |
$603.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$551.95
|
| Rate for Payer: United Healthcare Commercial |
$616.88
|
|
