|
AUTOMATED LEUKOCYTE COUNT
|
Facility
|
IP
|
$28.71
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
3008504801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$27.27 |
| Rate for Payer: Aetna of VT Commercial |
$27.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$24.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$24.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.97
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cigna Commercial |
$22.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.97
|
| Rate for Payer: Multiplan Commercial |
$26.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.40
|
| Rate for Payer: United Healthcare Commercial |
$27.27
|
|
|
AUTOMATED LEUKOCYTE COUNT
|
Facility
|
OP
|
$28.71
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
3008504801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$27.27 |
| Rate for Payer: Aetna of VT Commercial |
$27.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$12.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$12.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$17.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$24.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$23.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.82
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cigna Commercial |
$22.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.92
|
| Rate for Payer: Multiplan Commercial |
$26.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.92
|
| Rate for Payer: United Healthcare Commercial |
$27.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.54
|
| Rate for Payer: United Healthcare VA CCN |
$12.92
|
|
|
AUTOMATED RETICULOCYTE COUNT
|
Facility
|
IP
|
$75.95
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
3008504501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.21 |
| Max. Negotiated Rate |
$72.15 |
| Rate for Payer: Aetna of VT Commercial |
$72.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$56.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$56.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$64.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$60.76
|
| Rate for Payer: Cash Price |
$37.98
|
| Rate for Payer: Cigna Commercial |
$60.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$60.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$60.76
|
| Rate for Payer: Multiplan Commercial |
$70.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.56
|
| Rate for Payer: United Healthcare Commercial |
$72.15
|
|
|
AUTOMATED RETICULOCYTE COUNT
|
Facility
|
OP
|
$75.95
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
3008504501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$72.15 |
| Rate for Payer: Aetna of VT Commercial |
$72.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$19.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$33.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$19.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$45.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$64.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$61.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$34.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$60.38
|
| Rate for Payer: Cash Price |
$37.98
|
| Rate for Payer: Cash Price |
$37.98
|
| Rate for Payer: Cigna Commercial |
$60.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$60.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$60.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.18
|
| Rate for Payer: Multiplan Commercial |
$70.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.18
|
| Rate for Payer: United Healthcare Commercial |
$72.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.99
|
| Rate for Payer: United Healthcare VA CCN |
$34.18
|
|
|
AZITHROMYCIN 250 MG TAB
|
Professional
|
Both
|
$5.47
|
|
| Hospital Charge Code |
2500000332
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$5.14 |
| Rate for Payer: Aetna of VT Commercial |
$5.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4.90
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Multiplan Commercial |
$5.09
|
| Rate for Payer: United Healthcare Commercial |
$4.65
|
| Rate for Payer: United Healthcare VA CCN |
$2.19
|
|
|
AZITHROMYCIN 250 MG TAB
|
Professional
|
Both
|
$5.47
|
|
|
Service Code
|
NDC 5026807415
|
| Hospital Charge Code |
2500000332
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$5.14 |
| Rate for Payer: Aetna of VT Commercial |
$5.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4.90
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Multiplan Commercial |
$5.09
|
| Rate for Payer: United Healthcare Commercial |
$4.65
|
| Rate for Payer: United Healthcare VA CCN |
$2.19
|
|
|
BABESIA MICROTI AMP PRB
|
Facility
|
IP
|
$86.86
|
|
|
Service Code
|
CPT 87469
|
| Hospital Charge Code |
3008746901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.29 |
| Max. Negotiated Rate |
$82.52 |
| Rate for Payer: Aetna of VT Commercial |
$82.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.49
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cigna Commercial |
$69.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.49
|
| Rate for Payer: Multiplan Commercial |
$80.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.83
|
| Rate for Payer: United Healthcare Commercial |
$82.52
|
|
|
BABESIA MICROTI AMP PRB
|
Facility
|
OP
|
$86.86
|
|
|
Service Code
|
CPT 87469
|
| Hospital Charge Code |
3008746901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$82.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.05
