|
RPR VENTRAL HERN INIT BLOCK
|
Professional
|
Both
|
$2,430.00
|
|
|
Service Code
|
CPT 49561
|
| Hospital Charge Code |
9824956101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$972.00 |
| Max. Negotiated Rate |
$2,284.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,284.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,177.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,177.04
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Multiplan Commercial |
$2,259.90
|
| Rate for Payer: United Healthcare Commercial |
$2,065.50
|
| Rate for Payer: United Healthcare VA CCN |
$972.00
|
|
|
RPR VENTRAL HERN INIT BLOCK
|
Facility
|
IP
|
$2,430.00
|
|
|
Service Code
|
CPT 49561
|
| Hospital Charge Code |
9824956101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,798.44 |
| Max. Negotiated Rate |
$2,308.50 |
| Rate for Payer: Aetna of VT Commercial |
$2,308.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,798.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,798.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,065.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,041.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,944.00
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Cigna Commercial |
$1,944.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,944.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,944.00
|
| Rate for Payer: Multiplan Commercial |
$2,259.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,065.50
|
| Rate for Payer: United Healthcare Commercial |
$2,308.50
|
|
|
RPR VENTRAL HERN INIT REDUC
|
Professional
|
Both
|
$2,353.00
|
|
|
Service Code
|
CPT 49560
|
| Hospital Charge Code |
9824956001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$941.20 |
| Max. Negotiated Rate |
$2,211.82 |
| Rate for Payer: Aetna of VT Commercial |
$2,211.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,108.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,108.05
|
| Rate for Payer: Cash Price |
$1,176.50
|
| Rate for Payer: Multiplan Commercial |
$2,188.29
|
| Rate for Payer: United Healthcare Commercial |
$2,000.05
|
| Rate for Payer: United Healthcare VA CCN |
$941.20
|
|
|
RPR VENTRAL HERN INIT REDUC
|
Facility
|
IP
|
$2,353.00
|
|
|
Service Code
|
CPT 49560
|
| Hospital Charge Code |
9824956001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,741.46 |
| Max. Negotiated Rate |
$2,235.35 |
| Rate for Payer: Aetna of VT Commercial |
$2,235.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,741.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,741.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,000.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,976.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,882.40
|
| Rate for Payer: Cash Price |
$1,176.50
|
| Rate for Payer: Cigna Commercial |
$1,882.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,882.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,882.40
|
| Rate for Payer: Multiplan Commercial |
$2,188.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,000.05
|
| Rate for Payer: United Healthcare Commercial |
$2,235.35
|
|
|
RPR VENTRAL HERN INIT REDUC
|
Facility
|
OP
|
$2,353.00
|
|
|
Service Code
|
CPT 49560
|
| Hospital Charge Code |
9824956001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,042.14 |
| Max. Negotiated Rate |
$2,235.35 |
| Rate for Payer: Aetna of VT Commercial |
$2,235.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,108.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,042.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,108.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,416.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,000.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,905.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,058.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,870.63
|
| Rate for Payer: Cash Price |
$1,176.50
|
| Rate for Payer: Cigna Commercial |
$1,882.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,882.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,882.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,058.85
|
| Rate for Payer: Multiplan Commercial |
$2,188.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,000.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,058.85
|
| Rate for Payer: United Healthcare Commercial |
$2,235.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,058.85
|
| Rate for Payer: United Healthcare VA CCN |
$1,058.85
|
|
|
RSV VACC PREF BIVALENT IM
|
Professional
|
Both
|
$979.88
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
6369067801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$312.70 |
| Max. Negotiated Rate |
$921.09 |
| Rate for Payer: Aetna of VT Commercial |
$921.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$843.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$843.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$398.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$398.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$398.94
|
| Rate for Payer: Cash Price |
$489.94
|
| Rate for Payer: Cash Price |
$489.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$417.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$417.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$312.70
|
| Rate for Payer: Multiplan Commercial |
$911.29
|
| Rate for Payer: United Healthcare Commercial |
$832.90
|
| Rate for Payer: United Healthcare VA CCN |
$391.95
|
|
|
RSV VACC PREF BIVALENT IM
|
Facility
|
OP
|
$843.70
|
|
|
Service Code
|
HCPCS 90678
|
| Hospital Charge Code |
6369067801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$843.70 |
| Max. Negotiated Rate |
$843.70 |
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$843.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$843.70
|
|
|
RSV VACC PREF BIVALENT IM
|
Professional
|
Both
|
$979.88
|
|
|
Service Code
|
HCPCS 90678
|
| Hospital Charge Code |
6369067801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$312.70 |
| Max. Negotiated Rate |
$921.09 |
