|
BETA-AMYLOID 1-42 (ABETA 42)
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
CPT 82234
|
| Hospital Charge Code |
3008223401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$720.00 |
| Max. Negotiated Rate |
$1,692.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,692.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,612.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,612.62
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
| Rate for Payer: United Healthcare Commercial |
$1,530.00
|
| Rate for Payer: United Healthcare VA CCN |
$720.00
|
|
|
BETA-AMYLOID 1-42 (ABETA 42)
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
CPT 82234
|
| Hospital Charge Code |
3008223401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,332.18 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,710.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,332.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,332.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,512.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,440.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,440.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,440.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,440.00
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,530.00
|
| Rate for Payer: United Healthcare Commercial |
$1,710.00
|
|
|
BETAMETHASONE (CELESTONE) VIAL
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
636J070201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.85 |
| Max. Negotiated Rate |
$244.40 |
| Rate for Payer: Aetna of VT Commercial |
$244.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$18.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$18.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$9.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$8.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.85
|
| Rate for Payer: Multiplan Commercial |
$241.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.96
|
| Rate for Payer: United Healthcare Commercial |
$10.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.96
|
| Rate for Payer: United Healthcare VA CCN |
$6.96
|
|
|
BETAMETHASONE (CELESTONE) VIAL
|
Facility
|
OP
|
$18.84
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
636J070201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$18.84 |
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$18.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$18.84
|
|
|
BETAMETHASONE CREAM
|
Professional
|
Both
|
$10.43
|
|
|
Service Code
|
NDC 713032615
|
| Hospital Charge Code |
2500000036
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$9.80 |
| Rate for Payer: Aetna of VT Commercial |
$9.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$9.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$9.34
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$9.70
|
| Rate for Payer: United Healthcare Commercial |
$8.87
|
| Rate for Payer: United Healthcare VA CCN |
$4.17
|
|
|
BETAMETHASONE CREAM
|
Professional
|
Both
|
$10.43
|
|
| Hospital Charge Code |
2500000036
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$9.80 |
| Rate for Payer: Aetna of VT Commercial |
$9.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$9.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$9.34
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$9.70
|
| Rate for Payer: United Healthcare Commercial |
$8.87
|
| Rate for Payer: United Healthcare VA CCN |
$4.17
|
|
|
BG LKNG SCW, 2X08MM
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780074171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.47 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Aetna of VT Commercial |
$258.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$243.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$120.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$243.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$163.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.24
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$122.40
|
| Rate for Payer: Multiplan Commercial |
$252.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$231.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$122.40
|
| Rate for Payer: United Healthcare Commercial |
$258.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Healthcare VA CCN |
$122.40
|
|
|
BG LKNG SCW, 2X08MM
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780074171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.31 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Aetna of VT Commercial |
$258.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$201.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$201.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$228.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$217.60
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.60
|
| Rate for Payer: Multiplan Commercial |
$252.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$231.20
|
| Rate for Payer: United Healthcare Commercial |
$258.40
|
|
|
BILE ACIDS TOTAL
|
Professional
|
Both
|
$348.46
|
|
|
Service Code
|
CPT 82239
|
| Hospital Charge Code |
3008223901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.88 |
| Max. Negotiated Rate |
$327.55 |
| Rate for Payer: Aetna of VT Commercial |
$327.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$84.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$17.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$84.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$23.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$29.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$29.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$29.26
|
| Rate for Payer: Cash Price |
$174.23
|
| Rate for Payer: Cash Price |
$174.23
|
| Rate for Payer: Cigna Commercial |
$20.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$17.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$17.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.88
|
| Rate for Payer: Multiplan Commercial |
$324.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$17.12
|
| Rate for Payer: United Healthcare Commercial |
$26.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.12
|
| Rate for Payer: United Healthcare VA CCN |
$17.12
|
|
|
BILE ACIDS TOTAL
|
Facility
|
OP
|
$348.46
|
|
|
Service Code
|
CPT 82239
|
| Hospital Charge Code |
3008223901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$331.04 |
| Rate for Payer: Aetna of VT Commercial |
$331.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$84.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$154.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$84.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$209.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$296.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$282.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$156.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$277.03
|
| Rate for Payer: Cash Price |
$174.23
|
| Rate for Payer: Cash Price |
$174.23
|
| Rate for Payer: Cigna Commercial |
$278.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$278.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$278.77
|
| Rate for Payer: Martins Point Health Care Commercial |
$156.81
|
| Rate for Payer: Multiplan Commercial |
$324.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$296.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$156.81
