|
RABIES VACCINE IM
|
Facility
|
IP
|
$1,306.38
|
|
| Hospital Charge Code |
6369067501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$966.85 |
| Max. Negotiated Rate |
$1,241.06 |
| Rate for Payer: Aetna of VT Commercial |
$1,241.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$966.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$966.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,110.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,097.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,045.10
|
| Rate for Payer: Cash Price |
$653.19
|
| Rate for Payer: Cigna Commercial |
$1,045.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,045.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,045.10
|
| Rate for Payer: Multiplan Commercial |
$1,214.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,110.42
|
| Rate for Payer: United Healthcare Commercial |
$1,241.06
|
|
|
RABIES VACCINE IM
|
Facility
|
OP
|
$1,306.38
|
|
| Hospital Charge Code |
6369067501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$578.60 |
| Max. Negotiated Rate |
$1,241.06 |
| Rate for Payer: Aetna of VT Commercial |
$1,241.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,170.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$578.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,170.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$786.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,110.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,058.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$587.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,038.57
|
| Rate for Payer: Cash Price |
$653.19
|
| Rate for Payer: Cigna Commercial |
$1,045.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,045.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,045.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$587.87
|
| Rate for Payer: Multiplan Commercial |
$1,214.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,110.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$587.87
|
| Rate for Payer: United Healthcare Commercial |
$1,241.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$587.87
|
| Rate for Payer: United Healthcare VA CCN |
$587.87
|
|
|
RABIES VACCINE IM
|
Facility
|
IP
|
$1,834.88
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
6369067501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,357.99 |
| 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 |
$1,357.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,357.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,559.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,541.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,467.90
|
| 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: Multiplan Commercial |
$1,706.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,559.65
|
| Rate for Payer: United Healthcare Commercial |
$1,743.14
|
|
|
RABIES VACCINE IM
|
Professional
|
Both
|
$1,834.88
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
6369067501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$313.68 |
| Max. Negotiated Rate |
$1,724.79 |
| Rate for Payer: Aetna of VT Commercial |
$1,724.79
|
| 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 |
$323.09
|
| 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 |
$439.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$374.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$360.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$374.42
|
| Rate for Payer: Cash Price |
$917.44
|
| Rate for Payer: Cash Price |
$917.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$455.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$455.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$317.67
|
| Rate for Payer: Multiplan Commercial |
$1,706.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$313.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$313.68
|
| Rate for Payer: United Healthcare Commercial |
$482.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.68
|
| Rate for Payer: United Healthcare VA CCN |
$313.68
|
|
|
RABIES VACCINE IM
|
Professional
|
Both
|
$1,306.38
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
6369067501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$313.68 |
| Max. Negotiated Rate |
$1,228.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,228.00
|
| 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 |
$323.09
|
| 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 |
$439.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$374.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$360.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$374.42
|
| Rate for Payer: Cash Price |
$653.19
|
| Rate for Payer: Cash Price |
$653.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$455.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$455.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$317.67
|
| Rate for Payer: Multiplan Commercial |
$1,214.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$313.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$313.68
|
| Rate for Payer: United Healthcare Commercial |
$482.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.68
|
| Rate for Payer: United Healthcare VA CCN |
$313.68
|
|
|
RANOLAZINE 500 MG TABLET
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 4229177360
|
| Hospital Charge Code |
2500000567
|
|
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
|
|
|
RANOLAZINE 500 MG TABLET
|
Facility
|
IP
|
$0.01
|
|
| Hospital Charge Code |
2500000567
|
|
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
|
|
|
RANOLAZINE 500 MG TABLET
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 4229177360
|
| Hospital Charge Code |
2500000567
|
|
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
|
|
|
RANOLAZINE 500 MG TABLET
|
Facility
|
OP
|
$0.01
|
|
| Hospital Charge Code |
2500000567
|
|
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
|
|
|
RA TRACER ID OF SENTINL NODE
|
Facility
|
IP
|
$1,628.55
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
3413879201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,205.29 |
| Max. Negotiated Rate |
$1,547.12 |
| Rate for Payer: Aetna of VT Commercial |
$1,547.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,205.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,205.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,384.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,367.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,302.84
|
| Rate for Payer: Cash Price |
$814.28
|
| Rate for Payer: Cigna Commercial |
$1,302.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,302.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,302.84
|
| Rate for Payer: Multiplan Commercial |
$1,514.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,384.27
|
| Rate for Payer: United Healthcare Commercial |
$1,547.12
|
|
|
RA TRACER ID OF SENTINL NODE
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
9723879201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$101.42 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Aetna of VT Commercial |
$217.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$205.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$101.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$205.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$137.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$194.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$185.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$182.06
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cigna Commercial |
