|
MYCOBACTERIC IDENTIFICATION
|
Professional
|
Both
|
$140.48
|
|
|
Service Code
|
CPT 87118
|
| Hospital Charge Code |
3008711801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Aetna of VT Commercial |
$132.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$23.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$23.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$23.16
|
| Rate for Payer: Cash Price |
$70.24
|
| Rate for Payer: Cash Price |
$70.24
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.41
|
| Rate for Payer: Multiplan Commercial |
$130.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.61
|
| Rate for Payer: United Healthcare Commercial |
$22.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.61
|
| Rate for Payer: United Healthcare VA CCN |
$14.61
|
|
|
Mycophenolate 500MG tab
|
Facility
|
IP
|
$1.89
|
|
|
Service Code
|
NDC 6438072506
|
| Hospital Charge Code |
636J751701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of VT Commercial |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.51
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Cigna Commercial |
$1.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.61
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
|
|
Mycophenolate 500MG tab
|
Facility
|
OP
|
$1.89
|
|
|
Service Code
|
NDC 6438072506
|
| Hospital Charge Code |
636J751701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of VT Commercial |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.50
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Cigna Commercial |
$1.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.85
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.85
|
| Rate for Payer: United Healthcare VA CCN |
$0.85
|
|
|
MYOMECTOMY ABDOM METHOD
|
Facility
|
OP
|
$2,744.00
|
|
|
Service Code
|
CPT 58140
|
| Hospital Charge Code |
9825814001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,215.32 |
| Max. Negotiated Rate |
$2,606.80 |
| Rate for Payer: Aetna of VT Commercial |
$2,606.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,458.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,215.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,458.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,651.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,332.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,222.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,234.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,181.48
|
| Rate for Payer: Cash Price |
$1,372.00
|
| Rate for Payer: Cigna Commercial |
$2,195.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,195.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,195.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,234.80
|
| Rate for Payer: Multiplan Commercial |
$2,551.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,332.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,234.80
|
| Rate for Payer: United Healthcare Commercial |
$2,606.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,234.80
|
| Rate for Payer: United Healthcare VA CCN |
$1,234.80
|
|
|
MYOMECTOMY ABDOM METHOD
|
Facility
|
IP
|
$2,744.00
|
|
|
Service Code
|
CPT 58140
|
| Hospital Charge Code |
9825814001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,030.83 |
| Max. Negotiated Rate |
$2,606.80 |
| Rate for Payer: Aetna of VT Commercial |
$2,606.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,030.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,030.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,332.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,304.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,195.20
|
| Rate for Payer: Cash Price |
$1,372.00
|
| Rate for Payer: Cigna Commercial |
$2,195.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,195.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,195.20
|
| Rate for Payer: Multiplan Commercial |
$2,551.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,332.40
|
| Rate for Payer: United Healthcare Commercial |
$2,606.80
|
|
|
MYOMECTOMY ABDOM METHOD
|
Professional
|
Both
|
$2,744.00
|
|
|
Service Code
|
CPT 58140
|
| Hospital Charge Code |
9825814001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$852.90 |
| Max. Negotiated Rate |
$2,579.36 |
| Rate for Payer: Aetna of VT Commercial |
$2,579.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,458.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$878.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,458.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,194.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,502.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,502.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$980.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,502.51
|
| Rate for Payer: Cash Price |
$1,372.00
|
| Rate for Payer: Cash Price |
$1,372.00
|
| Rate for Payer: Cigna Commercial |
$1,508.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,425.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,425.13
|
| Rate for Payer: Martins Point Health Care Commercial |
$852.90
|
| Rate for Payer: Multiplan Commercial |
$2,551.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,211.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$852.91
|
| Rate for Payer: United Healthcare Commercial |
$1,312.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$852.91
|
| Rate for Payer: United Healthcare VA CCN |
$852.91
|
|
|
MYOMECTOMY VAG METHOD
|
Professional
|
Both
|
$2,035.00
|
|
|
Service Code
|
CPT 58145
|
| Hospital Charge Code |
9825814501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$523.40 |
| Max. Negotiated Rate |
$1,912.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,912.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,823.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$539.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,823.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$732.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$884.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$884.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$601.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$884.38
|
| Rate for Payer: Cash Price |
$1,017.50
|
| Rate for Payer: Cash Price |
$1,017.50
|
| Rate for Payer: Cigna Commercial |
$938.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$871.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$871.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$523.40
|
| Rate for Payer: Multiplan Commercial |
$1,892.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$743.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$523.41
|
| Rate for Payer: United Healthcare Commercial |
$805.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$523.41
|
| Rate for Payer: United Healthcare VA CCN |
$523.41
