|
PROPANOLOL ER 60 MG PROP
|
Facility
|
IP
|
$0.01
|
|
| Hospital Charge Code |
2500000563
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
PROPANOLOL ER 60 MG PROP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 527411637
|
| Hospital Charge Code |
2500000563
|
|
Hospital Revenue Code
|
250
|
| 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 Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| 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
|
|
|
PROPOFOL 1000 MG/100 ML VIAL
|
Facility
|
IP
|
$49.21
|
|
|
Service Code
|
NDC 6332326965
|
| Hospital Charge Code |
636J270403
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$46.75 |
| Rate for Payer: Aetna of VT Commercial |
$46.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$36.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$36.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$41.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$41.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$39.37
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$39.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$39.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$39.37
|
| Rate for Payer: Multiplan Commercial |
$45.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.83
|
| Rate for Payer: United Healthcare Commercial |
$46.75
|
|
|
PROPOFOL 1000 MG/100 ML VIAL
|
Facility
|
OP
|
$49.21
|
|
|
Service Code
|
NDC 6332326965
|
| Hospital Charge Code |
636J270403
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$46.75 |
| Rate for Payer: Aetna of VT Commercial |
$46.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$44.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$44.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$41.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$39.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$22.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$39.12
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$39.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$39.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$39.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$22.14
|
| Rate for Payer: Multiplan Commercial |
$45.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.14
|
| Rate for Payer: United Healthcare Commercial |
$46.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.14
|
| Rate for Payer: United Healthcare VA CCN |
$22.14
|
|
|
PROSTATECTOMY (TURP)
|
Facility
|
IP
|
$2,375.00
|
|
|
Service Code
|
CPT 52601
|
| Hospital Charge Code |
9825260101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,757.74 |
| Max. Negotiated Rate |
$2,256.25 |
| Rate for Payer: Aetna of VT Commercial |
$2,256.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,757.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,757.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,018.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,995.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,900.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,900.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,900.00
|
| Rate for Payer: Multiplan Commercial |
$2,208.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,018.75
|
| Rate for Payer: United Healthcare Commercial |
$2,256.25
|
|
|
PROSTATECTOMY (TURP)
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
CPT 52601
|
| Hospital Charge Code |
9825260101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$680.69 |
| Max. Negotiated Rate |
$2,232.50 |
| Rate for Payer: Aetna of VT Commercial |
$2,232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,127.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$701.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,127.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$952.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,567.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,567.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$782.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,567.92
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,185.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,124.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,124.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$680.69
|
| Rate for Payer: Multiplan Commercial |
$2,208.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$966.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$680.69
|
| Rate for Payer: United Healthcare Commercial |
$1,047.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$680.69
|
| Rate for Payer: United Healthcare VA CCN |
$680.69
|
|
|
PROSTATECTOMY (TURP)
|
Facility
|
OP
|
$2,375.00
|
|
|
Service Code
|
CPT 52601
|
| Hospital Charge Code |
9825260101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,051.89 |
| Max. Negotiated Rate |
$2,256.25 |
| Rate for Payer: Aetna of VT Commercial |
$2,256.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,127.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,051.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,127.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,429.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,018.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,923.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,068.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,888.12
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,900.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,900.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,900.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,068.75
|
| Rate for Payer: Multiplan Commercial |
$2,208.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,018.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,068.75
|
| Rate for Payer: United Healthcare Commercial |
$2,256.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,068.75
|
| Rate for Payer: United Healthcare VA CCN |
$1,068.75
|
|
|
PROSTHETIC TRAING 1ST ENC
|
Facility
|
OP
|
$192.32
|
|
|
Service Code
|
CPT 97761 GP
|
| Hospital Charge Code |
4209776101
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$85.18 |
| Max. Negotiated Rate |
$182.70 |
| Rate for Payer: Aetna of VT Commercial |
$182.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$85.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$115.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$163.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$155.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$86.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$152.89
|
| Rate for Payer: Cash Price |
$96.16
|
| Rate for Payer: Cigna Commercial |
$153.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$153.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$153.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.54
|
| Rate for Payer: Multiplan Commercial |
$178.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$86.54
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.54
|
| Rate for Payer: United Healthcare VA CCN |
$86.54
|
|
|
PROSTHETIC TRAING 1ST ENC
|
Facility
|
OP
|
$192.32
|
|
|
Service Code
|
CPT 97761 GO
|
| Hospital Charge Code |
4309776101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$85.18 |
| Max. Negotiated Rate |
$182.70 |
| Rate for Payer: Aetna of VT Commercial |
$182.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$85.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$115.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$163.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$155.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$86.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$152.89
|
| Rate for Payer: Cash Price |
$96.16
|
| Rate for Payer: Cigna Commercial |
$153.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$153.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$153.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.54
|
| Rate for Payer: Multiplan Commercial |
$178.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$86.54
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.54