|
| Rate for Payer: United Healthcare Commercial |
$331.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.12
|
| Rate for Payer: United Healthcare VA CCN |
$156.81
|
|
|
BILE ACIDS TOTAL
|
Facility
|
IP
|
$348.46
|
|
|
Service Code
|
CPT 82239
|
| Hospital Charge Code |
3008223901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$257.90 |
| Max. Negotiated Rate |
$331.04 |
| Rate for Payer: Aetna of VT Commercial |
$331.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$257.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$257.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$296.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$292.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$278.77
|
| Rate for Payer: Cash Price |
$174.23
|
| Rate for Payer: Cigna Commercial |
$278.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$278.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$278.77
|
| Rate for Payer: Multiplan Commercial |
$324.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$296.19
|
| Rate for Payer: United Healthcare Commercial |
$331.04
|
|
|
BILIRUBIN DIRECT
|
Facility
|
IP
|
$74.30
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
3008224801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.99 |
| Max. Negotiated Rate |
$70.58 |
| Rate for Payer: Aetna of VT Commercial |
$70.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.44
|
| Rate for Payer: Cash Price |
$37.15
|
| Rate for Payer: Cigna Commercial |
$59.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.44
|
| Rate for Payer: Multiplan Commercial |
$69.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.16
|
| Rate for Payer: United Healthcare Commercial |
$70.58
|
|
|
BILIRUBIN DIRECT
|
Facility
|
OP
|
$74.30
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
3008224801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$70.58 |
| Rate for Payer: Aetna of VT Commercial |
$70.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$24.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$24.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$44.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$60.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$33.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.07
|
| Rate for Payer: Cash Price |
$37.15
|
| Rate for Payer: Cash Price |
$37.15
|
| Rate for Payer: Cigna Commercial |
$59.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$33.44
|
| Rate for Payer: Multiplan Commercial |
$69.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.44
|
| Rate for Payer: United Healthcare Commercial |
$70.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: United Healthcare VA CCN |
$33.44
|
|
|
BILIRUBIN TOTAL
|
Facility
|
IP
|
$66.84
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
3008224701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.47 |
| Max. Negotiated Rate |
$63.50 |
| Rate for Payer: Aetna of VT Commercial |
$63.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$49.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$49.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$56.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$56.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$53.47
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cigna Commercial |
$53.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$53.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$53.47
|
| Rate for Payer: Multiplan Commercial |
$62.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.81
|
| Rate for Payer: United Healthcare Commercial |
$63.50
|
|
|
BILIRUBIN TOTAL
|
Facility
|
OP
|
$66.84
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
3008224701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$63.50 |
| Rate for Payer: Aetna of VT Commercial |
$63.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$24.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$29.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$24.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$40.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$56.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$54.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$53.14
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cigna Commercial |
$53.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$53.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$53.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$30.08
|
| Rate for Payer: Multiplan Commercial |
$62.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$30.08
|
| Rate for Payer: United Healthcare Commercial |
$63.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: United Healthcare VA CCN |
$30.08
|
|
|
BILIRUBIN TOTAL TRANSCUT
|
Facility
|
IP
|
$51.18
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
3008872001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.88 |
| Max. Negotiated Rate |
$48.62 |
| Rate for Payer: Aetna of VT Commercial |
$48.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$37.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$37.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$42.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$40.94
|
| Rate for Payer: Cash Price |
$25.59
|
| Rate for Payer: Cigna Commercial |
$40.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$40.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$40.94
|
| Rate for Payer: Multiplan Commercial |
$47.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$48.62
|
|
|
BILIRUBIN TOTAL TRANSCUT
|
Facility
|
OP
|
$51.18
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
3008872001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$48.62 |
| Rate for Payer: Aetna of VT Commercial |
$48.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$24.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$24.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$30.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$41.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$40.69
|
| Rate for Payer: Cash Price |
$25.59
|
| Rate for Payer: Cash Price |
$25.59
|
| Rate for Payer: Cigna Commercial |
$40.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$40.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$40.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$23.03
|
| Rate for Payer: Multiplan Commercial |
$47.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$43.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.03
|
| Rate for Payer: United Healthcare Commercial |
$48.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: United Healthcare VA CCN |
$23.03
|
|
|
BINDER ABD 15
|
Facility
|
IP
|
$70.57
|
|
|
Service Code
|
HCPCS A4461
|
| Hospital Charge Code |
2740022161
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.23 |
| Max. Negotiated Rate |
$67.04 |
| Rate for Payer: Aetna of VT Commercial |
$67.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$52.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$52.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.46
|
| Rate for Payer: Cash Price |
$35.28
|
| Rate for Payer: Cigna Commercial |
$56.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.46
|
| Rate for Payer: Multiplan Commercial |
$65.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.98
|
| Rate for Payer: United Healthcare Commercial |
$67.04
