|
THER/PRO/DX INJ PUSH EA NEW DG
|
Facility
|
OP
|
$246.09
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
2609637601
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$108.99 |
| Max. Negotiated Rate |
$233.79 |
| Rate for Payer: Aetna of VT Commercial |
$233.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$220.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$108.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$220.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$148.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$199.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$110.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$195.64
|
| Rate for Payer: Cash Price |
$123.04
|
| Rate for Payer: Cigna Commercial |
$196.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$110.74
|
| Rate for Payer: Multiplan Commercial |
$228.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$110.74
|
| Rate for Payer: United Healthcare Commercial |
$233.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.74
|
| Rate for Payer: United Healthcare VA CCN |
$110.74
|
|
|
THER/PRO/DX INJ PUSH EA NEW DG
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
9819637602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$139.88 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna of VT Commercial |
$179.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$158.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$151.20
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$151.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$151.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$151.20
|
| Rate for Payer: Multiplan Commercial |
$175.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$160.65
|
| Rate for Payer: United Healthcare Commercial |
$179.55
|
|
|
THER/PRO/DX INJ PUSH EA NEW DG
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
9819637601
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
THER/PRO/DX INJ PUSH EA NEW DG
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
9819637601
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$10.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$0.85
|
| Rate for Payer: United Healthcare VA CCN |
$19.10
|
|
|
THER/PRO/DX INJ PUSH EA NEW DG
|
Facility
|
IP
|
$246.09
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
2609637601
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$182.13 |
| Max. Negotiated Rate |
$233.79 |
| Rate for Payer: Aetna of VT Commercial |
$233.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$182.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$182.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$206.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.87
|
| Rate for Payer: Cash Price |
$123.04
|
| Rate for Payer: Cigna Commercial |
$196.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.87
|
| Rate for Payer: Multiplan Commercial |
$228.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.18
|
| Rate for Payer: United Healthcare Commercial |
$233.79
|
|
|
THER/PRO/DX INJ PUSH EA NEW DG
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
9819637601
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
THER/PROPH/DIAG INJ IV PUSH
|
Facility
|
OP
|
$351.56
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
2609637401
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$155.71 |
| Max. Negotiated Rate |
$333.98 |
| Rate for Payer: Aetna of VT Commercial |
$333.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$314.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$155.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$314.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$211.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$298.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$284.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$158.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$279.49
|
| Rate for Payer: Cash Price |
$175.78
|
| Rate for Payer: Cigna Commercial |
$281.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$281.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$281.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$158.20
|
| Rate for Payer: Multiplan Commercial |
$326.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$298.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$158.20
|
| Rate for Payer: United Healthcare Commercial |
$333.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$158.20
|
| Rate for Payer: United Healthcare VA CCN |
$158.20
|
|
|
THER/PROPH/DIAG INJ IV PUSH
|
Facility
|
OP
|
$351.56
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
4509637401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.71 |
| Max. Negotiated Rate |
$333.98 |
| Rate for Payer: Aetna of VT Commercial |
$333.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$314.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$155.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$314.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$211.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$298.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$284.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$158.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$279.49
|
| Rate for Payer: Cash Price |
$175.78
|
| Rate for Payer: Cigna Commercial |
$281.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$281.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$281.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$158.20
|
| Rate for Payer: Multiplan Commercial |
$326.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$298.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$158.20
|
| Rate for Payer: United Healthcare Commercial |
$333.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$158.20
|
| Rate for Payer: United Healthcare VA CCN |
$158.20
|
|
|
THER/PROPH/DIAG INJ IV PUSH
|
Facility
|
IP
|
$351.56
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
2609637401
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$260.19 |
| Max. Negotiated Rate |
$333.98 |
| Rate for Payer: Aetna of VT Commercial |
$333.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$260.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$260.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$298.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$295.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$281.25
|
| Rate for Payer: Cash Price |
$175.78
|
| Rate for Payer: Cigna Commercial |
$281.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$281.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$281.25
|
| Rate for Payer: Multiplan Commercial |
$326.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$298.83
|
| Rate for Payer: United Healthcare Commercial |
$333.98
|
|
|
THER/PROPH/DIAG INJ IV PUSH
|
Facility
|
IP
|
$351.56
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
4509637401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$260.19 |