|
| Rate for Payer: United Healthcare VA CCN |
$86.54
|
|
|
PROSTHETIC TRAING 1ST ENC
|
Facility
|
IP
|
$192.32
|
|
|
Service Code
|
CPT 97761 GO
|
| Hospital Charge Code |
4309776101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$142.34 |
| Max. Negotiated Rate |
$182.70 |
| Rate for Payer: Aetna of VT Commercial |
$182.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$142.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$142.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$163.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$161.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$153.86
|
| Rate for Payer: Cash Price |
$96.16
|
| Rate for Payer: Cigna Commercial |
$153.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$153.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$153.86
|
| Rate for Payer: Multiplan Commercial |
$178.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$163.47
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
|
|
PROSTHETIC TRAING 1ST ENC
|
Facility
|
IP
|
$192.32
|
|
|
Service Code
|
CPT 97761 GP
|
| Hospital Charge Code |
4209776101
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$142.34 |
| Max. Negotiated Rate |
$182.70 |
| Rate for Payer: Aetna of VT Commercial |
$182.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$142.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$142.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$163.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$161.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$153.86
|
| Rate for Payer: Cash Price |
$96.16
|
| Rate for Payer: Cigna Commercial |
$153.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$153.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$153.86
|
| Rate for Payer: Multiplan Commercial |
$178.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$163.47
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
|
|
PROTEIN E-PHORESIS SERUM
|
Facility
|
IP
|
$95.02
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
3008416501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.32 |
| Max. Negotiated Rate |
$90.27 |
| Rate for Payer: Aetna of VT Commercial |
$90.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$80.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$79.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.02
|
| Rate for Payer: Cash Price |
$47.51
|
| Rate for Payer: Cigna Commercial |
$76.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.02
|
| Rate for Payer: Multiplan Commercial |
$88.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.77
|
| Rate for Payer: United Healthcare Commercial |
$90.27
|
|
|
PROTEIN E-PHORESIS SERUM
|
Facility
|
OP
|
$95.02
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
3008416501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$90.27 |
| Rate for Payer: Aetna of VT Commercial |
$90.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$42.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$57.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$80.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$76.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$75.54
|
| Rate for Payer: Cash Price |
$47.51
|
| Rate for Payer: Cash Price |
$47.51
|
| Rate for Payer: Cigna Commercial |
$76.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$42.76
|
| Rate for Payer: Multiplan Commercial |
$88.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$42.76
|
| Rate for Payer: United Healthcare Commercial |
$90.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.74
|
| Rate for Payer: United Healthcare VA CCN |
$42.76
|
|
|
PROTEIN E-PHORESIS SERUM
|
Professional
|
Both
|
$95.02
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
3008416501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$89.32 |
| Rate for Payer: Aetna of VT Commercial |
$89.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$27.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$27.13
|
| Rate for Payer: Cash Price |
$47.51
|
| Rate for Payer: Cash Price |
$47.51
|
| Rate for Payer: Cigna Commercial |
$33.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$10.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$10.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$88.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.74
|
| Rate for Payer: United Healthcare Commercial |
$16.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.74
|
| Rate for Payer: United Healthcare VA CCN |
$10.74
|
|
|
PROTEIN E-PHORESIS/URINE/CSF
|
Facility
|
OP
|
$152.52
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
3008416601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$144.89 |
| Rate for Payer: Aetna of VT Commercial |
$144.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$87.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$67.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$87.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$91.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$123.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$68.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$121.25
|
| Rate for Payer: Cash Price |
$76.26
|
| Rate for Payer: Cash Price |
$76.26
|
| Rate for Payer: Cigna Commercial |
$122.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$122.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$122.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$68.63
|
| Rate for Payer: Multiplan Commercial |
$141.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$129.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$68.63
|
| Rate for Payer: United Healthcare Commercial |
$144.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.83
|
| Rate for Payer: United Healthcare VA CCN |
$68.63
|
|
|
PROTEIN E-PHORESIS/URINE/CSF
|
Facility
|
IP
|
$152.52
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
3008416601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$112.88 |
| Max. Negotiated Rate |
$144.89 |
| Rate for Payer: Aetna of VT Commercial |
$144.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$128.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.02
|
| Rate for Payer: Cash Price |
$76.26
|
| Rate for Payer: Cigna Commercial |
$122.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$122.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$122.02
|
| Rate for Payer: Multiplan Commercial |
$141.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$129.64
|
| Rate for Payer: United Healthcare Commercial |
$144.89
|
|
|
PROTEIN E-PHORESIS/URINE/CSF
|
Professional
|
Both
|
$152.52
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
3008416601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.58 |
| Max. Negotiated Rate |
$143.37 |
| Rate for Payer: Aetna of VT Commercial |
$143.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$87.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$87.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$24.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$40.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$40.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$20.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$40.05
|
| Rate for Payer: Cash Price |
$76.26
|
| Rate for Payer: Cash Price |
$76.26
|
| Rate for Payer: Cigna Commercial |
$41.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$17.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$17.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.58
|
| Rate for Payer: Multiplan Commercial |
$141.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$17.83
|
| Rate for Payer: United Healthcare Commercial |
$27.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.83
|
| Rate for Payer: United Healthcare VA CCN |
$17.83
|
|
|
PROTEIN WESTERN BLOT TEST
|
Professional
|
Both
|
$324.16
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
3008418201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$304.71 |
| Rate for Payer: Aetna of VT Commercial |