|
|
|
BINDER ABD 15
|
Facility
|
OP
|
$70.57
|
|
|
Service Code
|
HCPCS A4461
|
| Hospital Charge Code |
2740022161
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.26 |
| Max. Negotiated Rate |
$67.04 |
| Rate for Payer: Aetna of VT Commercial |
$67.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$42.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.10
|
| Rate for Payer: Cash Price |
$35.28
|
| Rate for Payer: Cigna Commercial |
$56.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.76
|
| Rate for Payer: Multiplan Commercial |
$65.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.76
|
| Rate for Payer: United Healthcare Commercial |
$67.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.76
|
| Rate for Payer: United Healthcare VA CCN |
$31.76
|
|
|
BINDER ABD 15
|
Professional
|
Both
|
$70.57
|
|
|
Service Code
|
HCPCS A4461
|
| Hospital Charge Code |
2740022161
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$66.34 |
| Rate for Payer: Aetna of VT Commercial |
$66.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$6.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$5.30
|
| Rate for Payer: Cash Price |
$35.28
|
| Rate for Payer: Cash Price |
$35.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.61
|
| Rate for Payer: Multiplan Commercial |
$65.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.61
|
| Rate for Payer: United Healthcare Commercial |
$7.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.61
|
| Rate for Payer: United Healthcare VA CCN |
$4.61
|
|
|
BIOPSY BONE OPEN DEEP
|
Facility
|
IP
|
$1,544.00
|
|
|
Service Code
|
CPT 20245
|
| Hospital Charge Code |
9822024501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,142.71 |
| Max. Negotiated Rate |
$1,466.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,466.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,142.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,142.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,312.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,296.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,235.20
|
| Rate for Payer: Cash Price |
$772.00
|
| Rate for Payer: Cigna Commercial |
$1,235.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,235.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,235.20
|
| Rate for Payer: Multiplan Commercial |
$1,435.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,312.40
|
| Rate for Payer: United Healthcare Commercial |
$1,466.80
|
|
|
BIOPSY BONE OPEN DEEP
|
Facility
|
OP
|
$1,544.00
|
|
|
Service Code
|
CPT 20245
|
| Hospital Charge Code |
9822024501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$683.84 |
| Max. Negotiated Rate |
$1,466.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,466.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,383.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$683.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,383.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$929.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,312.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,250.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$694.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,227.48
|
| Rate for Payer: Cash Price |
$772.00
|
| Rate for Payer: Cigna Commercial |
$1,235.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,235.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,235.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$694.80
|
| Rate for Payer: Multiplan Commercial |
$1,435.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,312.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$694.80
|
| Rate for Payer: United Healthcare Commercial |
$1,466.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$694.80
|
| Rate for Payer: United Healthcare VA CCN |
$694.80
|
|
|
BIOPSY BONE OPEN DEEP
|
Professional
|
Both
|
$1,544.00
|
|
|
Service Code
|
CPT 20245
|
| Hospital Charge Code |
9822024501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$316.19 |
| Max. Negotiated Rate |
$1,451.36 |
| Rate for Payer: Aetna of VT Commercial |
$1,451.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,383.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$325.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,383.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$442.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$614.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$614.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$363.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$614.86
|
| Rate for Payer: Cash Price |
$772.00
|
| Rate for Payer: Cash Price |
$772.00
|
| Rate for Payer: Cigna Commercial |
$600.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$528.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$528.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$316.19
|
| Rate for Payer: Multiplan Commercial |
$1,435.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$448.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$316.19
|
| Rate for Payer: United Healthcare Commercial |
$486.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$316.19
|
| Rate for Payer: United Healthcare VA CCN |
$316.19
|
|
|
BIOPSY NAIL UNIT
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT 11755
|
| Hospital Charge Code |
9601175502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$209.45 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Aetna of VT Commercial |
$268.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$209.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$209.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$240.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$237.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$226.40
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cigna Commercial |
$226.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$226.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$226.40
|
| Rate for Payer: Multiplan Commercial |
$263.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.55
|
| Rate for Payer: United Healthcare Commercial |
$268.85
|
|
|
BIOPSY NAIL UNIT
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
CPT 11755
|
| Hospital Charge Code |
9601175502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$125.34 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Aetna of VT Commercial |
$268.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$253.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$125.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$253.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$170.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$240.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$229.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$127.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$224.99
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cigna Commercial |
$226.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$226.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$226.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$127.35
|
| Rate for Payer: Multiplan Commercial |
$263.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$127.35
|
| Rate for Payer: United Healthcare Commercial |
$268.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.35
|
| Rate for Payer: United Healthcare VA CCN |
$127.35
|
|
