|
REVISION OF FOOT TENDON
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
CPT 28261
|
| Hospital Charge Code |
9822826101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,665.22 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Aetna of VT Commercial |
$2,137.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,665.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,665.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,912.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,890.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,800.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,800.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,800.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,800.00
|
| Rate for Payer: Multiplan Commercial |
$2,092.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,912.50
|
| Rate for Payer: United Healthcare Commercial |
$2,137.50
|
|
|
REVISION OF FOOT TENDON
|
Facility
|
OP
|
$1,712.00
|
|
|
Service Code
|
CPT 28238
|
| Hospital Charge Code |
9822823801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$758.24 |
| Max. Negotiated Rate |
$1,626.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,626.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,533.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$758.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,533.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,030.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,455.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,386.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$770.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,361.04
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cigna Commercial |
$1,369.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,369.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,369.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$770.40
|
| Rate for Payer: Multiplan Commercial |
$1,592.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,455.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$770.40
|
| Rate for Payer: United Healthcare Commercial |
$1,626.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$770.40
|
| Rate for Payer: United Healthcare VA CCN |
$770.40
|
|
|
REVISION OF FOOT TENDON
|
Facility
|
IP
|
$1,712.00
|
|
|
Service Code
|
CPT 28238
|
| Hospital Charge Code |
9822823801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,267.05 |
| Max. Negotiated Rate |
$1,626.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,626.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,267.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,267.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,455.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,438.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,369.60
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cigna Commercial |
$1,369.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,369.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,369.60
|
| Rate for Payer: Multiplan Commercial |
$1,592.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,455.20
|
| Rate for Payer: United Healthcare Commercial |
$1,626.40
|
|
|
REVISION OF FOOT TENDON
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
CPT 28261
|
| Hospital Charge Code |
9822826101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$803.42 |
| Max. Negotiated Rate |
$2,115.00 |
| Rate for Payer: Aetna of VT Commercial |
$2,115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,015.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$827.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,015.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,124.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,564.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,564.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$923.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,564.07
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,509.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,681.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,681.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,020.56
|
| Rate for Payer: Multiplan Commercial |
$2,092.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,140.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$803.42
|
| Rate for Payer: United Healthcare Commercial |
$1,235.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$803.42
|
| Rate for Payer: United Healthcare VA CCN |
$803.42
|
|
|
REVISION OF KNEE JOINT
|
Facility
|
IP
|
$4,116.00
|
|
|
Service Code
|
CPT 27446
|
| Hospital Charge Code |
9822744601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$3,046.25 |
| Max. Negotiated Rate |
$3,910.20 |
| Rate for Payer: Aetna of VT Commercial |
$3,910.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,046.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,046.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,498.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,457.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,292.80
|
| Rate for Payer: Cash Price |
$2,058.00
|
| Rate for Payer: Cigna Commercial |
$3,292.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,292.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,292.80
|
| Rate for Payer: Multiplan Commercial |
$3,827.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,498.60
|
| Rate for Payer: United Healthcare Commercial |
$3,910.20
|
|
|
REVISION OF KNEE JOINT
|
Facility
|
OP
|
$4,116.00
|
|
|
Service Code
|
CPT 27446
|
| Hospital Charge Code |
9822744601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,822.98 |
| Max. Negotiated Rate |
$3,910.20 |
| Rate for Payer: Aetna of VT Commercial |
$3,910.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,687.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,822.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,687.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,477.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,498.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,333.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,852.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,272.22
|
| Rate for Payer: Cash Price |
$2,058.00
|
| Rate for Payer: Cigna Commercial |
$3,292.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,292.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,292.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,852.20
