|
NFCT AGT GNTYP ALYS HEP C
|
Professional
|
Both
|
$626.71
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
3008790201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$253.85 |
| Max. Negotiated Rate |
$1,268.58 |
| Rate for Payer: Aetna of VT Commercial |
$589.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,268.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$265.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,268.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$360.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$354.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$354.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$296.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$354.05
|
| Rate for Payer: Cash Price |
$313.36
|
| Rate for Payer: Cash Price |
$313.36
|
| Rate for Payer: Cigna Commercial |
$311.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$257.45
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$257.45
|
| Rate for Payer: Martins Point Health Care Commercial |
$253.85
|
| Rate for Payer: Multiplan Commercial |
$582.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$257.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$257.45
|
| Rate for Payer: United Healthcare Commercial |
$396.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.45
|
| Rate for Payer: United Healthcare VA CCN |
$257.45
|
|
|
NFCT AGT GNTYP ALYS HEP C
|
Facility
|
IP
|
$626.71
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
3008790201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$463.83 |
| Max. Negotiated Rate |
$595.37 |
| Rate for Payer: Aetna of VT Commercial |
$595.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$463.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$463.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$532.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$526.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$501.37
|
| Rate for Payer: Cash Price |
$313.36
|
| Rate for Payer: Cigna Commercial |
$501.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$501.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$501.37
|
| Rate for Payer: Multiplan Commercial |
$582.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$532.70
|
| Rate for Payer: United Healthcare Commercial |
$595.37
|
|
|
NFCT AGT GNTYP ALYS HEP C
|
Facility
|
OP
|
$626.71
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
3008790201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$257.45 |
| Max. Negotiated Rate |
$1,268.58 |
| Rate for Payer: Aetna of VT Commercial |
$595.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,268.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$277.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,268.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$377.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$532.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$507.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$282.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$498.23
|
| Rate for Payer: Cash Price |
$313.36
|
| Rate for Payer: Cash Price |
$313.36
|
| Rate for Payer: Cigna Commercial |
$501.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$501.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$501.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$282.02
|
| Rate for Payer: Multiplan Commercial |
$582.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$532.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$282.02
|
| Rate for Payer: United Healthcare Commercial |
$595.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.45
|
| Rate for Payer: United Healthcare VA CCN |
$282.02
|
|
|
NFCT DS BV RNA VAG FLU ALG
|
Professional
|
Both
|
$48.63
|
|
|
Service Code
|
CPT 81513
|
| Hospital Charge Code |
3008151301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.23 |
| Max. Negotiated Rate |
$702.81 |
| Rate for Payer: Aetna of VT Commercial |
$45.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$702.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$146.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$702.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$199.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$168.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$168.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$164.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$168.13
|
| Rate for Payer: Cash Price |
$24.32
|
| Rate for Payer: Cash Price |
$24.32
|
| Rate for Payer: Cigna Commercial |
$172.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$142.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$142.63
|
| Rate for Payer: Martins Point Health Care Commercial |
$140.63
|
| Rate for Payer: Multiplan Commercial |
$45.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$142.63
|
| Rate for Payer: United Healthcare Commercial |
$219.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.63
|
| Rate for Payer: United Healthcare VA CCN |
$142.63
|
|
|
NFCT DS BV RNA VAG FLU ALG
|
Facility
|
IP
|
$48.63
|
|
|
Service Code
|
CPT 81513
|
| Hospital Charge Code |
3008151301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.99 |
| Max. Negotiated Rate |
$46.20 |
| Rate for Payer: Aetna of VT Commercial |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$35.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$35.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$41.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$40.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$38.90