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cigna Commercial |
$69.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$39.09
|
| Rate for Payer: Multiplan Commercial |
$80.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.09
|
| Rate for Payer: United Healthcare Commercial |
$82.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$39.09
|
|
|
BABESIA MICROTI AMP PRB
|
Professional
|
Both
|
$86.86
|
|
|
Service Code
|
CPT 87469
|
| Hospital Charge Code |
3008746901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$81.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.35
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cigna Commercial |
$42.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$48.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$48.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.60
|
| Rate for Payer: Multiplan Commercial |
$80.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$53.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$35.09
|
|
|
BACITRACIN 0.9 GRAM UD PACK
|
Professional
|
Both
|
$0.03
|
|
|
Service Code
|
NDC 4580206070
|
| Hospital Charge Code |
2500000028
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
BACITRACIN 0.9 GRAM UD PACK
|
Professional
|
Both
|
$0.03
|
|
| Hospital Charge Code |
2500000028
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
BANDGE COBAN 1X5 NS
|
Facility
|
OP
|
$1.92
|
|
| Hospital Charge Code |
2720060811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna of VT Commercial |
$1.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.53
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Cigna Commercial |
$1.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$1.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.86
|
| Rate for Payer: United Healthcare Commercial |
$1.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.86
|
| Rate for Payer: United Healthcare VA CCN |
$0.86
|
|
|
BANDGE COBAN 1X5 NS
|
Facility
|
IP
|
$1.92
|
|
| Hospital Charge Code |
2700060811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna of VT Commercial |
$1.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.54
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Cigna Commercial |
$1.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$1.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.63
|
| Rate for Payer: United Healthcare Commercial |
$1.82
|
|
|
BANDGE COBAN 1X5 NS
|
Facility
|
IP
|
$1.92
|
|
| Hospital Charge Code |
2720060811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna of VT Commercial |
$1.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.54
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Cigna Commercial |
$1.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$1.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.63
|
| Rate for Payer: United Healthcare Commercial |
$1.82
|
|
|
BANDGE COBAN 1X5 NS
|
Facility
|
OP
|
$1.92
|
|
| Hospital Charge Code |
2700060811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna of VT Commercial |
$1.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.53
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Cigna Commercial |
$1.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$1.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.86
|
| Rate for Payer: United Healthcare Commercial |
$1.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.86
|
| Rate for Payer: United Healthcare VA CCN |
$0.86
|
|
|
Barium
|
Facility
|
IP
|
$7.71
|
|
| Hospital Charge Code |
2720061951
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Aetna of VT Commercial |
$7.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6.17
|
| Rate for Payer: Cash Price |
$3.86
|
| Rate for Payer: Cigna Commercial |
$6.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.17
|
| Rate for Payer: Multiplan Commercial |
$7.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.55
|
| Rate for Payer: United Healthcare Commercial |
$7.32
|
|
|
Barium
|
Facility
|
OP
|
$7.71
|
|
| Hospital Charge Code |
2720061951
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Aetna of VT Commercial |
$7.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6.13
|
| Rate for Payer: Cash Price |
$3.86
|
| Rate for Payer: Cigna Commercial |
$6.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$3.47
|
| Rate for Payer: Multiplan Commercial |
$7.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3.47
|
| Rate for Payer: United Healthcare Commercial |
$7.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.47
|
| Rate for Payer: United Healthcare VA CCN |
$3.47
|
|
|
BARTONELLA ANTIBODY
|
Facility
|
IP
|
$135.33
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
3008661101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.16 |
| Max. Negotiated Rate |
$128.56 |
| Rate for Payer: Aetna of VT Commercial |
$128.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$115.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.26
|
| Rate for Payer: Cash Price |
$67.67
|
| Rate for Payer: Cigna Commercial |
$108.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.26
|
| Rate for Payer: Multiplan Commercial |
$125.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.03
|
| Rate for Payer: United Healthcare Commercial |
$128.56
|
|
|
BARTONELLA ANTIBODY
|
Facility
|
OP
|
$135.33
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
3008661101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$128.56 |
| Rate for Payer: Aetna of VT Commercial |