$183.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$103.05
|
| Rate for Payer: Multiplan Commercial |
$212.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$194.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.05
|
| Rate for Payer: United Healthcare Commercial |
$217.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.05
|
| Rate for Payer: United Healthcare VA CCN |
$103.05
|
|
|
RA TRACER ID OF SENTINL NODE
|
Professional
|
Both
|
$229.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
9723879201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$29.59 |
| Max. Negotiated Rate |
$215.26 |
| Rate for Payer: Aetna of VT Commercial |
$215.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$205.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$30.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$205.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$41.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$105.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$105.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$34.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$105.50
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cigna Commercial |
$54.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$126.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$126.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$78.08
|
| Rate for Payer: Multiplan Commercial |
$212.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$29.59
|
| Rate for Payer: United Healthcare Commercial |
$45.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.59
|
| Rate for Payer: United Healthcare VA CCN |
$29.59
|
|
|
RA TRACER ID OF SENTINL NODE
|
Facility
|
OP
|
$1,628.55
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
3413879201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$721.28 |
| Max. Negotiated Rate |
$1,547.12 |
| Rate for Payer: Aetna of VT Commercial |
$1,547.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,459.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$721.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,459.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$980.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,384.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,319.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$732.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,294.70
|
| Rate for Payer: Cash Price |
$814.28
|
| Rate for Payer: Cigna Commercial |
$1,302.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,302.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,302.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$732.85
|
| Rate for Payer: Multiplan Commercial |
$1,514.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,384.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$732.85
|
| Rate for Payer: United Healthcare Commercial |
$1,547.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$732.85
|
| Rate for Payer: United Healthcare VA CCN |
$732.85
|
|
|
RA TRACER ID OF SENTINL NODE
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
9723879201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$169.48 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Aetna of VT Commercial |
$217.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$169.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$169.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$194.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$192.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$183.20
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cigna Commercial |
$183.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.20
|
| Rate for Payer: Multiplan Commercial |
$212.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$194.65
|
| Rate for Payer: United Healthcare Commercial |
$217.55
|
|
|
RBC ANTIBODY ELUTION
|
Facility
|
IP
|
$227.67
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
3008686001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$168.50 |
| Max. Negotiated Rate |
$216.29 |
| Rate for Payer: Aetna of VT Commercial |
$216.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$168.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$168.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$193.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$191.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$182.14
|
| Rate for Payer: Cash Price |
$113.83
|
| Rate for Payer: Cigna Commercial |
$182.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$182.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$182.14
|
| Rate for Payer: Multiplan Commercial |
$211.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$193.52
|
| Rate for Payer: United Healthcare Commercial |
$216.29
|
|
|
RBC ANTIBODY ELUTION
|
Professional
|
Both
|
$227.67
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
3008686001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.18 |
| Max. Negotiated Rate |
$214.01 |
| Rate for Payer: Aetna of VT Commercial |
$214.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$168.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$168.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$49.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$49.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$49.12
|
| Rate for Payer: Cash Price |
$113.83
|
| Rate for Payer: Cash Price |
$113.83
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.18
|
| Rate for Payer: Multiplan Commercial |
$211.73
|
| Rate for Payer: United Healthcare Commercial |
$193.52
|
| Rate for Payer: United Healthcare VA CCN |
$114.00
|
|
|
RBC ANTIBODY ELUTION
|
Facility
|
OP
|
$227.67
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
3008686001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.84 |
| Max. Negotiated Rate |
$216.29 |
| Rate for Payer: Aetna of VT Commercial |
$216.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$168.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$100.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$168.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$137.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$193.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$184.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$102.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$181.00
|
| Rate for Payer: Cash Price |
$113.83
|
| Rate for Payer: Cash Price |
$113.83
|
| Rate for Payer: Cigna Commercial |
$182.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$182.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$182.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$102.45
|
| Rate for Payer: Multiplan Commercial |
$211.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$193.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$102.45
|
| Rate for Payer: United Healthcare Commercial |
$216.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.45
|
| Rate for Payer: United Healthcare VA CCN |
$102.45
|
|
|
RBC ANTIBODY IDENTIFICATION
|
Facility
|
OP
|
$330.88
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
3008687001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$146.55 |
| Max. Negotiated Rate |
$314.34 |
| Rate for Payer: Aetna of VT Commercial |
$314.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$231.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$146.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$231.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$199.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$281.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$268.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$148.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$263.05
