|
THER/PROPH/DIAG INJ SUBQ/IM
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
9819637201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$31.45 |
| 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 |
$63.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$60.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.45
|
| 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: Martins Point Health Care Commercial |
$31.95
|
| Rate for Payer: Multiplan Commercial |
$66.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.95
|
| Rate for Payer: United Healthcare Commercial |
$67.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.95
|
| Rate for Payer: United Healthcare VA CCN |
$31.95
|
|
|
THER/PROPH/DIAG INJ SUBQ/IM
|
Facility
|
IP
|
$113.74
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
9409637201
|
|
Hospital Revenue Code
|
940
|
| 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
|
Professional
|
Both
|
$113.74
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
9409637201
|
|
Hospital Revenue Code
|
940
|
| 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
|
$127.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
5209637201
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$56.25 |
| 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 |
$113.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$56.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$76.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$107.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$102.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$57.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$100.97
|
| 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: Martins Point Health Care Commercial |
$57.15
|
| Rate for Payer: Multiplan Commercial |
$118.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.15
|
| Rate for Payer: United Healthcare Commercial |
$120.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.15
|
| Rate for Payer: United Healthcare VA CCN |
$57.15
|
|
|
THER/PROPH/DIAG INJ SUBQ/IM
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
5219637201
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$86.59 |
| 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 |
$86.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$98.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$93.60
|
| 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: Multiplan Commercial |
$108.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.45
|
| Rate for Payer: United Healthcare Commercial |
$111.15
|
|
|
THER/PROPH/DIAG INJ SUBQ/IM
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
9819637202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$31.45 |
| 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 |
$63.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$60.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.45
|
| 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: Martins Point Health Care Commercial |
$31.95
|
| Rate for Payer: Multiplan Commercial |
$66.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.95
|
| Rate for Payer: United Healthcare Commercial |
$67.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.95
|
| Rate for Payer: United Healthcare VA CCN |
$31.95
|
|
|
THER/PROPH/DIAG INJ SUBQ/IM
|
Facility
|
OP
|
$113.74
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
9409637201
|
|
Hospital Revenue Code
|
940
|
| 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 |
2609637201
|
|
Hospital Revenue Code
|
260
|
| 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 IV INF ADDON
|
Facility
|
OP
|
$224.38
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
4509636601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.38 |
| Max. Negotiated Rate |
$213.16 |
| Rate for Payer: Aetna of VT Commercial |
$213.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$201.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$99.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$201.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$135.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$190.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$181.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$100.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$178.38
|
| Rate for Payer: Cash Price |
$112.19
|
| Rate for Payer: Cigna Commercial |
$179.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$179.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$179.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$100.97
|
| Rate for Payer: Multiplan Commercial |
$208.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$190.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.97
|
| Rate for Payer: United Healthcare Commercial |
$213.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Healthcare VA CCN |
$100.97
|
|
|
THER/PROPH/DIAG IV INF ADDON
|
Facility
|
IP
|
$224.38
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
4509636601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$166.06 |
| Max. Negotiated Rate |
$213.16 |
| Rate for Payer: Aetna of VT Commercial |
$213.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$166.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$166.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$190.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$188.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$179.50
|
| Rate for Payer: Cash Price |
$112.19
|
| Rate for Payer: Cigna Commercial |
$179.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$179.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$179.50
|
| Rate for Payer: Multiplan Commercial |
$208.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$190.72
|
| Rate for Payer: United Healthcare Commercial |
$213.16
|
|
|
THER/PROPH/DIAG IV INF INIT
|
Facility
|
OP
|
$649.35
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
4509636501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$287.60 |
| Max. Negotiated Rate |
$616.88 |
| Rate for Payer: Aetna of VT Commercial |
$616.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$581.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$287.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$581.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$390.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$551.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$525.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$292.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$516.23
|
| Rate for Payer: Cash Price |
$324.68
|
| Rate for Payer: Cigna Commercial |
$519.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$519.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$519.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$292.21
|
| Rate for Payer: Multiplan Commercial |
$603.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$551.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$292.21
|
| Rate for Payer: United Healthcare Commercial |
$616.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.21
|
| Rate for Payer: United Healthcare VA CCN |
$292.21
|
|
|
THER/PROPH/DIAG IV INF INIT
|
Facility
|
IP
|
$649.35
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
4509636501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$480.58 |
| Max. Negotiated Rate |
$616.88 |
| Rate for Payer: Aetna of VT Commercial |