$128.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$50.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$59.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$50.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$81.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$115.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$107.59
|
| Rate for Payer: Cash Price |
$67.67
|
| Rate for Payer: Cash Price |
$67.67
|
| Rate for Payer: Cigna Commercial |
$108.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$60.90
|
| Rate for Payer: Multiplan Commercial |
$125.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$60.90
|
| Rate for Payer: United Healthcare Commercial |
$128.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: United Healthcare VA CCN |
$60.90
|
|
|
BARTONELLA ANTIBODY
|
Professional
|
Both
|
$135.33
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
3008661101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$127.21 |
| Rate for Payer: Aetna of VT Commercial |
$127.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$50.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$50.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$14.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$14.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.82
|
| Rate for Payer: Cash Price |
$67.67
|
| Rate for Payer: Cash Price |
$67.67
|
| Rate for Payer: Cigna Commercial |
$12.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$10.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$10.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.04
|
| Rate for Payer: Multiplan Commercial |
$125.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.18
|
| Rate for Payer: United Healthcare Commercial |
$15.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: United Healthcare VA CCN |
$10.18
|
|
|
B CELLS TOTAL COUNT
|
Facility
|
OP
|
$155.93
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
3008635501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$185.91 |
| Rate for Payer: Aetna of VT Commercial |
$148.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$185.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$185.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$126.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$70.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$123.96
|
| Rate for Payer: Cash Price |
$77.97
|
| Rate for Payer: Cash Price |
$77.97
|
| Rate for Payer: Cigna Commercial |
$124.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.17
|
| Rate for Payer: Multiplan Commercial |
$145.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.17
|
| Rate for Payer: United Healthcare Commercial |
$148.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: United Healthcare VA CCN |
$70.17
|
|
|
B CELLS TOTAL COUNT
|
Professional
|
Both
|
$155.93
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
3008635501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$185.91 |
| Rate for Payer: Aetna of VT Commercial |
$146.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$185.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$185.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$51.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$51.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$51.89
|
| Rate for Payer: Cash Price |
$77.97
|
| Rate for Payer: Cash Price |
$77.97
|
| Rate for Payer: Cigna Commercial |
$45.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$37.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$37.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.20
|
| Rate for Payer: Multiplan Commercial |
$145.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.73
|
| Rate for Payer: United Healthcare Commercial |
$58.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: United Healthcare VA CCN |
$37.73
|
|
|
B CELLS TOTAL COUNT
|
Facility
|
IP
|
$155.93
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
3008635501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.40 |
| Max. Negotiated Rate |
$148.13 |
| Rate for Payer: Aetna of VT Commercial |
$148.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$115.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$115.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$130.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.74
|
| Rate for Payer: Cash Price |
$77.97
|
| Rate for Payer: Cigna Commercial |
$124.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.74
|
| Rate for Payer: Multiplan Commercial |
$145.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.54
|
| Rate for Payer: United Healthcare Commercial |
$148.13
|
|
|
BCG (TICE STRAIN) 50 MG VIAL
|
Professional
|
Both
|
$163.79
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
636J903001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$153.96 |
| Rate for Payer: Aetna of VT Commercial |
$153.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3.75
|
| Rate for Payer: Cash Price |
$81.89
|
| Rate for Payer: Cash Price |
$81.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$3.14
|
| Rate for Payer: Multiplan Commercial |
$152.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3.26
|
| Rate for Payer: United Healthcare Commercial |
$5.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.26
|
| Rate for Payer: United Healthcare VA CCN |
$3.26
|
|
|
BCG (TICE STRAIN) 50 MG VIAL
|
Facility
|
OP
|
$8.64
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
636J903001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8.64
|
|
