|
PATH CLIN CONSLTJ PROLNG SVC
|
Facility
|
IP
|
$86.86
|
|
|
Service Code
|
CPT 80506
|
| Hospital Charge Code |
3008050601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.29 |
| Max. Negotiated Rate |
$82.52 |
| Rate for Payer: Aetna of VT Commercial |
$82.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.49
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cigna Commercial |
$69.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.49
|
| Rate for Payer: Multiplan Commercial |
$80.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.83
|
| Rate for Payer: United Healthcare Commercial |
$82.52
|
|
|
PATH CLIN CONSLTJ PROLNG SVC
|
Facility
|
OP
|
$86.86
|
|
|
Service Code
|
CPT 80506
|
| Hospital Charge Code |
3008050601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.47 |
| Max. Negotiated Rate |
$203.31 |
| Rate for Payer: Aetna of VT Commercial |
$82.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$203.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$203.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.05
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cigna Commercial |
$69.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$39.09
|
| Rate for Payer: Multiplan Commercial |
$80.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.09
|
| Rate for Payer: United Healthcare Commercial |
$82.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.04
|
| Rate for Payer: United Healthcare VA CCN |
$39.09
|
|
|
PATH CLIN CONSLTJ SF 5-20
|
Facility
|
OP
|
$108.57
|
|
|
Service Code
|
CPT 80503
|
| Hospital Charge Code |
3008050301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.67 |
| Max. Negotiated Rate |
$129.10 |
| Rate for Payer: Aetna of VT Commercial |
$103.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$129.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$129.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$65.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$92.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$48.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$86.31
|
| Rate for Payer: Cash Price |
$54.28
|
| Rate for Payer: Cash Price |
$54.28
|
| Rate for Payer: Cigna Commercial |
$86.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$86.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$86.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$48.86
|
| Rate for Payer: Multiplan Commercial |
$100.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$92.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$48.86
|
| Rate for Payer: United Healthcare Commercial |
$103.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.67
|
| Rate for Payer: United Healthcare VA CCN |
$48.86
|
|
|
PATH CLIN CONSLTJ SF 5-20
|
Facility
|
IP
|
$108.57
|
|
|
Service Code
|
CPT 80503
|
| Hospital Charge Code |
3008050301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.35 |
| Max. Negotiated Rate |
$103.14 |
| Rate for Payer: Aetna of VT Commercial |
$103.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$80.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$80.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$92.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$86.86
|
| Rate for Payer: Cash Price |
$54.28
|
| Rate for Payer: Cigna Commercial |
$86.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$86.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$86.86
|
| Rate for Payer: Multiplan Commercial |
$100.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$92.28
|
| Rate for Payer: United Healthcare Commercial |
$103.14
|
|
|
PATH CLIN CONSLTJ SF 5-20
|
Professional
|
Both
|
$108.57
|
|
|
Service Code
|
CPT 80503
|
| Hospital Charge Code |
3008050301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.67 |
| Max. Negotiated Rate |
$129.10 |
| Rate for Payer: Aetna of VT Commercial |
$102.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$129.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$129.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$28.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$31.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$31.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$31.67
|
| Rate for Payer: Cash Price |
$54.28
|
| Rate for Payer: Cash Price |
$54.28
|
| Rate for Payer: Cigna Commercial |
$25.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$29.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$29.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$25.81
|
| Rate for Payer: Multiplan Commercial |
$100.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.67
|
| Rate for Payer: United Healthcare Commercial |
$31.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.67
|
| Rate for Payer: United Healthcare VA CCN |
$20.67
|
|
|
PATH CONSULT INTRAOP 1 BLOC
|
Professional
|
Both
|
$430.50
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
3008833101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$96.81 |
| Max. Negotiated Rate |
$404.67 |
| Rate for Payer: Aetna of VT Commercial |
$404.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$200.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$99.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$200.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$135.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$133.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$133.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$111.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.56
|
| Rate for Payer: Cash Price |
$215.25
|
| Rate for Payer: Cash Price |
$215.25
|
| Rate for Payer: Cigna Commercial |
$129.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$96.81
|
| Rate for Payer: Multiplan Commercial |
$400.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$96.81
|
| Rate for Payer: United Healthcare Commercial |
$148.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.81
|
| Rate for Payer: United Healthcare VA CCN |
$96.81
|
|
|
PATH CONSULT INTRAOP 1 BLOC
|
Facility
|
IP
|
$430.50
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
3008833101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$318.61 |
| Max. Negotiated Rate |
$408.98 |
| Rate for Payer: Aetna of VT Commercial |
$408.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$318.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$318.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$365.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$361.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$344.40
|
| Rate for Payer: Cash Price |
$215.25
|
| Rate for Payer: Cigna Commercial |
$344.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$344.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$344.40
|
| Rate for Payer: Multiplan Commercial |
$400.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$365.93
|
| Rate for Payer: United Healthcare Commercial |
$408.98
|
|
|
PATH CONSULT INTRAOP 1 BLOC
|
Facility
|
OP
|
$430.50
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
3008833101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$96.81 |
| Max. Negotiated Rate |
$408.98 |
| Rate for Payer: Aetna of VT Commercial |
$408.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$200.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$190.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$200.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$259.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$365.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$348.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$193.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$342.25
|
| Rate for Payer: Cash Price |
$215.25
|
| Rate for Payer: Cash Price |
$215.25
|
| Rate for Payer: Cigna Commercial |