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cigna Commercial |
$264.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$264.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$264.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$148.90
|
| Rate for Payer: Multiplan Commercial |
$307.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$281.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$148.90
|
| Rate for Payer: United Healthcare Commercial |
$314.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.90
|
| Rate for Payer: United Healthcare VA CCN |
$148.90
|
|
|
RBC ANTIBODY IDENTIFICATION
|
Facility
|
IP
|
$330.88
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
3008687001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$244.88 |
| Max. Negotiated Rate |
$314.34 |
| Rate for Payer: Aetna of VT Commercial |
$314.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$244.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$244.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$281.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$277.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$264.70
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cigna Commercial |
$264.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$264.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$264.70
|
| Rate for Payer: Multiplan Commercial |
$307.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$281.25
|
| Rate for Payer: United Healthcare Commercial |
$314.34
|
|
|
RBC ANTIBODY IDENTIFICATION
|
Professional
|
Both
|
$330.88
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
3008687001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$311.03 |
| Rate for Payer: Aetna of VT Commercial |
$311.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$231.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$231.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$34.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.27
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cigna Commercial |
$49.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$34.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$34.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$114.62
|
| Rate for Payer: Multiplan Commercial |
$307.72
|
| Rate for Payer: United Healthcare Commercial |
$281.25
|
| Rate for Payer: United Healthcare VA CCN |
$125.00
|
|
|
RBC ANTIBODY SCREEN
|
Facility
|
OP
|
$161.30
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
3008685001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$153.24 |
| Rate for Payer: Aetna of VT Commercial |
$153.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$71.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$97.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$137.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$130.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$72.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$128.23
|
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Cigna Commercial |
$129.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$129.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$129.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$72.58
|
| Rate for Payer: Multiplan Commercial |
$150.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$137.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$153.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.77
|
| Rate for Payer: United Healthcare VA CCN |
$72.58
|
|
|
RBC ANTIBODY SCREEN
|
Facility
|
IP
|
$161.30
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
3008685001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.38 |
| Max. Negotiated Rate |
$153.24 |
| Rate for Payer: Aetna of VT Commercial |
$153.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$119.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$119.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$137.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$135.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.04
|
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Cigna Commercial |
$129.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$129.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$129.04
|
| Rate for Payer: Multiplan Commercial |
$150.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$137.10
|
| Rate for Payer: United Healthcare Commercial |
$153.24
|
|
|
RBC ANTIBODY SCREEN
|
Professional
|
Both
|
$161.30
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
3008685001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$151.62 |
| Rate for Payer: Aetna of VT Commercial |
$151.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$13.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.48
|
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Cigna Commercial |
$11.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$9.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$9.77
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.44
|
| Rate for Payer: Multiplan Commercial |
$150.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.77
|
| Rate for Payer: United Healthcare Commercial |
$15.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.77
|
| Rate for Payer: United Healthcare VA CCN |
$9.77
|
|
|
RBC LEUKOCYTES REDUCED
|
Facility
|
OP
|
$1,015.08
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
390P901601
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$449.58 |
| Max. Negotiated Rate |
$964.33 |
| Rate for Payer: Aetna of VT Commercial |
$964.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$909.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$449.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$909.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$611.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$862.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$822.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$456.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$806.99
|
| Rate for Payer: Cash Price |
$507.54
|
| Rate for Payer: Cigna Commercial |
$812.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$812.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$812.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$456.79
|
| Rate for Payer: Multiplan Commercial |
$944.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$862.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$456.79
|
| Rate for Payer: United Healthcare Commercial |
$964.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$456.79
|
| Rate for Payer: United Healthcare VA CCN |
$456.79
|
|
|
RBC LEUKOCYTES REDUCED
|
Facility
|
IP
|
$1,015.08
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
390P901601
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$751.26 |
| Max. Negotiated Rate |
$964.33 |
| Rate for Payer: Aetna of VT Commercial |
$964.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$751.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$751.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$862.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$852.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$812.06
|
| Rate for Payer: Cash Price |
$507.54
|
| Rate for Payer: Cigna Commercial |
$812.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$812.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$812.06
|
| Rate for Payer: Multiplan Commercial |
$944.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$862.82
|
| Rate for Payer: United Healthcare Commercial |
$964.33
|
|
