|
PUNCTURE DRAINAGE OF LESION
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
9601016001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$492.17 |
| Max. Negotiated Rate |
$631.75 |
| Rate for Payer: Aetna of VT Commercial |
$631.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$492.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$492.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$565.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$558.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$532.00
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: Cigna Commercial |
$532.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$532.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$532.00
|
| Rate for Payer: Multiplan Commercial |
$618.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$565.25
|
| Rate for Payer: United Healthcare Commercial |
$631.75
|
|
|
PUNCTURE DRAINAGE OF LESION
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
9811016002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$181.59 |
| Max. Negotiated Rate |
$389.50 |
| Rate for Payer: Aetna of VT Commercial |
$389.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$367.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$181.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$367.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$246.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$348.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$332.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$184.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$325.95
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cigna Commercial |
$328.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$328.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$328.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$184.50
|
| Rate for Payer: Multiplan Commercial |
$381.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$348.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$184.50
|
| Rate for Payer: United Healthcare Commercial |
$389.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.50
|
| Rate for Payer: United Healthcare VA CCN |
$184.50
|
|
|
PUNCTURE DRAINAGE OF LESION
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
9601016001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$294.53 |
| Max. Negotiated Rate |
$631.75 |
| Rate for Payer: Aetna of VT Commercial |
$631.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$595.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$294.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$595.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$400.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$565.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$538.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$299.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$528.67
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: Cigna Commercial |
$532.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$532.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$532.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$299.25
|
| Rate for Payer: Multiplan Commercial |
$618.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$565.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$299.25
|
| Rate for Payer: United Healthcare Commercial |
$631.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$299.25
|
| Rate for Payer: United Healthcare VA CCN |
$299.25
|
|
|
PURE TONE AUDIOMETRY AIR
|
Professional
|
Both
|
$153.03
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
4719255201
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$38.39 |
| Max. Negotiated Rate |
$143.85 |
| Rate for Payer: Aetna of VT Commercial |
$143.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$38.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$38.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$38.39
|
| Rate for Payer: Cash Price |
$76.52
|
| Rate for Payer: Cash Price |
$76.52
|
| Rate for Payer: Cigna Commercial |
$41.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$61.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$61.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$38.39
|
| Rate for Payer: Multiplan Commercial |
$142.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.39
|
| Rate for Payer: United Healthcare Commercial |
$59.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.39
|
| Rate for Payer: United Healthcare VA CCN |
$38.39
|
|
|
PURE TONE AUDIOMETRY AIR
|
Facility
|
IP
|
$153.03
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
4719255201
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$113.26 |
| Max. Negotiated Rate |
$145.38 |
| Rate for Payer: Aetna of VT Commercial |
$145.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$128.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.42
|
| Rate for Payer: Cash Price |
$76.52
|
| Rate for Payer: Cigna Commercial |
$122.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$122.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$122.42
|
| Rate for Payer: Multiplan Commercial |
$142.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.08
|
| Rate for Payer: United Healthcare Commercial |
$145.38
|
|
|
PURE TONE AUDIOMETRY AIR
|
Facility
|
OP
|
$153.03
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
4719255201
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$67.78 |
| Max. Negotiated Rate |
$145.38 |
| Rate for Payer: Aetna of VT Commercial |
$145.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$67.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$123.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$68.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$121.66
|
| Rate for Payer: Cash Price |
$76.52
|
| Rate for Payer: Cigna Commercial |
$122.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$122.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$122.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$68.86
|
| Rate for Payer: Multiplan Commercial |
$142.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$68.86
|
| Rate for Payer: United Healthcare Commercial |
$145.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.86
|
| Rate for Payer: United Healthcare VA CCN |
$68.86
|
|
|
Q FEVER ANTIBODY
|
Facility
|
OP
|
$206.80
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
3008663801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$196.46 |
| Rate for Payer: Aetna of VT Commercial |
$196.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$91.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$124.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$175.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$167.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$164.41
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cigna Commercial |
