|
PIN RADIOULNAR DISLOCATION
|
Facility
|
IP
|
$1,571.00
|
|
|
Service Code
|
CPT 25671
|
| Hospital Charge Code |
9822567101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,162.70 |
| Max. Negotiated Rate |
$1,492.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,492.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,162.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,162.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,335.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,319.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,256.80
|
| Rate for Payer: Cash Price |
$785.50
|
| Rate for Payer: Cigna Commercial |
$1,256.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,256.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,256.80
|
| Rate for Payer: Multiplan Commercial |
$1,461.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,335.35
|
| Rate for Payer: United Healthcare Commercial |
$1,492.45
|
|
|
PIN RADIOULNAR DISLOCATION
|
Facility
|
OP
|
$1,571.00
|
|
|
Service Code
|
CPT 25671
|
| Hospital Charge Code |
9822567101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$695.80 |
| Max. Negotiated Rate |
$1,492.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,492.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,407.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$695.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,407.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$945.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,335.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,272.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$706.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,248.94
|
| Rate for Payer: Cash Price |
$785.50
|
| Rate for Payer: Cigna Commercial |
$1,256.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,256.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,256.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$706.95
|
| Rate for Payer: Multiplan Commercial |
$1,461.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,335.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$706.95
|
| Rate for Payer: United Healthcare Commercial |
$1,492.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$706.95
|
| Rate for Payer: United Healthcare VA CCN |
$706.95
|
|
|
PIN RADIOULNAR DISLOCATION
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
CPT 25671
|
| Hospital Charge Code |
9822567101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$515.17 |
| Max. Negotiated Rate |
$1,476.74 |
| Rate for Payer: Aetna of VT Commercial |
$1,476.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,407.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$530.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,407.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$721.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$898.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$898.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$592.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$898.37
|
| Rate for Payer: Cash Price |
$785.50
|
| Rate for Payer: Cash Price |
$785.50
|
| Rate for Payer: Cigna Commercial |
$974.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$854.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$854.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$515.17
|
| Rate for Payer: Multiplan Commercial |
$1,461.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$731.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$515.17
|
| Rate for Payer: United Healthcare Commercial |
$792.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$515.17
|
| Rate for Payer: United Healthcare VA CCN |
$515.17
|
|
|
PINWORM EXAMINATION
|
Professional
|
Both
|
$36.29
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
3008717201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Aetna of VT Commercial |
$34.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7.29
|
| Rate for Payer: Cash Price |
$18.14
|
| Rate for Payer: Cash Price |
$18.14
|
| Rate for Payer: Cigna Commercial |
$5.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.21
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare Commercial |
$6.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare VA CCN |
$4.27
|
|
|
PINWORM EXAMINATION
|
Facility
|
IP
|
$36.29
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
3008717201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.86 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna of VT Commercial |
$34.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$26.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$26.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$29.03
|
| Rate for Payer: Cash Price |
$18.14
|
| Rate for Payer: Cigna Commercial |
$29.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$29.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$29.03
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.85
|
| Rate for Payer: United Healthcare Commercial |
$34.48
|
|
|
PINWORM EXAMINATION
|
Facility
|
OP
|
$36.29
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
3008717201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna of VT Commercial |
$34.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$21.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$29.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.85
|
| Rate for Payer: Cash Price |
$18.14
|
| Rate for Payer: Cash Price |
$18.14
|
| Rate for Payer: Cigna Commercial |
$29.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$29.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$29.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.33
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.33
|
| Rate for Payer: United Healthcare Commercial |
$34.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare VA CCN |
$16.33
|
|
|
PIPERACILLIN/TAZO 3.375 GRAM
|
Facility
|
OP
|
$13.49
|
|
|
Service Code
|
NDC 6467905602
|
| Hospital Charge Code |
636J254303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$12.82 |
| Rate for Payer: Aetna of VT Commercial |
$12.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$12.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$12.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$8.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$10.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$10.72
|
| Rate for Payer: Cash Price |
$6.74
|
| Rate for Payer: Cigna Commercial |
$10.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$10.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$10.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.07
|
| Rate for Payer: Multiplan Commercial |
$12.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.07
|
| Rate for Payer: United Healthcare Commercial |