|
| Rate for Payer: Cash Price |
$24.32
|
| Rate for Payer: Cigna Commercial |
$38.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$38.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$38.90
|
| Rate for Payer: Multiplan Commercial |
$45.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.34
|
| Rate for Payer: United Healthcare Commercial |
$46.20
|
|
|
NFCT DS BV RNA VAG FLU ALG
|
Facility
|
OP
|
$48.63
|
|
|
Service Code
|
CPT 81513
|
| Hospital Charge Code |
3008151301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.54 |
| Max. Negotiated Rate |
$702.81 |
| Rate for Payer: Aetna of VT Commercial |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$702.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$702.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$41.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$39.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$21.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$38.66
|
| Rate for Payer: Cash Price |
$24.32
|
| Rate for Payer: Cash Price |
$24.32
|
| Rate for Payer: Cigna Commercial |
$38.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$38.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$38.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$21.88
|
| Rate for Payer: Multiplan Commercial |
$45.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.88
|
| Rate for Payer: United Healthcare Commercial |
$46.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.63
|
| Rate for Payer: United Healthcare VA CCN |
$21.88
|
|
|
NFCT DS CHRNC HCV 6 ASSAYS
|
Professional
|
Both
|
$868.56
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
3008159601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.18 |
| Max. Negotiated Rate |
$816.45 |
| Rate for Payer: Aetna of VT Commercial |
$816.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$355.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$74.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$355.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$101.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$90.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$83.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$90.21
|
| Rate for Payer: Cash Price |
$434.28
|
| Rate for Payer: Cash Price |
$434.28
|
| Rate for Payer: Cigna Commercial |
$87.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$72.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$72.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$71.18
|
| Rate for Payer: Multiplan Commercial |
$807.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$72.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$72.19
|
| Rate for Payer: United Healthcare Commercial |
$111.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.19
|
| Rate for Payer: United Healthcare VA CCN |
$72.19
|
|
|
NFCT DS CHRNC HCV 6 ASSAYS
|
Facility
|
IP
|
$868.56
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
3008159601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$642.82 |
| Max. Negotiated Rate |
$825.13 |
| Rate for Payer: Aetna of VT Commercial |
$825.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$642.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$642.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$738.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$729.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$694.85
|
| Rate for Payer: Cash Price |
$434.28
|
| Rate for Payer: Cigna Commercial |
$694.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$694.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$694.85
|
| Rate for Payer: Multiplan Commercial |
$807.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$738.28
|
| Rate for Payer: United Healthcare Commercial |
$825.13
|
|
|
NFCT DS CHRNC HCV 6 ASSAYS
|
Facility
|
OP
|
$868.56
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
3008159601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.19 |
| Max. Negotiated Rate |
$825.13 |
| Rate for Payer: Aetna of VT Commercial |
$825.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$355.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$384.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$355.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$522.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$738.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$703.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$390.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$690.51
|
| Rate for Payer: Cash Price |
$434.28
|
| Rate for Payer: Cash Price |
$434.28
|
| Rate for Payer: Cigna Commercial |
$694.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$694.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$694.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$390.85
|
| Rate for Payer: Multiplan Commercial |
$807.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$738.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$390.85
|
| Rate for Payer: United Healthcare Commercial |
$825.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.19
|
| Rate for Payer: United Healthcare VA CCN |
$390.85
|
|
|
NFCT DS VIR RESP RNA 4 TRGT
|
Facility
|
OP
|
$285.12
|
|
|
Service Code
|
CPT 0241U
|
| Hospital Charge Code |
3000241U01
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.28 |
| Max. Negotiated Rate |
$702.81 |
| Rate for Payer: Aetna of VT Commercial |