$165.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$165.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$165.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.06
|
| Rate for Payer: Multiplan Commercial |
$192.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$93.06
|
| Rate for Payer: United Healthcare Commercial |
$196.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.12
|
| Rate for Payer: United Healthcare VA CCN |
$93.06
|
|
|
Q FEVER ANTIBODY
|
Professional
|
Both
|
$206.80
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
3008663801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$194.39 |
| Rate for Payer: Aetna of VT Commercial |
$194.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.71
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cigna Commercial |
$14.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.95
|
| Rate for Payer: Multiplan Commercial |
$192.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.12
|
| Rate for Payer: United Healthcare Commercial |
$18.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.12
|
| Rate for Payer: United Healthcare VA CCN |
$12.12
|
|
|
Q FEVER ANTIBODY
|
Facility
|
IP
|
$206.80
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
3008663801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.05 |
| Max. Negotiated Rate |
$196.46 |
| Rate for Payer: Aetna of VT Commercial |
$196.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$153.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$153.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$175.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$173.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$165.44
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cigna Commercial |
$165.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$165.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$165.44
|
| Rate for Payer: Multiplan Commercial |
$192.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.78
|
| Rate for Payer: United Healthcare Commercial |
$196.46
|
|
|
QUANT ASSAY DRUG Ustekinumab
|
Facility
|
OP
|
$443.59
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3008029901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$421.41 |
| Rate for Payer: Aetna of VT Commercial |
$421.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$91.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$196.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$91.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$267.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$377.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$359.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$199.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$352.65
|
| Rate for Payer: Cash Price |
$221.79
|
| Rate for Payer: Cash Price |
$221.79
|
| Rate for Payer: Cigna Commercial |
$354.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$354.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$354.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$199.62
|
| Rate for Payer: Multiplan Commercial |
$412.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$377.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$199.62
|
| Rate for Payer: United Healthcare Commercial |
$421.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare VA CCN |
$199.62
|
|
|
QUANT ASSAY DRUG Ustekinumab
|
Facility
|
IP
|
$443.59
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3008029901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$328.30 |
| Max. Negotiated Rate |
$421.41 |
| Rate for Payer: Aetna of VT Commercial |
$421.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$328.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$328.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$377.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$372.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$354.87
|
| Rate for Payer: Cash Price |
$221.79
|
| Rate for Payer: Cigna Commercial |
$354.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$354.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$354.87
|
| Rate for Payer: Multiplan Commercial |
$412.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$377.05
|
| Rate for Payer: United Healthcare Commercial |
$421.41
|
|
|
QUANT ASSAY DRUG Ustekinumab
|
Professional
|
Both
|
$443.59
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3008029901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.38 |
| Max. Negotiated Rate |
$416.97 |
| Rate for Payer: Aetna of VT Commercial |
$416.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$91.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$19.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$91.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$26.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$31.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$31.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$21.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$31.86
|
| Rate for Payer: Cash Price |
$221.79
|
| Rate for Payer: Cash Price |
$221.79
|
| Rate for Payer: Cigna Commercial |
$22.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.38
|
| Rate for Payer: Multiplan Commercial |
$412.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare Commercial |
$28.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare VA CCN |
$18.64
|
|
|
RABIES IMMUNE GLOB 300 IU/1 ML
|
Facility
|
IP
|
$2,735.27
|
|
|
Service Code
|
CPT 90375
|
| Hospital Charge Code |
6369037501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,024.37 |
| Max. Negotiated Rate |
$2,598.51 |
| Rate for Payer: Aetna of VT Commercial |
$2,598.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,024.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,024.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,324.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,297.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,188.22
|
| Rate for Payer: Cash Price |
$1,367.63
|
| Rate for Payer: Cigna Commercial |
$2,188.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,188.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,188.22
|
| Rate for Payer: Multiplan Commercial |
$2,543.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,324.98
|
| Rate for Payer: United Healthcare Commercial |
$2,598.51
|
|
|
RABIES IMMUNE GLOB 300 IU/1 ML
|
Facility
|
OP
|
$2,735.27
|
|
|
Service Code
|
CPT 90375
|
| Hospital Charge Code |
6369037501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$797.25 |
| Max. Negotiated Rate |
$2,598.51 |
| Rate for Payer: Aetna of VT Commercial |
$2,598.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$797.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,211.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$797.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,646.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,324.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,215.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,230.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,174.54
