|
MIS FEMDISCUTBL-CT-GMK-LM-#3+
|
Facility
|
OP
|
$103.40
|
|
| Hospital Charge Code |
2720072151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$98.23 |
| Rate for Payer: Aetna of VT Commercial |
$98.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$83.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.20
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna Commercial |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.53
|
| Rate for Payer: Multiplan Commercial |
$96.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.53
|
| Rate for Payer: United Healthcare Commercial |
$98.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.53
|
| Rate for Payer: United Healthcare VA CCN |
$46.53
|
|
|
MIS FEMDISCUTBL-CT-GMK-LM-#3+
|
Facility
|
IP
|
$103.40
|
|
| Hospital Charge Code |
2720072151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.53 |
| Max. Negotiated Rate |
$98.23 |
| Rate for Payer: Aetna of VT Commercial |
$98.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$76.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$76.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$86.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.72
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna Commercial |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.72
|
| Rate for Payer: Multiplan Commercial |
$96.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.89
|
| Rate for Payer: United Healthcare Commercial |
$98.23
|
|
|
MIS FEMDISCUTBL-CT-GMK-LM-#5
|
Facility
|
IP
|
$491.15
|
|
| Hospital Charge Code |
2720055561
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$363.50 |
| Max. Negotiated Rate |
$466.59 |
| Rate for Payer: Aetna of VT Commercial |
$466.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$363.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$363.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$417.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$412.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$392.92
|
| Rate for Payer: Cash Price |
$245.57
|
| Rate for Payer: Cigna Commercial |
$392.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$392.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$392.92
|
| Rate for Payer: Multiplan Commercial |
$456.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$417.48
|
| Rate for Payer: United Healthcare Commercial |
$466.59
|
|
|
MIS FEMDISCUTBL-CT-GMK-LM-#5
|
Facility
|
OP
|
$491.15
|
|
| Hospital Charge Code |
2720055561
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.53 |
| Max. Negotiated Rate |
$466.59 |
| Rate for Payer: Aetna of VT Commercial |
$466.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$440.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$217.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$440.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$295.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$417.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$397.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$221.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$390.46
|
| Rate for Payer: Cash Price |
$245.57
|
| Rate for Payer: Cigna Commercial |
$392.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$392.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$392.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$221.02
|
| Rate for Payer: Multiplan Commercial |
$456.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$417.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$221.02
|
| Rate for Payer: United Healthcare Commercial |
$466.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$221.02
|
| Rate for Payer: United Healthcare VA CCN |
$221.02
|
|
|
MIS FEMDISCUTBL-CT-GMK-LM-#5-S
|
Facility
|
OP
|
$103.40
|
|
| Hospital Charge Code |
2720071991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$98.23 |
| Rate for Payer: Aetna of VT Commercial |
$98.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$83.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.20
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna Commercial |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.53
|
| Rate for Payer: Multiplan Commercial |
$96.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.53
|
| Rate for Payer: United Healthcare Commercial |
$98.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.53
|
| Rate for Payer: United Healthcare VA CCN |
$46.53
|
|
|
MIS FEMDISCUTBL-CT-GMK-LM-#5-S
|
Facility
|
IP
|
$103.40
|
|
| Hospital Charge Code |
2720071991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.53 |
| Max. Negotiated Rate |
$98.23 |
| Rate for Payer: Aetna of VT Commercial |
$98.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$76.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$76.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$86.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.72
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna Commercial |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.72
|
| Rate for Payer: Multiplan Commercial |
$96.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.89
|
| Rate for Payer: United Healthcare Commercial |
$98.23
|
|
|
MIS FEMDISCUTBL-CT-GMK-LM-#6+
|
Facility
|
OP
|
$103.40
|
|
| Hospital Charge Code |
2720072111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$98.23 |
| Rate for Payer: Aetna of VT Commercial |
$98.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$83.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.20
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna Commercial |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.53
|
| Rate for Payer: Multiplan Commercial |
$96.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.53
|
| Rate for Payer: United Healthcare Commercial |
$98.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.53
|
| Rate for Payer: United Healthcare VA CCN |
$46.53
|
|
|
MIS FEMDISCUTBL-CT-GMK-LM-#6+
|
Facility
|
IP
|
$103.40
|
|
| Hospital Charge Code |
2720072111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.53 |
| Max. Negotiated Rate |
$98.23 |
| Rate for Payer: Aetna of VT Commercial |
$98.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$76.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$76.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$86.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.72
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna Commercial |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.72
|
| Rate for Payer: Multiplan Commercial |
$96.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.89
|
| Rate for Payer: United Healthcare Commercial |
$98.23
|
|
|
MIS FEMDISCUTBL-CT-GMK-RM-#2
|
Facility
|
IP
|
$475.00
|
|
| Hospital Charge Code |
2720074081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$351.55 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Aetna of VT Commercial |
$451.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$351.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$351.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$399.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$380.00