$616.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$480.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$480.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$551.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$545.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$519.48
|
| Rate for Payer: Cash Price |
$324.68
|
| Rate for Payer: Cigna Commercial |
$519.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$519.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$519.48
|
| Rate for Payer: Multiplan Commercial |
$603.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$551.95
|
| Rate for Payer: United Healthcare Commercial |
$616.88
|
|
|
THORACENTESIS PLEURA W/IMAGING
|
Facility
|
OP
|
$1,363.35
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
4503255501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$603.83 |
| Max. Negotiated Rate |
$1,295.18 |
| Rate for Payer: Aetna of VT Commercial |
$1,295.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,221.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$603.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,221.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$820.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,158.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,104.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$613.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,083.86
|
| Rate for Payer: Cash Price |
$681.68
|
| Rate for Payer: Cigna Commercial |
$1,090.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,090.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,090.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$613.51
|
| Rate for Payer: Multiplan Commercial |
$1,267.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,158.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$613.51
|
| Rate for Payer: United Healthcare Commercial |
$1,295.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$613.51
|
| Rate for Payer: United Healthcare VA CCN |
$613.51
|
|
|
THORACENTESIS PLEURA W/IMAGING
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
9813255501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$234.74 |
| Max. Negotiated Rate |
$503.50 |
| Rate for Payer: Aetna of VT Commercial |
$503.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$474.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$234.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$474.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$319.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$450.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$429.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$421.35
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$424.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$424.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$424.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$238.50
|
| Rate for Payer: Multiplan Commercial |
$492.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$450.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$238.50
|
| Rate for Payer: United Healthcare Commercial |
$503.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$238.50
|
| Rate for Payer: United Healthcare VA CCN |
$238.50
|
|
|
THORACENTESIS PLEURA W/IMAGING
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
9813255501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$100.39 |
| Max. Negotiated Rate |
$561.62 |
| Rate for Payer: Aetna of VT Commercial |
$498.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$474.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$474.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$140.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$561.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$561.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$115.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$561.62
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$182.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$472.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$472.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$292.47
|
| Rate for Payer: Multiplan Commercial |
$492.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.39
|
| Rate for Payer: United Healthcare Commercial |
$154.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.39
|
| Rate for Payer: United Healthcare VA CCN |
$100.39
|
|
|
THORACENTESIS PLEURA W/IMAGING
|
Facility
|
IP
|
$1,363.35
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
4503255501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,009.02 |
| Max. Negotiated Rate |
$1,295.18 |
| Rate for Payer: Aetna of VT Commercial |
$1,295.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,009.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,009.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,158.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,145.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,090.68
|
| Rate for Payer: Cash Price |
$681.68
|
| Rate for Payer: Cigna Commercial |
$1,090.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,090.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,090.68
|
| Rate for Payer: Multiplan Commercial |
$1,267.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,158.85
|
| Rate for Payer: United Healthcare Commercial |
$1,295.18
|
|
|
THORACENTESIS PLEURA W/IMAGING
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
9813255502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$234.74 |
| Max. Negotiated Rate |
$503.50 |
| Rate for Payer: Aetna of VT Commercial |
$503.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$474.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$234.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$474.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$319.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$450.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$429.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$421.35
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$424.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$424.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$424.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$238.50
|
| Rate for Payer: Multiplan Commercial |
$492.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$450.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$238.50
|
| Rate for Payer: United Healthcare Commercial |
$503.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$238.50
|
| Rate for Payer: United Healthcare VA CCN |
$238.50
|
|
|
THORACENTESIS PLEURA W/IMAGING
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
9813255501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$392.25 |
| Max. Negotiated Rate |
$503.50 |
| Rate for Payer: Aetna of VT Commercial |
$503.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$392.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$392.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$450.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$445.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$424.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$424.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$424.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$424.00
|
| Rate for Payer: Multiplan Commercial |
$492.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$450.50
|
| Rate for Payer: United Healthcare Commercial |
$503.50
|
|
|
THORACENTESIS PLEURA W/IMAGING