|
| Rate for Payer: Multiplan Commercial |
$3,827.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,498.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,852.20
|
| Rate for Payer: United Healthcare Commercial |
$3,910.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,852.20
|
| Rate for Payer: United Healthcare VA CCN |
$1,852.20
|
|
|
REVISION OF KNEE JOINT
|
Professional
|
Both
|
$4,116.00
|
|
|
Service Code
|
CPT 27446
|
| Hospital Charge Code |
9822744601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,070.59 |
| Max. Negotiated Rate |
$3,869.04 |
| Rate for Payer: Aetna of VT Commercial |
$3,869.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,687.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,102.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,687.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,498.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,297.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,297.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,231.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,297.15
|
| Rate for Payer: Cash Price |
$2,058.00
|
| Rate for Payer: Cash Price |
$2,058.00
|
| Rate for Payer: Cigna Commercial |
$2,027.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,793.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,793.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,070.59
|
| Rate for Payer: Multiplan Commercial |
$3,827.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,520.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,070.59
|
| Rate for Payer: United Healthcare Commercial |
$1,646.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,070.59
|
| Rate for Payer: United Healthcare VA CCN |
$1,070.59
|
|
|
RHEUMATOID FACTOR QUANTITATIVE
|
Facility
|
IP
|
$93.06
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
3008643101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.87 |
| Max. Negotiated Rate |
$88.41 |
| Rate for Payer: Aetna of VT Commercial |
$88.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$68.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$68.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$74.45
|
| Rate for Payer: Cash Price |
$46.53
|
| Rate for Payer: Cigna Commercial |
$74.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$74.45
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$74.45
|
| Rate for Payer: Multiplan Commercial |
$86.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.10
|
| Rate for Payer: United Healthcare Commercial |
$88.41
|
|
|
RHEUMATOID FACTOR QUANTITATIVE
|
Professional
|
Both
|
$93.06
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
3008643101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.59 |
| Max. Negotiated Rate |
$87.48 |
| Rate for Payer: Aetna of VT Commercial |
$87.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$27.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$27.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$7.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9.70
|
| Rate for Payer: Cash Price |
$46.53
|
| Rate for Payer: Cash Price |
$46.53
|
| Rate for Payer: Cigna Commercial |
$6.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.59
|
| Rate for Payer: Multiplan Commercial |
$86.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.67
|
| Rate for Payer: United Healthcare Commercial |
$8.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.67
|
| Rate for Payer: United Healthcare VA CCN |
$5.67
|
|
|
RHEUMATOID FACTOR QUANTITATIVE
|
Facility
|
OP
|
$93.06
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
3008643101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$88.41 |
| Rate for Payer: Aetna of VT Commercial |
$88.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$27.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$41.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$27.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$56.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$75.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$41.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$73.98
|
| Rate for Payer: Cash Price |
$46.53
|
| Rate for Payer: Cash Price |
$46.53
|
| Rate for Payer: Cigna Commercial |
$74.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$74.45
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$74.45
|
| Rate for Payer: Martins Point Health Care Commercial |
$41.88
|
| Rate for Payer: Multiplan Commercial |
$86.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$41.88
|
| Rate for Payer: United Healthcare Commercial |
$88.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.67
|
| Rate for Payer: United Healthcare VA CCN |
$41.88
|
|
|
RH IG MINIDOSE IM
|
Facility
|
OP
|
$52.73
|
|
|
Service Code
|
CPT 90385
|
| Hospital Charge Code |
6369038501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$82.06 |
| Rate for Payer: Aetna of VT Commercial |
$50.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$82.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$82.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$42.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$41.92
|
| Rate for Payer: Cash Price |
$26.36
|
| Rate for Payer: Cash Price |
$26.36
|
| Rate for Payer: Cigna Commercial |
$42.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$23.73
|
| Rate for Payer: Multiplan Commercial |
$49.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.73
|
| Rate for Payer: United Healthcare Commercial |
$50.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.73
|
| Rate for Payer: United Healthcare VA CCN |
$23.73
|
|
|
RH IG MINIDOSE IM
|
Professional
|
Both
|
$52.73
|
|
|
Service Code
|
CPT 90385
|
| Hospital Charge Code |
6369038501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.66 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna of VT Commercial |
$49.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$82.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$82.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$46.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$46.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$46.36
|
| Rate for Payer: Cash Price |
$26.36
|
| Rate for Payer: Cash Price |