$270.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$702.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$126.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$702.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$171.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$242.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$230.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$128.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$226.67
|
| Rate for Payer: Cash Price |
$142.56
|
| Rate for Payer: Cash Price |
$142.56
|
| Rate for Payer: Cigna Commercial |
$228.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$228.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$228.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$128.30
|
| Rate for Payer: Multiplan Commercial |
$265.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$242.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$128.30
|
| Rate for Payer: United Healthcare Commercial |
$270.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$128.30
|
| Rate for Payer: United Healthcare VA CCN |
$128.30
|
|
|
NFCT DS VIR RESP RNA 4 TRGT
|
Facility
|
IP
|
$285.12
|
|
|
Service Code
|
CPT 0241U
|
| Hospital Charge Code |
3000241U01
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$270.86 |
| Rate for Payer: Aetna of VT Commercial |
$270.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$211.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$211.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$242.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$239.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$228.10
|
| Rate for Payer: Cash Price |
$142.56
|
| Rate for Payer: Cigna Commercial |
$228.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$228.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$228.10
|
| Rate for Payer: Multiplan Commercial |
$265.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$242.35
|
| Rate for Payer: United Healthcare Commercial |
$270.86
|
|
|
N.GONORRHOEAE DNA AMP PROB
|
Facility
|
OP
|
$161.78
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
3008759101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$153.69
|
| 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 |
$71.65
|
| 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 |
$97.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$137.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$131.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$72.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$128.62
|
| Rate for Payer: Cash Price |
$80.89
|
| Rate for Payer: Cash Price |
$80.89
|
| Rate for Payer: Cigna Commercial |
$129.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$129.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$129.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$72.80
|
| Rate for Payer: Multiplan Commercial |
$150.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$137.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$72.80
|
| Rate for Payer: United Healthcare Commercial |
$153.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$72.80
|
|
|
N.GONORRHOEAE DNA AMP PROB
|
Facility
|
IP
|
$161.78
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
3008759101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.73 |
| Max. Negotiated Rate |
$153.69 |
| Rate for Payer: Aetna of VT Commercial |
$153.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$119.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$119.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$137.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$135.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.42
|
| Rate for Payer: Cash Price |
$80.89
|
| Rate for Payer: Cigna Commercial |
$129.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$129.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$129.42
|
| Rate for Payer: Multiplan Commercial |
$150.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$137.51
|
| Rate for Payer: United Healthcare Commercial |
$153.69
|
|
|
N.GONORRHOEAE DNA AMP PROB
|
Professional
|
Both
|
$161.78
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
3008759101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$152.07
|
| 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 |
$59.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.98
|
| 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 |
$59.98
|
| Rate for Payer: Cash Price |
$80.89
|
| Rate for Payer: Cash Price |
$80.89
|
| 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 |
$150.46
|
| 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
|
|
|
NIFEDIPINE 10 MG CAP
|
Professional
|
Both
|
$2.40
|
|
| Hospital Charge Code |
2500000453
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$2.26 |
| Rate for Payer: Aetna of VT Commercial |
$2.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.15
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$2.23
|
| Rate for Payer: United Healthcare Commercial |
$2.04
|
| Rate for Payer: United Healthcare VA CCN |
$0.96
|
|
|
NIFEDIPINE 10 MG CAP
|
Professional
|
Both
|
$2.40
|
|
|
Service Code
|
NDC 6931521101
|
| Hospital Charge Code |
2500000453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$2.26 |
| Rate for Payer: Aetna of VT Commercial |
$2.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.15
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$2.23
|
| Rate for Payer: United Healthcare Commercial |
$2.04
|
| Rate for Payer: United Healthcare VA CCN |
$0.96
|
|
|
NITROGLYCERIN 0.4 MG SL TAB
|
Professional
|
Both
|
$0.03
|
|
| Hospital Charge Code |
6370000012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
NITROGLYCERIN 0.4 MG SL TAB