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$380.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$380.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$380.00
|
| Rate for Payer: Multiplan Commercial |
$441.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$403.75
|
| Rate for Payer: United Healthcare Commercial |
$451.25
|
|
|
MIS FEMDISCUTBL-CT-GMK-RM-#2
|
Facility
|
OP
|
$475.00
|
|
| Hospital Charge Code |
2720074081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.38 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Aetna of VT Commercial |
$451.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$425.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$425.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$285.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$384.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$213.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$377.62
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$380.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$380.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$380.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$213.75
|
| Rate for Payer: Multiplan Commercial |
$441.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$403.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$213.75
|
| Rate for Payer: United Healthcare Commercial |
$451.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$213.75
|
| Rate for Payer: United Healthcare VA CCN |
$213.75
|
|
|
MISFEMDISCUTBL-CT-GMK-RM-#6
|
Facility
|
OP
|
$147.50
|
|
| Hospital Charge Code |
2720073731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.33 |
| Max. Negotiated Rate |
$140.12 |
| Rate for Payer: Aetna of VT Commercial |
$140.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$132.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$65.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$132.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$88.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$125.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$119.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$66.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$117.26
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cigna Commercial |
$118.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$118.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$118.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$66.38
|
| Rate for Payer: Multiplan Commercial |
$137.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$125.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.38
|
| Rate for Payer: United Healthcare Commercial |
$140.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.38
|
| Rate for Payer: United Healthcare VA CCN |
$66.38
|
|
|
MISFEMDISCUTBL-CT-GMK-RM-#6
|
Facility
|
IP
|
$147.50
|
|
| Hospital Charge Code |
2720073731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.16 |
| Max. Negotiated Rate |
$140.12 |
| Rate for Payer: Aetna of VT Commercial |
$140.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$109.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$109.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$125.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$123.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$118.00
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cigna Commercial |
$118.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$118.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$118.00
|
| Rate for Payer: Multiplan Commercial |
$137.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$125.38
|
| Rate for Payer: United Healthcare Commercial |
$140.12
|
|
|
MIS FEMUR BONE MODEL LF MEDIAL
|
Facility
|
IP
|
$103.40
|
|
| Hospital Charge Code |
2720051951
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.53 |
| Max. Negotiated Rate |
$98.23 |
| Rate for Payer: Aetna of VT Commercial |
$98.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$76.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$76.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$86.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.72
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna Commercial |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.72
|
| Rate for Payer: Multiplan Commercial |
$96.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.89
|
| Rate for Payer: United Healthcare Commercial |
$98.23
|
|
|
MIS FEMUR BONE MODEL LF MEDIAL
|
Facility
|
OP
|
$103.40
|
|
| Hospital Charge Code |
2720051951
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$98.23 |
| Rate for Payer: Aetna of VT Commercial |
$98.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$83.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.20
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna Commercial |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.53
|
| Rate for Payer: Multiplan Commercial |
$96.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.53
|
| Rate for Payer: United Healthcare Commercial |
$98.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.53
|
| Rate for Payer: United Healthcare VA CCN |
$46.53
|
|
|
MIS TIB CUTBI-CT-GMK-LM-#3
|
Facility
|
IP
|
$103.40
|
|
| Hospital Charge Code |
2720051681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.53 |
| Max. Negotiated Rate |
$98.23 |
| Rate for Payer: Aetna of VT Commercial |
$98.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$76.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$76.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$86.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.72
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna Commercial |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.72
|
| Rate for Payer: Multiplan Commercial |
$96.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.89
|
| Rate for Payer: United Healthcare Commercial |
$98.23
|
|
|
MIS TIB CUTBI-CT-GMK-LM-#3
|
Facility
|
OP
|
$103.40
|
|
| Hospital Charge Code |
2720051681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$98.23 |
| Rate for Payer: Aetna of VT Commercial |
$98.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$83.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.20
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna Commercial |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.53
|
| Rate for Payer: Multiplan Commercial |
$96.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.53
|
| Rate for Payer: United Healthcare Commercial |
$98.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.53
|
| Rate for Payer: United Healthcare VA CCN |
$46.53
|
|
|
MIS TIBCUTBL-CT-GMK-LT-#4
|
Facility
|
IP
|
$103.40
|
|
| Hospital Charge Code |
2720072121
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.53 |
| Max. Negotiated Rate |
$98.23 |
| Rate for Payer: Aetna of VT Commercial |
$98.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$76.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$76.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$86.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.72