$26.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$48.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$48.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.66
|
| Rate for Payer: Multiplan Commercial |
$49.04
|
| Rate for Payer: United Healthcare Commercial |
$44.82
|
| Rate for Payer: United Healthcare VA CCN |
$97.00
|
|
|
RH IG MINIDOSE IM
|
Facility
|
IP
|
$52.73
|
|
|
Service Code
|
CPT 90385
|
| Hospital Charge Code |
6369038501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.03 |
| Max. Negotiated Rate |
$50.09 |
| Rate for Payer: Aetna of VT Commercial |
$50.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.18
|
| Rate for Payer: Cash Price |
$26.36
|
| Rate for Payer: Cigna Commercial |
$42.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.18
|
| Rate for Payer: Multiplan Commercial |
$49.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.82
|
| Rate for Payer: United Healthcare Commercial |
$50.09
|
|
|
RHO(D) IG FULL-DOSE IM
|
Professional
|
Both
|
$196.77
|
|
|
Service Code
|
CPT 90384
|
| Hospital Charge Code |
6369038401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.43 |
| Max. Negotiated Rate |
$227.78 |
| Rate for Payer: Aetna of VT Commercial |
$184.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$227.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$227.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$132.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$132.52
|
| Rate for Payer: Cash Price |
$98.39
|
| Rate for Payer: Cash Price |
$98.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$117.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$117.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.43
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: United Healthcare Commercial |
$167.25
|
| Rate for Payer: United Healthcare VA CCN |
$101.00
|
|
|
RHO(D) IG FULL-DOSE IM
|
Facility
|
IP
|
$196.77
|
|
|
Service Code
|
CPT 90384
|
| Hospital Charge Code |
6369038401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$145.63 |
| Max. Negotiated Rate |
$186.93 |
| Rate for Payer: Aetna of VT Commercial |
$186.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$145.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$145.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$167.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$165.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$157.42
|
| Rate for Payer: Cash Price |
$98.39
|
| Rate for Payer: Cigna Commercial |
$157.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$157.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$157.42
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$167.25
|
| Rate for Payer: United Healthcare Commercial |
$186.93
|
|
|
RHO(D) IG FULL-DOSE IM
|
Facility
|
OP
|
$196.77
|
|
|
Service Code
|
CPT 90384
|
| Hospital Charge Code |
6369038401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.15 |
| Max. Negotiated Rate |
$227.78 |
| Rate for Payer: Aetna of VT Commercial |
$186.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$227.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$227.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$118.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$167.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$156.43
|
| Rate for Payer: Cash Price |
$98.39
|
| Rate for Payer: Cash Price |
$98.39
|
| Rate for Payer: Cigna Commercial |
$157.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$157.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$157.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$88.55
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$167.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$88.55
|
| Rate for Payer: United Healthcare Commercial |
$186.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.55
|
| Rate for Payer: United Healthcare VA CCN |
$88.55
|
|
|
RHO D IMMUNE GLOBULIN INJ
|
Professional
|
Both
|
$292.88
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
636J279001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.16 |
| Max. Negotiated Rate |
$275.31 |
| Rate for Payer: Aetna of VT Commercial |
$275.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$212.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$85.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$212.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$115.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$94.97
|
| Rate for Payer: Cash Price |
$146.44
|
| Rate for Payer: Cash Price |
$146.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.16
|
| Rate for Payer: Multiplan Commercial |
$272.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$82.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$82.58
|
| Rate for Payer: United Healthcare Commercial |
$127.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.58
|
| Rate for Payer: United Healthcare VA CCN |
$82.58
|
|
|
RHO D IMMUNE GLOBULIN INJ
|
Facility
|
OP
|
$292.88
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
636J279001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.72 |
| Max. Negotiated Rate |
$278.24 |
| Rate for Payer: Aetna of VT Commercial |
$278.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$212.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$129.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$212.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$176.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$248.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$237.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$131.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$232.84
|
| Rate for Payer: Cash Price |
$146.44
|
| Rate for Payer: Cash Price |
$146.44
|
| Rate for Payer: Cigna Commercial |
$234.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$234.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$234.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$131.80
|
| Rate for Payer: Multiplan Commercial |
$272.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$248.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$131.80
|
| Rate for Payer: United Healthcare Commercial |
$278.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.80
|
| Rate for Payer: United Healthcare VA CCN |
$131.80
|
|
|
RHO D IMMUNE GLOBULIN INJ
|
Facility
|
IP
|
$292.88
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
636J279001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$216.76 |