|
| Rate for Payer: Cash Price |
$1,367.63
|
| Rate for Payer: Cash Price |
$1,367.63
|
| Rate for Payer: Cigna Commercial |
$2,188.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,188.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,188.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,230.87
|
| Rate for Payer: Multiplan Commercial |
$2,543.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,324.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,230.87
|
| Rate for Payer: United Healthcare Commercial |
$2,598.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,230.87
|
| Rate for Payer: United Healthcare VA CCN |
$1,230.87
|
|
|
RABIES IMMUNE GLOB 300 IU/1 ML
|
Facility
|
OP
|
$2,735.27
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
6369037501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$797.25 |
| Max. Negotiated Rate |
$2,598.51 |
| Rate for Payer: Aetna of VT Commercial |
$2,598.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$797.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,211.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$797.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,646.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,324.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,215.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,230.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,174.54
|
| Rate for Payer: Cash Price |
$1,367.63
|
| Rate for Payer: Cash Price |
$1,367.63
|
| Rate for Payer: Cigna Commercial |
$2,188.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,188.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,188.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,230.87
|
| Rate for Payer: Multiplan Commercial |
$2,543.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,324.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,230.87
|
| Rate for Payer: United Healthcare Commercial |
$2,598.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,230.87
|
| Rate for Payer: United Healthcare VA CCN |
$1,230.87
|
|
|
RABIES IMMUNE GLOB 300 IU/1 ML
|
Facility
|
IP
|
$2,735.27
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
6369037501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,024.37 |
| Max. Negotiated Rate |
$2,598.51 |
| Rate for Payer: Aetna of VT Commercial |
$2,598.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,024.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,024.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,324.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,297.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,188.22
|
| Rate for Payer: Cash Price |
$1,367.63
|
| Rate for Payer: Cigna Commercial |
$2,188.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,188.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,188.22
|
| Rate for Payer: Multiplan Commercial |
$2,543.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,324.98
|
| Rate for Payer: United Healthcare Commercial |
$2,598.51
|
|
|
RABIES IMMUNE GLOB 900 IU/3 ML
|
Facility
|
OP
|
$2,911.59
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
6369037502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$797.25 |
| Max. Negotiated Rate |
$2,766.01 |
| Rate for Payer: Aetna of VT Commercial |
$2,766.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$797.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,289.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$797.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,752.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,474.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,358.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,310.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,314.71
|
| Rate for Payer: Cash Price |
$1,455.80
|
| Rate for Payer: Cash Price |
$1,455.80
|
| Rate for Payer: Cigna Commercial |
$2,329.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,329.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,329.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,310.22
|
| Rate for Payer: Multiplan Commercial |
$2,707.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,474.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,310.22
|
| Rate for Payer: United Healthcare Commercial |
$2,766.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,310.22
|
| Rate for Payer: United Healthcare VA CCN |
$1,310.22
|
|
|
RABIES IMMUNE GLOB 900 IU/3 ML
|
Facility
|
IP
|
$2,911.59
|
|
|
Service Code
|
CPT 90375
|
| Hospital Charge Code |
6369037502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,154.87 |
| Max. Negotiated Rate |
$2,766.01 |
| Rate for Payer: Aetna of VT Commercial |
$2,766.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,154.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,154.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,474.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,445.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,329.27
|
| Rate for Payer: Cash Price |
$1,455.80
|
| Rate for Payer: Cigna Commercial |
$2,329.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,329.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,329.27
|
| Rate for Payer: Multiplan Commercial |
$2,707.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,474.85
|
| Rate for Payer: United Healthcare Commercial |
$2,766.01
|
|
|
RABIES IMMUNE GLOB 900 IU/3 ML
|
Facility
|
IP
|
$2,911.59
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
6369037502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,154.87 |
| Max. Negotiated Rate |
$2,766.01 |
| Rate for Payer: Aetna of VT Commercial |
$2,766.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,154.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,154.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,474.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,445.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,329.27
|
| Rate for Payer: Cash Price |
$1,455.80
|
| Rate for Payer: Cigna Commercial |
$2,329.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,329.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,329.27
|
| Rate for Payer: Multiplan Commercial |
$2,707.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,474.85
|
| Rate for Payer: United Healthcare Commercial |
$2,766.01
|
|
|
RABIES IMMUNE GLOB 900 IU/3 ML
|
Facility
|
OP
|
$2,911.59
|
|
|
Service Code
|
CPT 90375
|
| Hospital Charge Code |
6369037502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$797.25 |
| Max. Negotiated Rate |
$2,766.01 |
| Rate for Payer: Aetna of VT Commercial |
$2,766.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$797.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,289.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$797.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,752.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,474.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,358.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,310.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,314.71