$12.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.07
|
| Rate for Payer: United Healthcare VA CCN |
$6.07
|
|
|
PIPERACILLIN/TAZO 3.375 GRAM
|
Facility
|
IP
|
$13.49
|
|
|
Service Code
|
NDC 6467905602
|
| Hospital Charge Code |
636J254303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$12.82 |
| Rate for Payer: Aetna of VT Commercial |
$12.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$9.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$9.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$10.79
|
| Rate for Payer: Cash Price |
$6.74
|
| Rate for Payer: Cigna Commercial |
$10.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$10.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$10.79
|
| Rate for Payer: Multiplan Commercial |
$12.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.47
|
| Rate for Payer: United Healthcare Commercial |
$12.82
|
|
|
PLASMA, FRZ BETWEEN 8-24HOUR
|
Facility
|
IP
|
$222.23
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
390P905901
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$164.47 |
| Max. Negotiated Rate |
$211.12 |
| Rate for Payer: Aetna of VT Commercial |
$211.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$164.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$164.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$188.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$186.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$177.78
|
| Rate for Payer: Cash Price |
$111.11
|
| Rate for Payer: Cigna Commercial |
$177.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$177.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$177.78
|
| Rate for Payer: Multiplan Commercial |
$206.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$188.90
|
| Rate for Payer: United Healthcare Commercial |
$211.12
|
|
|
PLASMA, FRZ BETWEEN 8-24HOUR
|
Facility
|
OP
|
$222.23
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
390P905901
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$98.43 |
| Max. Negotiated Rate |
$211.12 |
| Rate for Payer: Aetna of VT Commercial |
$211.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$199.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$98.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$199.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$133.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$188.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$180.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$100.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.67
|
| Rate for Payer: Cash Price |
$111.11
|
| Rate for Payer: Cigna Commercial |
$177.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$177.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$177.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$100.00
|
| Rate for Payer: Multiplan Commercial |
$206.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$188.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.00
|
| Rate for Payer: United Healthcare Commercial |
$211.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.00
|
| Rate for Payer: United Healthcare VA CCN |
$100.00
|
|
|
PLATE L 6 HOLE L2, LT
|
Facility
|
IP
|
$1,146.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$848.77 |
| Max. Negotiated Rate |
$1,089.49 |
| Rate for Payer: Aetna of VT Commercial |
$1,089.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$848.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$848.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$974.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$963.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$917.46
|
| Rate for Payer: Cash Price |
$573.42
|
| Rate for Payer: Cigna Commercial |
$917.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$917.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$917.46
|
| Rate for Payer: Multiplan Commercial |
$1,066.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$974.81
|
| Rate for Payer: United Healthcare Commercial |
$1,089.49
|
|
|
PLATE L 6 HOLE L2, LT
|
Facility
|
OP
|
$1,146.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.93 |
| Max. Negotiated Rate |
$1,089.49 |
| Rate for Payer: Aetna of VT Commercial |
$1,089.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,027.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$507.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,027.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$690.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$974.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$928.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$516.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$911.73
|
| Rate for Payer: Cash Price |
$573.42
|
| Rate for Payer: Cigna Commercial |
$917.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$917.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$917.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$516.07
|
| Rate for Payer: Multiplan Commercial |
$1,066.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$974.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$516.07
|
| Rate for Payer: United Healthcare Commercial |
$1,089.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$516.07
|
| Rate for Payer: United Healthcare VA CCN |
$516.07
|
|
|
PLATELETS LEUKOCYTES REDUCED
|
Facility
|
IP
|
$899.58
|
|
|
Service Code
|
HCPCS P9031
|
| Hospital Charge Code |
390P903101
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$665.78 |
| Max. Negotiated Rate |
$854.60 |
| Rate for Payer: Aetna of VT Commercial |
$854.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$665.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$665.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$764.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$755.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$719.66
|
| Rate for Payer: Cash Price |
$449.79
|
| Rate for Payer: Cigna Commercial |
$719.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$719.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$719.66
|
| Rate for Payer: Multiplan Commercial |
$836.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$764.64
|
| Rate for Payer: United Healthcare Commercial |
$854.60
|
|
|
PLATELETS LEUKOCYTES REDUCED
|
Facility
|
OP
|
$899.58
|
|
|
Service Code
|
HCPCS P9031
|
| Hospital Charge Code |
390P903101
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$398.42 |
| Max. Negotiated Rate |
$854.60 |
| Rate for Payer: Aetna of VT Commercial |
$854.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$805.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$398.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$805.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$541.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$764.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$728.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$404.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$715.17