| Max. Negotiated Rate |
$278.24 |
| Rate for Payer: Aetna of VT Commercial |
$278.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$216.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$216.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$248.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$246.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$234.30
|
| Rate for Payer: Cash Price |
$146.44
|
| Rate for Payer: Cigna Commercial |
$234.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$234.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$234.30
|
| Rate for Payer: Multiplan Commercial |
$272.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$248.95
|
| Rate for Payer: United Healthcare Commercial |
$278.24
|
|
|
RIA NONANTIBODY
|
Facility
|
OP
|
$258.92
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
3008351901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$245.97 |
| Rate for Payer: Aetna of VT Commercial |
$245.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$90.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$114.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$90.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$155.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$209.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$205.84
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cigna Commercial |
$207.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$116.51
|
| Rate for Payer: Multiplan Commercial |
$240.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$116.51
|
| Rate for Payer: United Healthcare Commercial |
$245.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: United Healthcare VA CCN |
$116.51
|
|
|
RIA NONANTIBODY
|
Facility
|
IP
|
$258.92
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
3008351901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$191.63 |
| Max. Negotiated Rate |
$245.97 |
| Rate for Payer: Aetna of VT Commercial |
$245.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$191.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$191.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.14
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cigna Commercial |
$207.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.14
|
| Rate for Payer: Multiplan Commercial |
$240.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.08
|
| Rate for Payer: United Healthcare Commercial |
$245.97
|
|
|
RIA NONANTIBODY
|
Professional
|
Both
|
$258.92
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
3008351901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$243.38 |
| Rate for Payer: Aetna of VT Commercial |
$243.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$90.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$90.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$21.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$26.03
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cigna Commercial |
$22.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.14
|
| Rate for Payer: Multiplan Commercial |
$240.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.40
|
| Rate for Payer: United Healthcare Commercial |
$28.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: United Healthcare VA CCN |
$18.40
|
|
|
RICHIE BRACE
|
Professional
|
Both
|
$2,637.00
|
|
|
Service Code
|
HCPCS L1970 50
|
| Hospital Charge Code |
274L197001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$865.41 |
| Max. Negotiated Rate |
$2,478.78 |
| Rate for Payer: Aetna of VT Commercial |
$2,478.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,362.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,362.49
|
| Rate for Payer: Cash Price |
$1,318.50
|
| Rate for Payer: Cash Price |
$1,318.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$865.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$865.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,068.86
|
| Rate for Payer: Multiplan Commercial |
$2,452.41
|
| Rate for Payer: United Healthcare Commercial |
$2,241.45
|
| Rate for Payer: United Healthcare VA CCN |
$1,054.80
|
|
|
RICHIE BRACE
|
Facility
|
OP
|
$2,637.00
|
|
|
Service Code
|
HCPCS L1970 50
|
| Hospital Charge Code |
274L197001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,167.93 |
| Max. Negotiated Rate |
$2,505.15 |
| Rate for Payer: Aetna of VT Commercial |
$2,505.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,362.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,167.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,362.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,587.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,241.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,135.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,186.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,096.41
|
| Rate for Payer: Cash Price |
$1,318.50
|
| Rate for Payer: Cigna Commercial |
$2,109.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,109.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,109.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,186.65
|
| Rate for Payer: Multiplan Commercial |
$2,452.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,241.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,186.65
|
| Rate for Payer: United Healthcare Commercial |
$2,505.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,186.65
|
| Rate for Payer: United Healthcare VA CCN |
$1,186.65
|
|
|
RICHIE BRACE
|
Facility
|
IP
|
$2,637.00
|
|
|
Service Code
|
HCPCS L1970 50
|
| Hospital Charge Code |
274L197001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,951.64 |
| Max. Negotiated Rate |
$2,505.15 |
| Rate for Payer: Aetna of VT Commercial |
$2,505.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,951.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,951.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,241.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,215.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,109.60
|
| Rate for Payer: Cash Price |
$1,318.50
|
| Rate for Payer: Cigna Commercial |
$2,109.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,109.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,109.60
|
| Rate for Payer: Multiplan Commercial |
$2,452.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,241.45
|
| Rate for Payer: United Healthcare Commercial |
$2,505.15
|
|