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
9813255502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$392.25 |
| Max. Negotiated Rate |
$503.50 |
| Rate for Payer: Aetna of VT Commercial |
$503.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$392.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$392.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$450.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$445.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$424.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$424.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$424.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$424.00
|
| Rate for Payer: Multiplan Commercial |
$492.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$450.50
|
| Rate for Payer: United Healthcare Commercial |
$503.50
|
|
|
THORACENTESIS PLEURA W/IMAGING
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
9813255502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$100.39 |
| Max. Negotiated Rate |
$561.62 |
| Rate for Payer: Aetna of VT Commercial |
$498.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$474.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$474.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$140.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$561.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$561.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$115.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$561.62
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$182.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$472.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$472.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$292.47
|
| Rate for Payer: Multiplan Commercial |
$492.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.39
|
| Rate for Payer: United Healthcare Commercial |
$154.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.39
|
| Rate for Payer: United Healthcare VA CCN |
$100.39
|
|
|
THROMBIN TIME PLASMA
|
Facility
|
IP
|
$45.50
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
3008567001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$43.23 |
| Rate for Payer: Aetna of VT Commercial |
$43.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$33.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$33.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$38.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$38.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$36.40
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Cigna Commercial |
$36.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$36.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$42.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.67
|
| Rate for Payer: United Healthcare Commercial |
$43.23
|
|
|
THROMBIN TIME PLASMA
|
Facility
|
OP
|
$45.50
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
3008567001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$43.23 |
| Rate for Payer: Aetna of VT Commercial |
$43.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$28.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$28.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$27.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$38.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$36.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$20.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$36.17
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Cigna Commercial |
$36.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$36.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$36.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$20.48
|
| Rate for Payer: Multiplan Commercial |
$42.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.48
|
| Rate for Payer: United Healthcare Commercial |
$43.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.77
|
| Rate for Payer: United Healthcare VA CCN |
$20.48
|
|
|
THROMBIN TIME PLASMA
|
Professional
|
Both
|
$45.50
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
3008567001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$42.77 |
| Rate for Payer: Aetna of VT Commercial |
$42.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$28.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$28.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$8.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9.86
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Cigna Commercial |
$7.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.77
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.69
|
| Rate for Payer: Multiplan Commercial |
$42.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.77
|
| Rate for Payer: United Healthcare Commercial |
$8.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.77
|
| Rate for Payer: United Healthcare VA CCN |
$5.77
|
|
|
THROMBOLYSIS CEREBRAL IV INFUS
|
Facility
|
OP
|
$1,495.00
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
9813719501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$662.14 |
| Max. Negotiated Rate |
$1,420.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,420.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,339.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$662.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,339.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$899.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,270.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,210.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$672.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,188.53
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cigna Commercial |
$1,196.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,196.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,196.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$672.75
|
| Rate for Payer: Multiplan Commercial |
$1,390.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$672.75
|
| Rate for Payer: United Healthcare Commercial |
$1,420.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$672.75
|
| Rate for Payer: United Healthcare VA CCN |
$672.75
|
|
|
THROMBOLYSIS CEREBRAL IV INFUS
|
Facility
|
OP
|
$1,495.00
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
9813719502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$662.14 |
| Max. Negotiated Rate |
$1,420.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,420.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,339.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$662.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,339.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$899.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,270.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,210.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$672.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,188.53
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cigna Commercial |
$1,196.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,196.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,196.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$672.75
|
| Rate for Payer: Multiplan Commercial |
$1,390.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$672.75
|
| Rate for Payer: United Healthcare Commercial |
$1,420.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$672.75
|
| Rate for Payer: United Healthcare VA CCN |
$672.75
|
|