|
|
|
MYOMECTOMY VAG METHOD
|
Facility
|
IP
|
$2,035.00
|
|
|
Service Code
|
CPT 58145
|
| Hospital Charge Code |
9825814501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,506.10 |
| Max. Negotiated Rate |
$1,933.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,933.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,506.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,506.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,729.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,709.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,628.00
|
| Rate for Payer: Cash Price |
$1,017.50
|
| Rate for Payer: Cigna Commercial |
$1,628.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,628.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,628.00
|
| Rate for Payer: Multiplan Commercial |
$1,892.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,729.75
|
| Rate for Payer: United Healthcare Commercial |
$1,933.25
|
|
|
MYOMECTOMY VAG METHOD
|
Facility
|
OP
|
$2,035.00
|
|
|
Service Code
|
CPT 58145
|
| Hospital Charge Code |
9825814501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$901.30 |
| Max. Negotiated Rate |
$1,933.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,933.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,823.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$901.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,823.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,225.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,729.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,648.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$915.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,617.83
|
| Rate for Payer: Cash Price |
$1,017.50
|
| Rate for Payer: Cigna Commercial |
$1,628.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,628.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,628.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$915.75
|
| Rate for Payer: Multiplan Commercial |
$1,892.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,729.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$915.75
|
| Rate for Payer: United Healthcare Commercial |
$1,933.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$915.75
|
| Rate for Payer: United Healthcare VA CCN |
$915.75
|
|
|
MYOSURE LITE TISSUE REMOVAL
|
Facility
|
OP
|
$901.00
|
|
|
Service Code
|
HCPCS C1782
|
| Hospital Charge Code |
2720071681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.05 |
| Max. Negotiated Rate |
$855.95 |
| Rate for Payer: Aetna of VT Commercial |
$855.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$807.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$399.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$807.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$542.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$765.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$729.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$405.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$716.29
|
| Rate for Payer: Cash Price |
$450.50
|
| Rate for Payer: Cigna Commercial |
$720.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$720.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$720.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$405.45
|
| Rate for Payer: Multiplan Commercial |
$837.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$765.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$405.45
|
| Rate for Payer: United Healthcare Commercial |
$855.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$405.45
|
| Rate for Payer: United Healthcare VA CCN |
$405.45
|
|
|
MYOSURE LITE TISSUE REMOVAL
|
Facility
|
IP
|
$901.00
|
|
|
Service Code
|
HCPCS C1782
|
| Hospital Charge Code |
2720071681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$666.83 |
| Max. Negotiated Rate |
$855.95 |
| Rate for Payer: Aetna of VT Commercial |
$855.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$666.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$666.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$765.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$756.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$720.80
|
| Rate for Payer: Cash Price |
$450.50
|
| Rate for Payer: Cigna Commercial |
$720.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$720.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$720.80
|
| Rate for Payer: Multiplan Commercial |
$837.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$765.85
|
| Rate for Payer: United Healthcare Commercial |
$855.95
|
|
|
NALOXONE 0.4 MG/ML VIAL
|
Facility
|
OP
|
$25.33
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
636J231001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.33 |
| Max. Negotiated Rate |
$25.33 |
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.33
|
|
|
NALOXONE 0.4 MG/ML VIAL
|
Professional
|
Both
|
$29.46
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
636J231001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$27.69 |
| Rate for Payer: Aetna of VT Commercial |
$27.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.33
|
| Rate for Payer: Cash Price |
$14.73
|
| Rate for Payer: Cash Price |
$14.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.21
|
| Rate for Payer: Multiplan Commercial |
$27.40
|
| Rate for Payer: United Healthcare Commercial |
$25.04
|
| Rate for Payer: United Healthcare VA CCN |
$11.78
|
|
|
NALTREXONE 380MG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
636J231501
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$11.33 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$11.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$11.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
NALTREXONE 380MG
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
636J231501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
NASAL/OROGASTRIC W/TUBE PLMT
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
9814375201
|
|
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
|
|
|
NASAL/OROGASTRIC W/TUBE PLMT
|
Professional
|
Both
|
$183.00
|
|
| Hospital Charge Code |
9824375201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$172.02 |
| Rate for Payer: Aetna of VT Commercial |
$172.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.95
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Multiplan Commercial |
$170.19
|
| Rate for Payer: United Healthcare Commercial |
$155.55
|
| Rate for Payer: United Healthcare VA CCN |
$73.20
|
|
|
NASAL/OROGASTRIC W/TUBE PLMT
|
Facility
|
IP
|
$81.69
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
4504375201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$77.61 |
| Rate for Payer: Aetna of VT Commercial |
$77.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$69.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.35