$304.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$143.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$30.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$143.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$40.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$42.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$42.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$33.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.62
|
| Rate for Payer: Cash Price |
$162.08
|
| Rate for Payer: Cash Price |
$162.08
|
| Rate for Payer: Cigna Commercial |
$55.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$29.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$29.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$301.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$29.21
|
| Rate for Payer: United Healthcare Commercial |
$44.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.21
|
| Rate for Payer: United Healthcare VA CCN |
$29.21
|
|
|
PROTEIN WESTERN BLOT TEST
|
Facility
|
OP
|
$324.16
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
3008418201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.21 |
| Max. Negotiated Rate |
$307.95 |
| Rate for Payer: Aetna of VT Commercial |
$307.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$143.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$143.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$143.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$195.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$275.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$262.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$145.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$257.71
|
| Rate for Payer: Cash Price |
$162.08
|
| Rate for Payer: Cash Price |
$162.08
|
| Rate for Payer: Cigna Commercial |
$259.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$259.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$259.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$145.87
|
| Rate for Payer: Multiplan Commercial |
$301.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$275.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$145.87
|
| Rate for Payer: United Healthcare Commercial |
$307.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.21
|
| Rate for Payer: United Healthcare VA CCN |
$145.87
|
|
|
PROTEIN WESTERN BLOT TEST
|
Facility
|
IP
|
$324.16
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
3008418201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$239.91 |
| Max. Negotiated Rate |
$307.95 |
| Rate for Payer: Aetna of VT Commercial |
$307.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$239.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$239.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$275.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$272.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$259.33
|
| Rate for Payer: Cash Price |
$162.08
|
| Rate for Payer: Cigna Commercial |
$259.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$259.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$259.33
|
| Rate for Payer: Multiplan Commercial |
$301.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$275.54
|
| Rate for Payer: United Healthcare Commercial |
$307.95
|
|
|
PROTHROMBIN TIME
|
Facility
|
IP
|
$53.45
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
3008561001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.56 |
| Max. Negotiated Rate |
$50.78 |
| Rate for Payer: Aetna of VT Commercial |
$50.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.76
|
| Rate for Payer: Cash Price |
$26.73
|
| Rate for Payer: Cigna Commercial |
$42.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.76
|
| Rate for Payer: Multiplan Commercial |
$49.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.43
|
| Rate for Payer: United Healthcare Commercial |
$50.78
|
|
|
PROTHROMBIN TIME
|
Professional
|
Both
|
$53.45
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
3008561001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$50.24 |
| Rate for Payer: Aetna of VT Commercial |
$50.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7.33
|
| Rate for Payer: Cash Price |
$26.73
|
| Rate for Payer: Cash Price |
$26.73
|
| Rate for Payer: Cigna Commercial |
$5.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$49.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.29
|
| Rate for Payer: United Healthcare Commercial |
$6.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.29
|
| Rate for Payer: United Healthcare VA CCN |
$4.29
|
|
|
PROTHROMBIN TIME
|
Facility
|
OP
|
$53.45
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
3008561001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$50.78 |
| Rate for Payer: Aetna of VT Commercial |
$50.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$43.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.49
|
| Rate for Payer: Cash Price |
$26.73
|
| Rate for Payer: Cash Price |
$26.73
|
| Rate for Payer: Cigna Commercial |
$42.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$24.05
|
| Rate for Payer: Multiplan Commercial |
$49.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$24.05
|
| Rate for Payer: United Healthcare Commercial |
$50.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.29
|
| Rate for Payer: United Healthcare VA CCN |
$24.05
|
|
|
PRP I/HERN INIT BLOCK >5 YR
|
Facility
|
OP
|
$1,892.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
9824950701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$837.97 |
| Max. Negotiated Rate |
$1,797.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,797.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,695.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$837.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,695.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,138.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,608.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,532.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$851.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,504.14
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Cigna Commercial |
$1,513.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,513.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,513.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$851.40
|
| Rate for Payer: Multiplan Commercial |
$1,759.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,608.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$851.40
|
| Rate for Payer: United Healthcare Commercial |
$1,797.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$851.40
|
| Rate for Payer: United Healthcare VA CCN |
$851.40
|
|
|
PRP I/HERN INIT BLOCK >5 YR
|
Professional
|
Both
|
$1,892.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
9824950701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$542.12 |
| Max. Negotiated Rate |
$1,778.48 |
| Rate for Payer: Aetna of VT Commercial |
$1,778.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,695.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$558.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,695.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$758.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$977.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$977.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$623.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$977.92
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Cigna Commercial |
$990.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$920.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$920.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$542.12
|
| Rate for Payer: Multiplan Commercial |
$1,759.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$769.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$542.12
|
| Rate for Payer: United Healthcare Commercial |
$833.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$542.12
|
| Rate for Payer: United Healthcare VA CCN |
$542.12
|
|