|
| Rate for Payer: Cash Price |
$449.79
|
| Rate for Payer: Cigna Commercial |
$719.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$719.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$719.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$404.81
|
| Rate for Payer: Multiplan Commercial |
$836.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$764.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$404.81
|
| Rate for Payer: United Healthcare Commercial |
$854.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$404.81
|
| Rate for Payer: United Healthcare VA CCN |
$404.81
|
|
|
PLATELETS LEUKOREDUCED IRRAD
|
Facility
|
IP
|
$325.71
|
|
|
Service Code
|
HCPCS P9033
|
| Hospital Charge Code |
390P903301
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$241.06 |
| Max. Negotiated Rate |
$309.42 |
| Rate for Payer: Aetna of VT Commercial |
$309.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$241.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$241.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$276.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$273.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$260.57
|
| Rate for Payer: Cash Price |
$162.85
|
| Rate for Payer: Cigna Commercial |
$260.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$260.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$260.57
|
| Rate for Payer: Multiplan Commercial |
$302.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$276.85
|
| Rate for Payer: United Healthcare Commercial |
$309.42
|
|
|
PLATELETS LEUKOREDUCED IRRAD
|
Facility
|
OP
|
$325.71
|
|
|
Service Code
|
HCPCS P9033
|
| Hospital Charge Code |
390P903301
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$144.26 |
| Max. Negotiated Rate |
$309.42 |
| Rate for Payer: Aetna of VT Commercial |
$309.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$291.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$144.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$291.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$196.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$276.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$263.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$146.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$258.94
|
| Rate for Payer: Cash Price |
$162.85
|
| Rate for Payer: Cigna Commercial |
$260.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$260.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$260.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$146.57
|
| Rate for Payer: Multiplan Commercial |
$302.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$276.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$146.57
|
| Rate for Payer: United Healthcare Commercial |
$309.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$146.57
|
| Rate for Payer: United Healthcare VA CCN |
$146.57
|
|
|
P-MASTECTOMY W/LN REMOVAL
|
Facility
|
OP
|
$2,523.00
|
|
|
Service Code
|
CPT 19302
|
| Hospital Charge Code |
9821930201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,117.44 |
| Max. Negotiated Rate |
$2,396.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,396.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,260.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,117.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,260.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,518.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,144.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,043.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,135.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,005.79
|
| Rate for Payer: Cash Price |
$1,261.50
|
| Rate for Payer: Cigna Commercial |
$2,018.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,018.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,018.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,135.35
|
| Rate for Payer: Multiplan Commercial |
$2,346.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,144.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,135.35
|
| Rate for Payer: United Healthcare Commercial |
$2,396.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,135.35
|
| Rate for Payer: United Healthcare VA CCN |
$1,135.35
|
|
|
P-MASTECTOMY W/LN REMOVAL
|
Professional
|
Both
|
$2,523.00
|
|
|
Service Code
|
CPT 19302
|
| Hospital Charge Code |
9821930201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$832.37 |
| Max. Negotiated Rate |
$2,371.62 |
| Rate for Payer: Aetna of VT Commercial |
$2,371.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,260.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$857.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,260.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,165.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,314.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,314.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$957.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,314.18
|
| Rate for Payer: Cash Price |
$1,261.50
|
| Rate for Payer: Cash Price |
$1,261.50
|
| Rate for Payer: Cigna Commercial |
$1,523.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,413.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,413.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$832.38
|
| Rate for Payer: Multiplan Commercial |
$2,346.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,181.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$832.37
|
| Rate for Payer: United Healthcare Commercial |
$1,280.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$832.37
|
| Rate for Payer: United Healthcare VA CCN |
$832.37
|
|
|
P-MASTECTOMY W/LN REMOVAL
|
Facility
|
IP
|
$2,523.00
|
|
|
Service Code
|
CPT 19302
|
| Hospital Charge Code |
9821930201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,867.27 |
| Max. Negotiated Rate |
$2,396.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,396.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,867.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,867.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,144.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,119.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,018.40
|
| Rate for Payer: Cash Price |
$1,261.50
|
| Rate for Payer: Cigna Commercial |
$2,018.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,018.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,018.40
|
| Rate for Payer: Multiplan Commercial |
$2,346.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,144.55
|
| Rate for Payer: United Healthcare Commercial |
$2,396.85
|
|
|
PORPHYRINS FECES QUANTITATIVE
|
Professional