|
Professional
|
Both
|
$0.03
|
|
|
Service Code
|
NDC 6846263945
|
| Hospital Charge Code |
6370000012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
NIVOLUMAB 240 MG/24ML
|
Facility
|
OP
|
$32.12
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
636J929901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.23 |
| Max. Negotiated Rate |
$88.96 |
| Rate for Payer: Aetna of VT Commercial |
$30.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.54
|
| Rate for Payer: Cash Price |
$16.06
|
| Rate for Payer: Cash Price |
$16.06
|
| Rate for Payer: Cigna Commercial |
$25.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.45
|
| Rate for Payer: Multiplan Commercial |
$29.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.45
|
| Rate for Payer: United Healthcare Commercial |
$30.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.45
|
| Rate for Payer: United Healthcare VA CCN |
$14.45
|
|
|
NIVOLUMAB 240 MG/24ML
|
Facility
|
IP
|
$32.12
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
636J929901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.77 |
| Max. Negotiated Rate |
$30.51 |
| Rate for Payer: Aetna of VT Commercial |
$30.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$23.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$23.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.70
|
| Rate for Payer: Cash Price |
$16.06
|
| Rate for Payer: Cigna Commercial |
$25.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.70
|
| Rate for Payer: Multiplan Commercial |
$29.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.30
|
| Rate for Payer: United Healthcare Commercial |
$30.51
|
|
|
NIVOLUMAB 240 MG/24ML *340B*
|
Facility
|
OP
|
$32.12
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
636J929902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.23 |
| Max. Negotiated Rate |
$88.96 |
| Rate for Payer: Aetna of VT Commercial |
$30.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.54
|
| Rate for Payer: Cash Price |
$16.06
|
| Rate for Payer: Cash Price |
$16.06
|
| Rate for Payer: Cigna Commercial |
$25.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.45
|
| Rate for Payer: Multiplan Commercial |
$29.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.45
|
| Rate for Payer: United Healthcare Commercial |
$30.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.45
|
| Rate for Payer: United Healthcare VA CCN |
$14.45
|
|
|
NIVOLUMAB 240 MG/24ML *340B*
|
Facility
|
IP
|
$32.12
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
636J929902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.77 |
| Max. Negotiated Rate |
$30.51 |
| Rate for Payer: Aetna of VT Commercial |
$30.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$23.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$23.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.70
|
| Rate for Payer: Cash Price |
$16.06
|
| Rate for Payer: Cigna Commercial |
$25.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.70
|
| Rate for Payer: Multiplan Commercial |
$29.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.30
|
| Rate for Payer: United Healthcare Commercial |
$30.51
|
|
|
NIVOLUMAB 240 MG/24ML *340B*
|
Facility
|
OP
|
$32.12
|
|
|
Service Code
|
HCPCS J9299 TB
|
| Hospital Charge Code |
636J929902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.23 |
| Max. Negotiated Rate |
$88.96 |
| Rate for Payer: Aetna of VT Commercial |
$30.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.54
|
| Rate for Payer: Cash Price |
$16.06
|
| Rate for Payer: Cash Price |
$16.06
|
| Rate for Payer: Cigna Commercial |
$25.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.45
|
| Rate for Payer: Multiplan Commercial |
$29.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.45
|
| Rate for Payer: United Healthcare Commercial |
$30.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.45
|
| Rate for Payer: United Healthcare VA CCN |
$14.45
|
|
|
NIVOLUMAB 240 MG/24ML *340B*
|
Facility
|
IP
|
$32.12
|
|
|
Service Code
|
HCPCS J9299 TB
|
| Hospital Charge Code |
636J929902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.77 |
| Max. Negotiated Rate |
$30.51 |
| Rate for Payer: Aetna of VT Commercial |
$30.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$23.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$23.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.70
|
| Rate for Payer: Cash Price |
$16.06
|
| Rate for Payer: Cigna Commercial |
$25.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.70
|
| Rate for Payer: Multiplan Commercial |
$29.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.30
|
| Rate for Payer: United Healthcare Commercial |
$30.51
|
|
|
NJ GADOTERATE MEGLUMI 15 ml
|
Facility
|
OP
|
$105.25
|
|
|
Service Code
|
HCPCS A9575
|
| Hospital Charge Code |
636A957501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$99.99 |
| Rate for Payer: Aetna of VT Commercial |
$99.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$46.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$63.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$47.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.67
|
| Rate for Payer: Cash Price |
$52.62
|
| Rate for Payer: Cash Price |
$52.62
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.36
|
| Rate for Payer: Multiplan Commercial |
$97.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.36
|
| Rate for Payer: United Healthcare Commercial |
$99.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.36
|
| Rate for Payer: United Healthcare VA CCN |
$47.36
|
|