| Max. Negotiated Rate |
$333.98 |
| Rate for Payer: Aetna of VT Commercial |
$333.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$260.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$260.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$298.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$295.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$281.25
|
| Rate for Payer: Cash Price |
$175.78
|
| Rate for Payer: Cigna Commercial |
$281.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$281.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$281.25
|
| Rate for Payer: Multiplan Commercial |
$326.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$298.83
|
| Rate for Payer: United Healthcare Commercial |
$333.98
|
|
|
THER/PROPH/DIAG INJ IV PUSH
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
9819637402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$33.46 |
| Max. Negotiated Rate |
$125.02 |
| Rate for Payer: Aetna of VT Commercial |
$125.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$119.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$119.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$78.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$38.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.45
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cigna Commercial |
$41.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$54.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$54.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$33.46
|
| Rate for Payer: Multiplan Commercial |
$123.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.46
|
| Rate for Payer: United Healthcare Commercial |
$51.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.46
|
| Rate for Payer: United Healthcare VA CCN |
$33.46
|
|
|
THER/PROPH/DIAG INJ IV PUSH
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
9819637402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$98.43 |
| Max. Negotiated Rate |
$126.35 |
| Rate for Payer: Aetna of VT Commercial |
$126.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$98.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$98.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$111.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$106.40
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cigna Commercial |
$106.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$123.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$113.05
|
| Rate for Payer: United Healthcare Commercial |
$126.35
|
|
|
THER/PROPH/DIAG INJ IV PUSH
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
9819637402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$58.91 |
| Max. Negotiated Rate |
$126.35 |
| Rate for Payer: Aetna of VT Commercial |
$126.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$119.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$119.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$80.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$107.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$105.73
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cigna Commercial |
$106.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$59.85
|
| Rate for Payer: Multiplan Commercial |
$123.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$113.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.85
|
| Rate for Payer: United Healthcare Commercial |
$126.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.85
|
| Rate for Payer: United Healthcare VA CCN |
$59.85
|
|
|
THER/PROPH/DIAG INJ SUBQ/IM
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
5219637201
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$13.70 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna of VT Commercial |
$109.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$35.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$35.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$30.78
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$16.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.70
|
| Rate for Payer: Multiplan Commercial |
$108.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.70
|
| Rate for Payer: United Healthcare Commercial |
$21.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.70
|
| Rate for Payer: United Healthcare VA CCN |
$13.70
|
|
|
THER/PROPH/DIAG INJ SUBQ/IM
|
Professional
|
Both
|
$113.74
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
2609637201
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$13.70 |
| Max. Negotiated Rate |
$106.92 |
| Rate for Payer: Aetna of VT Commercial |
$106.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$35.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$35.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$30.78
|
| Rate for Payer: Cash Price |
$56.87
|
| Rate for Payer: Cash Price |
$56.87
|
| Rate for Payer: Cigna Commercial |
$16.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.70
|
| Rate for Payer: Multiplan Commercial |
$105.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.70
|
| Rate for Payer: United Healthcare Commercial |
$21.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.70
|
| Rate for Payer: United Healthcare VA CCN |
$13.70
|
|
|
THER/PROPH/DIAG INJ SUBQ/IM
|
Facility
|
OP
|
$113.74
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
4509637201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.38 |
| Max. Negotiated Rate |
$108.05 |
| Rate for Payer: Aetna of VT Commercial |
$108.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$101.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$101.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$68.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$90.42
|
| Rate for Payer: Cash Price |
$56.87
|
| Rate for Payer: Cigna Commercial |
$90.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$90.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$90.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$51.18
|
| Rate for Payer: Multiplan Commercial |
$105.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.18
|
| Rate for Payer: United Healthcare Commercial |
$108.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.18
|
| Rate for Payer: United Healthcare VA CCN |
$51.18
|
|
|
THER/PROPH/DIAG INJ SUBQ/IM
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
5219637201
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$51.82 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Aetna of VT Commercial |
$111.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$51.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$70.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$52.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$93.02
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$93.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$93.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$93.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$52.65