$344.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$344.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$344.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$193.72
|
| Rate for Payer: Multiplan Commercial |
$400.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$365.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$193.72
|
| Rate for Payer: United Healthcare Commercial |
$408.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.81
|
| Rate for Payer: United Healthcare VA CCN |
$193.72
|
|
|
PATH CONSULT INTRAOP ADDL
|
Professional
|
Both
|
$235.63
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
3008833201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$221.49 |
| Rate for Payer: Aetna of VT Commercial |
$221.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$121.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$121.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$69.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$69.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.16
|
| Rate for Payer: Cash Price |
$117.82
|
| Rate for Payer: Cash Price |
$117.82
|
| Rate for Payer: Cigna Commercial |
$69.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$219.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.50
|
| Rate for Payer: United Healthcare Commercial |
$80.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.50
|
| Rate for Payer: United Healthcare VA CCN |
$52.50
|
|
|
PATH CONSULT INTRAOP ADDL
|
Facility
|
OP
|
$235.63
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
3008833201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$223.85 |
| Rate for Payer: Aetna of VT Commercial |
$223.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$121.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$104.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$121.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$141.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$200.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$190.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$106.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$187.33
|
| Rate for Payer: Cash Price |
$117.82
|
| Rate for Payer: Cash Price |
$117.82
|
| Rate for Payer: Cigna Commercial |
$188.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$188.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$188.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$106.03
|
| Rate for Payer: Multiplan Commercial |
$219.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$200.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$106.03
|
| Rate for Payer: United Healthcare Commercial |
$223.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.50
|
| Rate for Payer: United Healthcare VA CCN |
$106.03
|
|
|
PATH CONSULT INTRAOP ADDL
|
Facility
|
IP
|
$235.63
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
3008833201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$174.39 |
| Max. Negotiated Rate |
$223.85 |
| Rate for Payer: Aetna of VT Commercial |
$223.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$174.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$174.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$200.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$197.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$188.50
|
| Rate for Payer: Cash Price |
$117.82
|
| Rate for Payer: Cigna Commercial |
$188.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$188.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$188.50
|
| Rate for Payer: Multiplan Commercial |
$219.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$200.29
|
| Rate for Payer: United Healthcare Commercial |
$223.85
|
|
|
PCV20 VACCINE IM
|
Facility
|
OP
|
$880.86
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
6369067701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$390.13 |
| Max. Negotiated Rate |
$860.48 |
| Rate for Payer: Aetna of VT Commercial |
$836.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$860.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$390.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$860.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$530.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$748.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$713.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$396.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$700.28
|
| Rate for Payer: Cash Price |
$440.43
|
| Rate for Payer: Cash Price |
$440.43
|
| Rate for Payer: Cigna Commercial |
$704.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$704.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$704.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$396.39
|
| Rate for Payer: Multiplan Commercial |
$819.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$748.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$396.39
|
| Rate for Payer: United Healthcare Commercial |
$836.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$396.39
|
| Rate for Payer: United Healthcare VA CCN |
$396.39
|
|
|
PCV20 VACCINE IM
|
Facility
|
IP
|
$880.86
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
6369067701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$651.92 |
| Max. Negotiated Rate |
$836.82 |
| Rate for Payer: Aetna of VT Commercial |
$836.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$651.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$651.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$748.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$739.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$704.69
|
| Rate for Payer: Cash Price |
$440.43
|
| Rate for Payer: Cigna Commercial |
$704.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$704.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$704.69
|
| Rate for Payer: Multiplan Commercial |
$819.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$748.73
|
| Rate for Payer: United Healthcare Commercial |
$836.82
|
|
|
PCV20 VACCINE IM
|
Professional
|
Both
|
$880.86
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
6369067701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$312.90 |
| Max. Negotiated Rate |
$860.48 |
| Rate for Payer: Aetna of VT Commercial |
$828.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$860.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$322.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$860.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$438.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$312.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$359.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$312.90
|
| Rate for Payer: Cash Price |
$440.43
|
| Rate for Payer: Cash Price |
$440.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$414.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$414.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$312.90
|
| Rate for Payer: Multiplan Commercial |
$819.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$312.90
|
| Rate for Payer: United Healthcare Commercial |
$481.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$312.90
|
| Rate for Payer: United Healthcare VA CCN |
$312.90
|
|
|
PCV20 VACCINE IM
|
Facility
|
IP
|
$880.86
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
6369067701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$651.92 |
| Max. Negotiated Rate |
$836.82 |
| Rate for Payer: Aetna of VT Commercial |
$836.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$651.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$651.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$748.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$739.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$704.69
|