|
| Rate for Payer: Cash Price |
$1,455.80
|
| Rate for Payer: Cash Price |
$1,455.80
|
| Rate for Payer: Cigna Commercial |
$2,329.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,329.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,329.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,310.22
|
| Rate for Payer: Multiplan Commercial |
$2,707.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,474.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,310.22
|
| Rate for Payer: United Healthcare Commercial |
$2,766.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,310.22
|
| Rate for Payer: United Healthcare VA CCN |
$1,310.22
|
|
|
RABIES IMMUN GLOB 1500 IU/5 ML
|
Facility
|
OP
|
$2,911.59
|
|
|
Service Code
|
CPT 90375
|
| Hospital Charge Code |
6369037503
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$797.25 |
| Max. Negotiated Rate |
$2,766.01 |
| Rate for Payer: Aetna of VT Commercial |
$2,766.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$797.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,289.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$797.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,752.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,474.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,358.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,310.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,314.71
|
| Rate for Payer: Cash Price |
$1,455.80
|
| Rate for Payer: Cash Price |
$1,455.80
|
| Rate for Payer: Cigna Commercial |
$2,329.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,329.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,329.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,310.22
|
| Rate for Payer: Multiplan Commercial |
$2,707.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,474.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,310.22
|
| Rate for Payer: United Healthcare Commercial |
$2,766.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,310.22
|
| Rate for Payer: United Healthcare VA CCN |
$1,310.22
|
|
|
RABIES IMMUN GLOB 1500 IU/5 ML
|
Facility
|
IP
|
$2,911.59
|
|
|
Service Code
|
CPT 90375
|
| Hospital Charge Code |
6369037503
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,154.87 |
| Max. Negotiated Rate |
$2,766.01 |
| Rate for Payer: Aetna of VT Commercial |
$2,766.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,154.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,154.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,474.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,445.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,329.27
|
| Rate for Payer: Cash Price |
$1,455.80
|
| Rate for Payer: Cigna Commercial |
$2,329.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,329.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,329.27
|
| Rate for Payer: Multiplan Commercial |
$2,707.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,474.85
|
| Rate for Payer: United Healthcare Commercial |
$2,766.01
|
|
|
RABIES IMMUN GLOB 1500 IU/5 ML
|
Facility
|
OP
|
$2,911.59
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
6369037503
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$797.25 |
| Max. Negotiated Rate |
$2,766.01 |
| Rate for Payer: Aetna of VT Commercial |
$2,766.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$797.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,289.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$797.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,752.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,474.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,358.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,310.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,314.71
|
| Rate for Payer: Cash Price |
$1,455.80
|
| Rate for Payer: Cash Price |
$1,455.80
|
| Rate for Payer: Cigna Commercial |
$2,329.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,329.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,329.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,310.22
|
| Rate for Payer: Multiplan Commercial |
$2,707.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,474.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,310.22
|
| Rate for Payer: United Healthcare Commercial |
$2,766.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,310.22
|
| Rate for Payer: United Healthcare VA CCN |
$1,310.22
|
|
|
RABIES IMMUN GLOB 1500 IU/5 ML
|
Facility
|
IP
|
$2,911.59
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
6369037503
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,154.87 |
| Max. Negotiated Rate |
$2,766.01 |
| Rate for Payer: Aetna of VT Commercial |
$2,766.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,154.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,154.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,474.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,445.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,329.27
|
| Rate for Payer: Cash Price |
$1,455.80
|
| Rate for Payer: Cigna Commercial |
$2,329.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,329.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,329.27
|
| Rate for Payer: Multiplan Commercial |
$2,707.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,474.85
|
| Rate for Payer: United Healthcare Commercial |
$2,766.01
|
|
|
RABIES VACCINE IM
|
Facility
|
OP
|
$1,834.88
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
6369067501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$812.67 |
| Max. Negotiated Rate |
$1,743.14 |
| Rate for Payer: Aetna of VT Commercial |
$1,743.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$873.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$812.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$873.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,104.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,559.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,486.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$825.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,458.73
|
| Rate for Payer: Cash Price |
$917.44
|
| Rate for Payer: Cash Price |
$917.44
|
| Rate for Payer: Cigna Commercial |
$1,467.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,467.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,467.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$825.70
|
| Rate for Payer: Multiplan Commercial |
$1,706.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,559.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$825.70
|
| Rate for Payer: United Healthcare Commercial |
$1,743.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$825.70
|
| Rate for Payer: United Healthcare VA CCN |
$825.70
|
|