|
| Rate for Payer: Cash Price |
$40.84
|
| Rate for Payer: Cigna Commercial |
$65.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$65.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$65.35
|
| Rate for Payer: Multiplan Commercial |
$75.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.44
|
| Rate for Payer: United Healthcare Commercial |
$77.61
|
|
|
NASAL/OROGASTRIC W/TUBE PLMT
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
9814375202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$81.05 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Aetna of VT Commercial |
$173.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$110.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$148.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$82.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$145.49
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$146.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$146.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$146.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$82.35
|
| Rate for Payer: Multiplan Commercial |
$170.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$82.35
|
| Rate for Payer: United Healthcare Commercial |
$173.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.35
|
| Rate for Payer: United Healthcare VA CCN |
$82.35
|
|
|
NASAL/OROGASTRIC W/TUBE PLMT
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
9814375202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$36.87 |
| Max. Negotiated Rate |
$172.02 |
| Rate for Payer: Aetna of VT Commercial |
$172.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$51.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$72.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$72.60
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$67.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$61.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$61.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.87
|
| Rate for Payer: Multiplan Commercial |
$170.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.87
|
| Rate for Payer: United Healthcare Commercial |
$56.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.87
|
| Rate for Payer: United Healthcare VA CCN |
$36.87
|
|
|
NASAL/OROGASTRIC W/TUBE PLMT
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
9824375201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$135.44 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Aetna of VT Commercial |
$173.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$135.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$135.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$153.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$146.40
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$146.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$146.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$146.40
|
| Rate for Payer: Multiplan Commercial |
$170.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.55
|
| Rate for Payer: United Healthcare Commercial |
$173.85
|
|
|
NASAL/OROGASTRIC W/TUBE PLMT
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
9824375201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$81.05 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Aetna of VT Commercial |
$173.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$110.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$148.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$82.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$145.49
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$146.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$146.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$146.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$82.35
|
| Rate for Payer: Multiplan Commercial |
$170.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$82.35
|
| Rate for Payer: United Healthcare Commercial |
$173.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.35
|
| Rate for Payer: United Healthcare VA CCN |
$82.35
|
|
|
NASAL/OROGASTRIC W/TUBE PLMT
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
9814375201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$72.60 |
| 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 |
$37.98
|
| 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 |
$51.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$72.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$72.60
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$67.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$61.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$61.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.87
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.87
|
| Rate for Payer: United Healthcare Commercial |
$56.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.87
|
| Rate for Payer: United Healthcare VA CCN |
$36.87
|
|
|
NASAL/OROGASTRIC W/TUBE PLMT
|
Facility
|
OP
|
$81.69
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
4504375201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.18 |
| Max. Negotiated Rate |
$77.61 |
| Rate for Payer: Aetna of VT Commercial |
$77.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$73.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$73.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$69.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$66.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.94
|
| Rate for Payer: Cash Price |
$40.84
|
| Rate for Payer: Cigna Commercial |
$65.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$65.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$65.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.76
|
| Rate for Payer: Multiplan Commercial |
$75.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.76
|
| Rate for Payer: United Healthcare Commercial |
$77.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.76
|
| Rate for Payer: United Healthcare VA CCN |
$36.76
|
|
|
NASAL/OROGASTRIC W/TUBE PLMT
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
9814375202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$135.44 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Aetna of VT Commercial |
$173.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$135.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$135.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$153.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$146.40
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$146.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$146.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$146.40
|
| Rate for Payer: Multiplan Commercial |
$170.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.55
|
| Rate for Payer: United Healthcare Commercial |
$173.85
|
|
