|
METHYLPRED ACETATE 40MG/ML
|
Professional
|
Both
|
$62.26
|
|
|
Service Code
|
HCPCS J1030
|
| Hospital Charge Code |
636J103001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$58.52 |
| Rate for Payer: Aetna of VT Commercial |
$58.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$55.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$55.78
|
| Rate for Payer: Cash Price |
$31.13
|
| Rate for Payer: Cash Price |
$31.13
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.42
|
| Rate for Payer: Multiplan Commercial |
$57.90
|
| Rate for Payer: United Healthcare Commercial |
$52.92
|
| Rate for Payer: United Healthcare VA CCN |
$24.90
|
|
|
METHYLPRED ACETATE 40MG/MLVIAL
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
636J101001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.30
|
|
|
METHYLPRED ACETATE 40MG/MLVIAL
|
Professional
|
Both
|
$62.26
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
636J101001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$58.52 |
| Rate for Payer: Aetna of VT Commercial |
$58.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.14
|
| Rate for Payer: Cash Price |
$31.13
|
| Rate for Payer: Cash Price |
$31.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$57.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.12
|
| Rate for Payer: United Healthcare Commercial |
$0.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.12
|
| Rate for Payer: United Healthcare VA CCN |
$0.12
|
|
|
METHYLPRED ACETATE 80 MG/ML
|
Professional
|
Both
|
$40.41
|
|
|
Service Code
|
HCPCS J1040
|
| Hospital Charge Code |
636J104001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$37.99 |
| Rate for Payer: Aetna of VT Commercial |
$37.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$36.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$36.20
|
| Rate for Payer: Cash Price |
$20.20
|
| Rate for Payer: Cash Price |
$20.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$37.58
|
| Rate for Payer: United Healthcare Commercial |
$34.35
|
| Rate for Payer: United Healthcare VA CCN |
$16.16
|
|
|
METHYLPRED ACETATE 80MG/MLVIAL
|
Professional
|
Both
|
$40.41
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
636J101002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$37.99 |
| Rate for Payer: Aetna of VT Commercial |
$37.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.14
|
| Rate for Payer: Cash Price |
$20.20
|
| Rate for Payer: Cash Price |
$20.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$37.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.12
|
| Rate for Payer: United Healthcare Commercial |
$0.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.12
|
| Rate for Payer: United Healthcare VA CCN |
$0.12
|
|
|
METHYLPREDNISOLONE 4 MG TAB
|
Professional
|
Both
|
$1.29
|
|
|
Service Code
|
HCPCS J5709
|
| Hospital Charge Code |
636J570901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Aetna of VT Commercial |
$1.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.16
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$1.10
|
| Rate for Payer: United Healthcare VA CCN |
$0.52
|
|
|
METHYLPREDNISOLONE 4 MG TAB
|
Facility
|
IP
|
$1.29
|
|
|
Service Code
|
HCPCS J5709
|
| Hospital Charge Code |
636J570901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of VT Commercial |
$1.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.03
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Cigna Commercial |
$1.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.10
|
| Rate for Payer: United Healthcare Commercial |
$1.23
|
|
|
METHYLPREDNISOLONE 4 MG TAB
|
Facility
|
OP
|
$1.29
|
|
|
Service Code
|
HCPCS J5709
|
| Hospital Charge Code |
636J570901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of VT Commercial |
$1.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.03
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Cigna Commercial |
$1.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.58
|
| Rate for Payer: United Healthcare Commercial |
$1.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.58
|
| Rate for Payer: United Healthcare VA CCN |
$0.58
|
|
|
METHYLPREDNISOLONE ORAL
|
Professional
|
Both
|
$1.13
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
636J750901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Aetna of VT Commercial |
$1.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.13
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.11
|
| Rate for Payer: United Healthcare Commercial |
$0.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.11
|
| Rate for Payer: United Healthcare VA CCN |
$0.11
|
|
|
METHYLPREDNISOLONE ORAL
|
Facility
|
OP
|
$0.66
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
636J750901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.66
|
|
|
METOCLOPRAMIDE 10 MG/2 ML VIAL
|
Facility
|
IP
|
$5.13
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
636J276501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Aetna of VT Commercial |
$4.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.10
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cigna Commercial |
$4.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.10
|
| Rate for Payer: Multiplan Commercial |
$4.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.36
|
| Rate for Payer: United Healthcare Commercial |
$4.87
|
|
|
METOCLOPRAMIDE 10 MG/2 ML VIAL
|
Facility
|
OP
|
$5.13
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
636J276501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Aetna of VT Commercial |
$4.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.08
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cigna Commercial |
$4.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.31
|
| Rate for Payer: Multiplan Commercial |
$4.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.31
|
| Rate for Payer: United Healthcare Commercial |
$4.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.31
|
| Rate for Payer: United Healthcare VA CCN |
$2.31
|
|
|
METOCLOPRAMIDE 10 MG/2 ML VIAL
|
Professional
|
Both
|
$5.13
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
636J276501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna of VT Commercial |
$4.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.25
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$4.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.09
|
| Rate for Payer: United Healthcare Commercial |
$1.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.09
|
| Rate for Payer: United Healthcare VA CCN |
$1.09
|
|
|
METRONIDAZ 500MG/100ML PREMIX
|
Facility
|
IP
|
$5.23
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
636J183602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of VT Commercial |
$4.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.18
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Cigna Commercial |
$4.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.18
|
| Rate for Payer: Multiplan Commercial |
$4.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.45
|
| Rate for Payer: United Healthcare Commercial |
$4.97
|
|
|
METRONIDAZ 500MG/100ML PREMIX
|
Facility
|
OP
|
$5.23
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
636J183602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of VT Commercial |
$4.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.16
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Cigna Commercial |
$4.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$4.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.35
|
| Rate for Payer: United Healthcare Commercial |
$4.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.35
|
| Rate for Payer: United Healthcare VA CCN |