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna Commercial |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.72
|
| Rate for Payer: Multiplan Commercial |
$96.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.89
|
| Rate for Payer: United Healthcare Commercial |
$98.23
|
|
|
MIS TIBCUTBL-CT-GMK-LT-#4
|
Facility
|
OP
|
$103.40
|
|
| Hospital Charge Code |
2720072121
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$98.23 |
| Rate for Payer: Aetna of VT Commercial |
$98.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$83.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.20
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna Commercial |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.53
|
| Rate for Payer: Multiplan Commercial |
$96.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.53
|
| Rate for Payer: United Healthcare Commercial |
$98.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.53
|
| Rate for Payer: United Healthcare VA CCN |
$46.53
|
|
|
MIS TIBCUTBL-CT-GMK-RM#6
|
Facility
|
OP
|
$147.50
|
|
| Hospital Charge Code |
2720073721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.33 |
| Max. Negotiated Rate |
$140.12 |
| Rate for Payer: Aetna of VT Commercial |
$140.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$132.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$65.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$132.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$88.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$125.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$119.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$66.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$117.26
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cigna Commercial |
$118.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$118.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$118.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$66.38
|
| Rate for Payer: Multiplan Commercial |
$137.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$125.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.38
|
| Rate for Payer: United Healthcare Commercial |
$140.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.38
|
| Rate for Payer: United Healthcare VA CCN |
$66.38
|
|
|
MIS TIBCUTBL-CT-GMK-RM#6
|
Facility
|
IP
|
$147.50
|
|
| Hospital Charge Code |
2720073721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.16 |
| Max. Negotiated Rate |
$140.12 |
| Rate for Payer: Aetna of VT Commercial |
$140.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$109.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$109.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$125.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$123.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$118.00
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cigna Commercial |
$118.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$118.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$118.00
|
| Rate for Payer: Multiplan Commercial |
$137.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$125.38
|
| Rate for Payer: United Healthcare Commercial |
$140.12
|
|
|
MITOCHONDRIAL ANTIBODY EACH
|
Facility
|
OP
|
$206.80
|
|
|
Service Code
|
CPT 86381
|
| Hospital Charge Code |
3008638101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$196.46 |
| Rate for Payer: Aetna of VT Commercial |
$196.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$91.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$124.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$175.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$167.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$164.41
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cigna Commercial |
$165.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$165.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$165.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.06
|
| Rate for Payer: Multiplan Commercial |
$192.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$93.06
|
| Rate for Payer: United Healthcare Commercial |
$196.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: United Healthcare VA CCN |
$93.06
|
|
|
MITOCHONDRIAL ANTIBODY EACH
|
Facility
|
IP
|
$206.80
|
|
|
Service Code
|
CPT 86381
|
| Hospital Charge Code |
3008638101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.05 |
| Max. Negotiated Rate |
$196.46 |
| Rate for Payer: Aetna of VT Commercial |
$196.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$153.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$153.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$175.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$173.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$165.44
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cigna Commercial |
$165.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$165.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$165.44
|
| Rate for Payer: Multiplan Commercial |
$192.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.78
|
| Rate for Payer: United Healthcare Commercial |
$196.46
|
|
|
MITOCHONDRIAL ANTIBODY EACH
|
Professional
|
Both
|
$206.80
|
|
|
Service Code
|
CPT 86381
|
| Hospital Charge Code |
3008638101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.09 |
| Max. Negotiated Rate |
$194.39 |
| Rate for Payer: Aetna of VT Commercial |
$194.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$35.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$30.00
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cigna Commercial |
$30.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.45
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.45
|
| Rate for Payer: Martins Point Health Care Commercial |
$25.09
|
| Rate for Payer: Multiplan Commercial |
$192.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.45
|
| Rate for Payer: United Healthcare Commercial |
$39.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: United Healthcare VA CCN |
$25.45
|
|
|
MITOMYCIN 40 MG VI
|
Professional
|
Both
|
$407.24
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
636J928001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.35 |
| Max. Negotiated Rate |
$382.81 |
| Rate for Payer: Aetna of VT Commercial |
$382.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$28.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.40
|
| Rate for Payer: Cash Price |
$203.62
|
| Rate for Payer: Cash Price |
$203.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$46.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$46.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$25.60
|
| Rate for Payer: Multiplan Commercial |
$378.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.35
|
| Rate for Payer: United Healthcare Commercial |
$31.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.35
|
| Rate for Payer: United Healthcare VA CCN |
$20.35
|
|
|
MITOMYCIN 40 MG VI
|
Facility
|
OP
|
$70.40
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
636J928001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$70.40 |
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.40
|
|