| Rate for Payer: Aetna of VT Commercial |
$921.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$843.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$843.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$398.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$398.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$398.94
|
| Rate for Payer: Cash Price |
$489.94
|
| Rate for Payer: Cash Price |
$489.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$417.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$417.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$312.70
|
| Rate for Payer: Multiplan Commercial |
$911.29
|
| Rate for Payer: United Healthcare Commercial |
$832.90
|
| Rate for Payer: United Healthcare VA CCN |
$391.95
|
|
|
RUSCH SLICK STYLET 10FR
|
Facility
|
IP
|
$14.58
|
|
| Hospital Charge Code |
2720074811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$13.85 |
| Rate for Payer: Aetna of VT Commercial |
$13.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$10.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$10.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.66
|
| Rate for Payer: Cash Price |
$7.29
|
| Rate for Payer: Cigna Commercial |
$11.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.66
|
| Rate for Payer: Multiplan Commercial |
$13.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.39
|
| Rate for Payer: United Healthcare Commercial |
$13.85
|
|
|
RUSCH SLICK STYLET 10FR
|
Facility
|
OP
|
$14.58
|
|
| Hospital Charge Code |
2720074811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$13.85 |
| Rate for Payer: Aetna of VT Commercial |
$13.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$13.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$6.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$13.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$8.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.59
|
| Rate for Payer: Cash Price |
$7.29
|
| Rate for Payer: Cigna Commercial |
$11.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.56
|
| Rate for Payer: Multiplan Commercial |
$13.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.56
|
| Rate for Payer: United Healthcare Commercial |
$13.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.56
|
| Rate for Payer: United Healthcare VA CCN |
$6.56
|
|
|
RUSSELL VIPER VENOM DILUTED
|
Facility
|
OP
|
$108.25
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
3008561301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$102.84 |
| Rate for Payer: Aetna of VT Commercial |
$102.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$47.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$47.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$47.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$65.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$92.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$48.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$86.06
|
| Rate for Payer: Cash Price |
$54.12
|
| Rate for Payer: Cash Price |
$54.12
|
| Rate for Payer: Cigna Commercial |
$86.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$86.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$86.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$48.71
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$92.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$48.71
|
| Rate for Payer: United Healthcare Commercial |
$102.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.58
|
| Rate for Payer: United Healthcare VA CCN |
$48.71
|
|
|
RUSSELL VIPER VENOM DILUTED
|
Facility
|
IP
|
$108.25
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
3008561301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.12 |
| Max. Negotiated Rate |
$102.84 |
| Rate for Payer: Aetna of VT Commercial |
$102.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$80.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$80.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$92.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$86.60
|
| Rate for Payer: Cash Price |
$54.12
|
| Rate for Payer: Cigna Commercial |
$86.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$86.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$86.60
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$92.01
|
| Rate for Payer: United Healthcare Commercial |
$102.84
|
|
|
RUSSELL VIPER VENOM DILUTED
|
Professional
|
Both
|
$108.25
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
3008561301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$101.75 |
| Rate for Payer: Aetna of VT Commercial |
$101.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$47.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$47.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$13.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.94
|
| Rate for Payer: Cash Price |
$54.12
|
| Rate for Payer: Cash Price |
$54.12
|
| Rate for Payer: Cigna Commercial |
$11.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$9.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$9.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.45
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.58
|
| Rate for Payer: United Healthcare Commercial |
$14.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.58
|
| Rate for Payer: United Healthcare VA CCN |
$9.58
|
|
|
RUSSELL VIPER VENOM DILUTED X2
|
Facility
|
IP
|
$216.50
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
3008561302
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$160.23 |
| Max. Negotiated Rate |
$205.68 |
| Rate for Payer: Aetna of VT Commercial |
$205.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$181.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$173.20
|
| Rate for Payer: Cash Price |
$108.25
|
| Rate for Payer: Cigna Commercial |
$173.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$173.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$173.20
|
| Rate for Payer: Multiplan Commercial |
$201.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$184.03