| Rate for Payer: Cash Price |
$440.43
|
| Rate for Payer: Cigna Commercial |
$704.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$704.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$704.69
|
| Rate for Payer: Multiplan Commercial |
$819.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$748.73
|
| Rate for Payer: United Healthcare Commercial |
$836.82
|
|
|
PCV20 VACCINE IM
|
Professional
|
Both
|
$880.86
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
6369067701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$312.90 |
| Max. Negotiated Rate |
$860.48 |
| Rate for Payer: Aetna of VT Commercial |
$828.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$860.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$322.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$860.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$438.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$312.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$359.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$312.90
|
| Rate for Payer: Cash Price |
$440.43
|
| Rate for Payer: Cash Price |
$440.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$414.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$414.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$312.90
|
| Rate for Payer: Multiplan Commercial |
$819.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$312.90
|
| Rate for Payer: United Healthcare Commercial |
$481.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$312.90
|
| Rate for Payer: United Healthcare VA CCN |
$312.90
|
|
|
PCV20 VACCINE IM
|
Facility
|
OP
|
$880.86
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
6369067701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$390.13 |
| Max. Negotiated Rate |
$860.48 |
| Rate for Payer: Aetna of VT Commercial |
$836.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$860.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$390.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$860.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$530.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$748.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$713.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$396.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$700.28
|
| Rate for Payer: Cash Price |
$440.43
|
| Rate for Payer: Cash Price |
$440.43
|
| Rate for Payer: Cigna Commercial |
$704.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$704.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$704.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$396.39
|
| Rate for Payer: Multiplan Commercial |
$819.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$748.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$396.39
|
| Rate for Payer: United Healthcare Commercial |
$836.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$396.39
|
| Rate for Payer: United Healthcare VA CCN |
$396.39
|
|
|
PCV21 PNEUMOCOCCAL VACCINE IM
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
HCPCS 90684
|
| Hospital Charge Code |
6369068401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$279.93 |
| Max. Negotiated Rate |
$901.70 |
| Rate for Payer: Aetna of VT Commercial |
$282.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$901.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$337.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$901.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$459.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$377.07
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$455.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$455.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$327.89
|
| Rate for Payer: Multiplan Commercial |
$279.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$327.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$327.89
|
| Rate for Payer: United Healthcare Commercial |
$504.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$327.89
|
| Rate for Payer: United Healthcare VA CCN |
$327.89
|
|
|
PCV21 PNEUMOCOCCAL VACCINE IM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90684
|
| Hospital Charge Code |
6369068401
|
|
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
|
|
|
PCV21 PNEUMOCOCCAL VACCINE IM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90684
|
| Hospital Charge Code |
6369068401
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$901.70 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$901.70
|
| 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 |
$901.70
|
| 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
|
|
|
PCV21 PNEUMOCOCCAL VACCINE IM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 90684
|
| Hospital Charge Code |
6369068401
|
|
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
|
|
|
PCV21 PNEUMOCOCCAL VACCINE IM
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
CPT 90684
|
| Hospital Charge Code |
6369068401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$279.93 |
| Max. Negotiated Rate |
$901.70 |
| Rate for Payer: Aetna of VT Commercial |
$282.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$901.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$337.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$901.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$459.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$377.07
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$455.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$455.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$327.89
|
| Rate for Payer: Multiplan Commercial |
$279.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$327.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$327.89
|
| Rate for Payer: United Healthcare Commercial |
$504.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$327.89
|
| Rate for Payer: United Healthcare VA CCN |
$327.89
|
|
|
PCV21 PNEUMOCOCCAL VACCINE IM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 90684
|
| Hospital Charge Code |
6369068401
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$901.70 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$901.70
|
| 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 |
$901.70
|
| 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
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML 340B
|
Professional
|
Both
|
$16,598.00
|
|
|
Service Code
|
HCPCS J2506 TB
|
| Hospital Charge Code |
636J250602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.98 |
| Max. Negotiated Rate |
$15,602.12 |
| Rate for Payer: Aetna of VT Commercial |
$15,602.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.95
|
| Rate for Payer: Cash Price |
$8,299.00
|
| Rate for Payer: Cash Price |
$8,299.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.98
|
| Rate for Payer: Multiplan Commercial |
$15,436.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.34
|
| Rate for Payer: United Healthcare Commercial |
$14,108.30
|
| Rate for Payer: United Healthcare VA CCN |
$6,639.20
|
|
|
PEGFILGRASTIM-JMDB 6 MG/0.6 ML
|
Professional
|
Both
|
$1,569.17
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
636J250601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.98 |
| Max. Negotiated Rate |
$1,475.02 |
| Rate for Payer: Aetna of VT Commercial |
$1,475.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$102.74
|
| Rate for Payer: Cash Price |
$784.58
|
| Rate for Payer: Cash Price |
$784.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.98
|
| Rate for Payer: Multiplan Commercial |
$1,459.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$89.34
|
| Rate for Payer: United Healthcare Commercial |
$137.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.34
|
| Rate for Payer: United Healthcare VA CCN |
$89.34
|
|