|
| Rate for Payer: Multiplan Commercial |
$108.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.65
|
| Rate for Payer: United Healthcare Commercial |
$111.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.65
|
| Rate for Payer: United Healthcare VA CCN |
$52.65
|
|
|
THER/PROPH/DIAG INJ SUBQ/IM
|
Facility
|
OP
|
$113.74
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
2609637201
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$50.38 |
| Max. Negotiated Rate |
$108.05 |
| Rate for Payer: Aetna of VT Commercial |
$108.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$101.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$101.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$68.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$90.42
|
| Rate for Payer: Cash Price |
$56.87
|
| Rate for Payer: Cigna Commercial |
$90.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$90.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$90.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$51.18
|
| Rate for Payer: Multiplan Commercial |
$105.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.18
|
| Rate for Payer: United Healthcare Commercial |
$108.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.18
|
| Rate for Payer: United Healthcare VA CCN |
$51.18
|
|
|
THER/PROPH/DIAG INJ SUBQ/IM
|
Facility
|
IP
|
$113.74
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
4509637201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.18 |
| Max. Negotiated Rate |
$108.05 |
| Rate for Payer: Aetna of VT Commercial |
$108.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$84.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$84.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$95.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$90.99
|
| Rate for Payer: Cash Price |
$56.87
|
| Rate for Payer: Cigna Commercial |
$90.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$90.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$90.99
|
| Rate for Payer: Multiplan Commercial |
$105.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.68
|
| Rate for Payer: United Healthcare Commercial |
$108.05
|
|
|
THER/PROPH/DIAG INJ SUBQ/IM
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
9819637202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$52.55 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Aetna of VT Commercial |
$67.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$52.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$52.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$60.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.80
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cigna Commercial |
$56.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.80
|
| Rate for Payer: Multiplan Commercial |
$66.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.35
|
| Rate for Payer: United Healthcare Commercial |
$67.45
|
|
|
THER/PROPH/DIAG INJ SUBQ/IM
|
Professional
|
Both
|
$127.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
5209637201
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$13.70 |
| Max. Negotiated Rate |
$119.38 |
| Rate for Payer: Aetna of VT Commercial |
$119.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$35.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$35.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$30.78
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Cigna Commercial |
$16.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.70
|
| Rate for Payer: Multiplan Commercial |
$118.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.70
|
| Rate for Payer: United Healthcare Commercial |
$21.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.70
|
| Rate for Payer: United Healthcare VA CCN |
$13.70
|
|
|
THER/PROPH/DIAG INJ SUBQ/IM
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
5209637201
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$93.99 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Aetna of VT Commercial |
$120.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$107.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$101.60
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Cigna Commercial |
$101.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$101.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$101.60
|
| Rate for Payer: Multiplan Commercial |
$118.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.95
|
| Rate for Payer: United Healthcare Commercial |
$120.65
|
|
|
THER/PROPH/DIAG INJ SUBQ/IM
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
9819637201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$13.70 |
| Max. Negotiated Rate |
$66.74 |
| Rate for Payer: Aetna of VT Commercial |
$66.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$35.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$35.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$30.78
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cigna Commercial |
$16.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.70
|
| Rate for Payer: Multiplan Commercial |
$66.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.70
|
| Rate for Payer: United Healthcare Commercial |
$21.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.70
|
| Rate for Payer: United Healthcare VA CCN |
$13.70
|
|
|
THER/PROPH/DIAG INJ SUBQ/IM
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
9819637201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$52.55 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Aetna of VT Commercial |
$67.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$52.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$52.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$60.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.80
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cigna Commercial |
$56.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.80
|
| Rate for Payer: Multiplan Commercial |
$66.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.35
|
| Rate for Payer: United Healthcare Commercial |
$67.45
|
|
|
THER/PROPH/DIAG INJ SUBQ/IM
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
9819637202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$13.70 |
| Max. Negotiated Rate |
$66.74 |
| Rate for Payer: Aetna of VT Commercial |
$66.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$35.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$35.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$30.78
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cigna Commercial |
$16.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.70
|
| Rate for Payer: Multiplan Commercial |
$66.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.70
|
| Rate for Payer: United Healthcare Commercial |
$21.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.70
|
| Rate for Payer: United Healthcare VA CCN |
$13.70
|
|