|
| Rate for Payer: United Healthcare Commercial |
$205.68
|
|
|
RUSSELL VIPER VENOM DILUTED X2
|
Professional
|
Both
|
$216.50
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
3008561302
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$203.51 |
| Rate for Payer: Aetna of VT Commercial |
$203.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$47.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$47.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$13.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.94
|
| Rate for Payer: Cash Price |
$108.25
|
| Rate for Payer: Cash Price |
$108.25
|
| Rate for Payer: Cigna Commercial |
$11.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$9.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$9.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.45
|
| Rate for Payer: Multiplan Commercial |
$201.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.58
|
| Rate for Payer: United Healthcare Commercial |
$14.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.58
|
| Rate for Payer: United Healthcare VA CCN |
$9.58
|
|
|
RUSSELL VIPER VENOM DILUTED X2
|
Facility
|
OP
|
$216.50
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
3008561302
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$205.68 |
| Rate for Payer: Aetna of VT Commercial |
$205.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$47.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$95.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$47.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$130.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$175.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$172.12
|
| Rate for Payer: Cash Price |
$108.25
|
| Rate for Payer: Cash Price |
$108.25
|
| Rate for Payer: Cigna Commercial |
$173.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$173.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$173.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$97.42
|
| Rate for Payer: Multiplan Commercial |
$201.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$184.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$97.42
|
| Rate for Payer: United Healthcare Commercial |
$205.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.58
|
| Rate for Payer: United Healthcare VA CCN |
$97.42
|
|
|
SAME DAY NB DISCHARGE
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
CPT 99463
|
| Hospital Charge Code |
9879946301
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$125.78 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Aetna of VT Commercial |
$269.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$254.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$125.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$254.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$170.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$241.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$230.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$127.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$225.78
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cigna Commercial |
$227.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$227.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$227.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$127.80
|
| Rate for Payer: Multiplan Commercial |
$264.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$241.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$127.80
|
| Rate for Payer: United Healthcare Commercial |
$269.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.80
|
| Rate for Payer: United Healthcare VA CCN |
$127.80
|
|
|
SAME DAY NB DISCHARGE
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT 99463
|
| Hospital Charge Code |
9879946301
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$210.19 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Aetna of VT Commercial |
$269.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$210.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$210.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$241.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$238.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$227.20
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cigna Commercial |
$227.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$227.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$227.20
|
| Rate for Payer: Multiplan Commercial |
$264.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$241.40
|
| Rate for Payer: United Healthcare Commercial |
$269.80
|
|
|
SARS-COV-2 COVID-19 AMP PRB
|
Facility
|
OP
|
$129.25
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
3008763501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$252.83 |
| Rate for Payer: Aetna of VT Commercial |
$122.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$252.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$57.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$252.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$77.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$109.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$104.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$58.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$102.75
|
| Rate for Payer: Cash Price |
$64.62
|
| Rate for Payer: Cash Price |
$64.62
|
| Rate for Payer: Cigna Commercial |
$103.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$103.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$103.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$58.16
|
| Rate for Payer: Multiplan Commercial |
$120.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$109.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$58.16
|
| Rate for Payer: United Healthcare Commercial |
$122.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.31
|
| Rate for Payer: United Healthcare VA CCN |
$58.16
|
|
|
SARS-COV-2 COVID-19 AMP PRB
|
Facility
|
IP
|
$129.25
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