$2.35
|
|
|
M. GENITALIUM AMP PROBE
|
Professional
|
Both
|
$170.87
|
|
|
Service Code
|
CPT 87563
|
| Hospital Charge Code |
3008756301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$160.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$45.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$45.50
|
| Rate for Payer: Cash Price |
$85.44
|
| Rate for Payer: Cash Price |
$85.44
|
| Rate for Payer: Cigna Commercial |
$42.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$35.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$35.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.60
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$53.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$35.09
|
|
|
M. GENITALIUM AMP PROBE
|
Facility
|
OP
|
$170.87
|
|
|
Service Code
|
CPT 87563
|
| Hospital Charge Code |
3008756301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$162.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$75.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$102.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$138.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.84
|
| Rate for Payer: Cash Price |
$85.44
|
| Rate for Payer: Cash Price |
$85.44
|
| Rate for Payer: Cigna Commercial |
$136.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.89
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.89
|
| Rate for Payer: United Healthcare Commercial |
$162.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$76.89
|
|
|
M. GENITALIUM AMP PROBE
|
Facility
|
IP
|
$170.87
|
|
|
Service Code
|
CPT 87563
|
| Hospital Charge Code |
3008756301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.46 |
| Max. Negotiated Rate |
$162.33 |
| Rate for Payer: Aetna of VT Commercial |
$162.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$143.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$136.70
|
| Rate for Payer: Cash Price |
$85.44
|
| Rate for Payer: Cigna Commercial |
$136.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.70
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.24
|
| Rate for Payer: United Healthcare Commercial |
$162.33
|
|
|
MICROSOMAL ANTIBODIES EACH
|
Facility
|
OP
|
$217.14
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
3008637601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$206.28 |
| Rate for Payer: Aetna of VT Commercial |
$206.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$96.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$130.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$175.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$172.63
|
| Rate for Payer: Cash Price |
$108.57
|
| Rate for Payer: Cash Price |
$108.57
|
| Rate for Payer: Cigna Commercial |
$173.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$173.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$173.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$97.71
|
| Rate for Payer: Multiplan Commercial |
$201.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$184.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$97.71
|
| Rate for Payer: United Healthcare Commercial |
$206.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.55
|
| Rate for Payer: United Healthcare VA CCN |
$97.71
|
|
|
MICROSOMAL ANTIBODIES EACH
|
Facility
|
IP
|
$217.14
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
3008637601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$160.71 |
| Max. Negotiated Rate |
$206.28 |
| Rate for Payer: Aetna of VT Commercial |
$206.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$182.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$173.71
|
| Rate for Payer: Cash Price |
$108.57
|
| Rate for Payer: Cigna Commercial |
$173.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$173.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$173.71
|
| Rate for Payer: Multiplan Commercial |
$201.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$184.57
|
| Rate for Payer: United Healthcare Commercial |
$206.28
|
|
|
MICROSOMAL ANTIBODIES EACH
|
Professional
|
Both
|
$217.14
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
3008637601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$204.11 |
| Rate for Payer: Aetna of VT Commercial |
$204.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$24.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$24.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.87
|
| Rate for Payer: Cash Price |
$108.57
|
| Rate for Payer: Cash Price |
$108.57
|
| Rate for Payer: Cigna Commercial |
$17.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.35
|
| Rate for Payer: Multiplan Commercial |
$201.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.55
|
| Rate for Payer: United Healthcare Commercial |
$22.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.55
|
| Rate for Payer: United Healthcare VA CCN |
$14.55
|
|
|
MIRENA (LEVONORGESTREL) IUD
|
Facility
|
OP
|
$3,340.23
|
|
|
Service Code
|
HCPCS J7298
|
| Hospital Charge Code |
636J729801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,340.23 |
| Max. Negotiated Rate |
$3,340.23 |
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,340.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,340.23
|
|
|
MIRENA (LEVONORGESTREL) IUD
|
Professional
|
Both
|
$4,339.66
|
|
|
Service Code
|
HCPCS J7298
|
| Hospital Charge Code |
636J729801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,101.00 |
| Max. Negotiated Rate |
$4,079.28 |
| Rate for Payer: Aetna of VT Commercial |
$4,079.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,340.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,340.23
|
| Rate for Payer: Cash Price |
$2,169.83
|
| Rate for Payer: Cash Price |
$2,169.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,179.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,179.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,384.68
|
| Rate for Payer: Multiplan Commercial |
$4,035.88
|
| Rate for Payer: United Healthcare Commercial |
$3,688.71
|
| Rate for Payer: United Healthcare VA CCN |
$1,101.00
|
|
|
MIS FEMDISCUTBI-CT-GMK-RM-#1+
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
2720074661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna of VT Commercial |
$98.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$46.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$88.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.68
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$83.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$83.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$83.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$96.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$88.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.80
|
| Rate for Payer: United Healthcare Commercial |
$98.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.80
|
| Rate for Payer: United Healthcare VA CCN |
$46.80
|
|
|
MIS FEMDISCUTBI-CT-GMK-RM-#1+
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
2720074661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.97 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna of VT Commercial |
$98.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$76.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$76.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$88.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.20
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$83.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$83.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$96.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$88.40
|
| Rate for Payer: United Healthcare Commercial |
$98.80
|
|