|
Both
|
$211.71
|
|
|
Service Code
|
CPT 84126
|
| Hospital Charge Code |
3008412601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.56 |
| Max. Negotiated Rate |
$199.01 |
| Rate for Payer: Aetna of VT Commercial |
$199.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$192.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$40.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$192.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$60.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$60.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$60.32
|
| Rate for Payer: Cash Price |
$105.86
|
| Rate for Payer: Cash Price |
$105.86
|
| Rate for Payer: Cigna Commercial |
$47.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$39.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$39.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$38.56
|
| Rate for Payer: Multiplan Commercial |
$196.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.11
|
| Rate for Payer: United Healthcare Commercial |
$60.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.11
|
| Rate for Payer: United Healthcare VA CCN |
$39.11
|
|
|
PORPHYRINS FECES QUANTITATIVE
|
Facility
|
OP
|
$211.71
|
|
|
Service Code
|
CPT 84126
|
| Hospital Charge Code |
3008412601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.11 |
| Max. Negotiated Rate |
$201.12 |
| Rate for Payer: Aetna of VT Commercial |
$201.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$192.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$93.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$192.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$127.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$95.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$168.31
|
| Rate for Payer: Cash Price |
$105.86
|
| Rate for Payer: Cash Price |
$105.86
|
| Rate for Payer: Cigna Commercial |
$169.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$169.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$169.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$95.27
|
| Rate for Payer: Multiplan Commercial |
$196.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$95.27
|
| Rate for Payer: United Healthcare Commercial |
$201.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.11
|
| Rate for Payer: United Healthcare VA CCN |
$95.27
|
|
|
PORPHYRINS FECES QUANTITATIVE
|
Facility
|
IP
|
$211.71
|
|
|
Service Code
|
CPT 84126
|
| Hospital Charge Code |
3008412601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.69 |
| Max. Negotiated Rate |
$201.12 |
| Rate for Payer: Aetna of VT Commercial |
$201.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$156.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$156.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$177.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.37
|
| Rate for Payer: Cash Price |
$105.86
|
| Rate for Payer: Cigna Commercial |
$169.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$169.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$169.37
|
| Rate for Payer: Multiplan Commercial |
$196.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.95
|
| Rate for Payer: United Healthcare Commercial |
$201.12
|
|
|
POS AIRWAY PRESSURE CPAP
|
Facility
|
IP
|
$648.84
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4109466001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$480.21 |
| Max. Negotiated Rate |
$616.40 |
| Rate for Payer: Aetna of VT Commercial |
$616.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$480.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$480.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$551.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$545.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$519.07
|
| Rate for Payer: Cash Price |
$324.42
|
| Rate for Payer: Cigna Commercial |
$519.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$519.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$519.07
|
| Rate for Payer: Multiplan Commercial |
$603.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$551.51
|
| Rate for Payer: United Healthcare Commercial |
$616.40
|
|
|
POS AIRWAY PRESSURE CPAP
|
Facility
|
OP
|
$648.84
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4109466001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$287.37 |
| Max. Negotiated Rate |
$616.40 |
| Rate for Payer: Aetna of VT Commercial |
$616.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$581.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$287.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$581.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$390.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$551.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$525.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$291.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$515.83
|
| Rate for Payer: Cash Price |
$324.42
|
| Rate for Payer: Cigna Commercial |
$519.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$519.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$519.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$291.98
|
| Rate for Payer: Multiplan Commercial |
$603.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$551.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$291.98
|
| Rate for Payer: United Healthcare Commercial |
$616.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$291.98
|
| Rate for Payer: United Healthcare VA CCN |
$291.98
|
|
|
POSTPARTUM CARE ONLY SPX
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
CPT 59430
|
| Hospital Charge Code |
9695943001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$178.49 |
| Max. Negotiated Rate |
$382.85 |
| Rate for Payer: Aetna of VT Commercial |
$382.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$361.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$178.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$361.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$242.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$342.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$326.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$181.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$320.38
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Cigna Commercial |
$322.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$322.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$322.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$181.35
|
| Rate for Payer: Multiplan Commercial |
$374.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$342.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$181.35
|
| Rate for Payer: United Healthcare Commercial |
$382.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.35
|
| Rate for Payer: United Healthcare VA CCN |
$181.35
|
|