3008763501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.66 |
| Max. Negotiated Rate |
$122.79 |
| Rate for Payer: Aetna of VT Commercial |
$122.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$95.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$95.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$109.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$108.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$103.40
|
| Rate for Payer: Cash Price |
$64.62
|
| Rate for Payer: Cigna Commercial |
$103.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$103.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$103.40
|
| Rate for Payer: Multiplan Commercial |
$120.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$109.86
|
| Rate for Payer: United Healthcare Commercial |
$122.79
|
|
|
SARS-COV-2 COVID-19 ANTIBODY
|
Professional
|
Both
|
$88.92
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
3008676901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.54 |
| Max. Negotiated Rate |
$207.60 |
| Rate for Payer: Aetna of VT Commercial |
$83.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$207.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$43.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$207.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$58.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$42.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$42.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$48.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.13
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cigna Commercial |
$51.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.13
|
| Rate for Payer: Martins Point Health Care Commercial |
$41.54
|
| Rate for Payer: Multiplan Commercial |
$82.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$42.13
|
| Rate for Payer: United Healthcare Commercial |
$64.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.13
|
| Rate for Payer: United Healthcare VA CCN |
$42.13
|
|
|
SARS-COV-2 COVID-19 ANTIBODY
|
Facility
|
IP
|
$88.92
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
3008676901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.81 |
| Max. Negotiated Rate |
$84.47 |
| Rate for Payer: Aetna of VT Commercial |
$84.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$75.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$74.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$71.14
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cigna Commercial |
$71.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$71.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$71.14
|
| Rate for Payer: Multiplan Commercial |
$82.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.58
|
| Rate for Payer: United Healthcare Commercial |
$84.47
|
|
|
SARS-COV-2 COVID-19 ANTIBODY
|
Facility
|
OP
|
$88.92
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
3008676901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.38 |
| Max. Negotiated Rate |
$207.60 |
| Rate for Payer: Aetna of VT Commercial |
$84.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$207.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$207.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$75.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.69
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cigna Commercial |
$71.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$71.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$71.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$40.01
|
| Rate for Payer: Multiplan Commercial |
$82.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.01
|
| Rate for Payer: United Healthcare Commercial |
$84.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.13
|
| Rate for Payer: United Healthcare VA CCN |
$40.01
|
|
|
SARS-COV-2 COVID19 W/OPTIC
|
Facility
|
IP
|
$289.27
|
|
|
Service Code
|
CPT 87811
|
| Hospital Charge Code |
3008781101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$214.09 |
| Max. Negotiated Rate |
$274.81 |
| Rate for Payer: Aetna of VT Commercial |
$274.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$214.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$214.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$245.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$242.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$231.42
|
| Rate for Payer: Cash Price |
$144.64
|
| Rate for Payer: Cigna Commercial |
$231.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$231.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$231.42
|
| Rate for Payer: Multiplan Commercial |
$269.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$245.88
|
| Rate for Payer: United Healthcare Commercial |
$274.81
|
|
|
SARS-COV-2 COVID19 W/OPTIC
|
Professional
|
Both
|
$289.27
|
|
|
Service Code
|
CPT 87811
|
| Hospital Charge Code |
3008781101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.38 |
| Max. Negotiated Rate |
$271.91 |
| Rate for Payer: Aetna of VT Commercial |
$271.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$203.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$42.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$203.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$57.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$41.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$41.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$47.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$41.38
|
| Rate for Payer: Cash Price |
$144.64
|
| Rate for Payer: Cash Price |
$144.64
|
| Rate for Payer: Cigna Commercial |
$49.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$41.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$41.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$151.38
|
| Rate for Payer: Multiplan Commercial |
$269.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$41.38
|
| Rate for Payer: United Healthcare Commercial |
$63.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.38
|
| Rate for Payer: United Healthcare VA CCN |
$41.38
|
|
