|
VANCOMYCIN 1.75 GM/350 ML IV
|
Facility
|
IP
|
$0.01
|
|
| Hospital Charge Code |
2500000557
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
VANCOMYCIN 1.75 GRAM/350 ML PR
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
636J337203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
VANCOMYCIN 1.75 GRAM/350 ML PR
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
636J337203
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$17.99 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$17.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$17.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
VARICELLA-ZOSTER GE/AS01B/PF
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
HCPCS 90750
|
| Hospital Charge Code |
6369075001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$592.65 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$592.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$592.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$235.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$235.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$235.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$280.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$280.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$228.44
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$196.00
|
|
|
VARICELLA-ZOSTER GE/AS01B/PF
|
Facility
|
OP
|
$592.65
|
|
|
Service Code
|
HCPCS 90750
|
| Hospital Charge Code |
6369075001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$592.65 |
| Max. Negotiated Rate |
$592.65 |
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$592.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$592.65
|
|
|
VARICELLA-ZOSTER GE/AS01B/PF
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
6369075001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$592.65 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$592.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$592.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$235.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$235.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$235.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$280.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$280.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$228.44
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$196.00
|
|
|
VASCULAR STUDY
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
9729397501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$97.65 |
| Max. Negotiated Rate |
$994.33 |
| Rate for Payer: Aetna of VT Commercial |
$98.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$994.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$256.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$994.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$348.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$456.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$456.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$286.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$456.54
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$301.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$401.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$401.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$249.28
|
| Rate for Payer: Multiplan Commercial |
$97.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$353.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$249.28
|
| Rate for Payer: United Healthcare Commercial |
$383.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$249.28
|
| Rate for Payer: United Healthcare VA CCN |
$249.28
|
|
|
VASCULAR STUDY
|
Facility
|
IP
|
$1,198.92
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
9219397501
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$887.32 |
| Max. Negotiated Rate |
$1,138.97 |
| Rate for Payer: Aetna of VT Commercial |
$1,138.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$887.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$887.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,019.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,007.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$959.14
|
| Rate for Payer: Cash Price |
$599.46
|
| Rate for Payer: Cigna Commercial |
$959.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$959.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$959.14
|
| Rate for Payer: Multiplan Commercial |
$1,115.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,019.08
|
| Rate for Payer: United Healthcare Commercial |
$1,138.97
|
|
|
VASCULAR STUDY
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
9729397501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$77.71 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna of VT Commercial |
$99.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$77.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$77.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.00
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$97.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$99.75
|
|
|
VASCULAR STUDY
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
9729397501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna of VT Commercial |
$99.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$94.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$46.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$94.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$63.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.47
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$97.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.25
|
| Rate for Payer: United Healthcare Commercial |
$99.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.25
|
| Rate for Payer: United Healthcare VA CCN |
$47.25
|
|
|
VASCULAR STUDY
|
Facility
|
OP
|
$1,198.92
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
9219397501
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$531.00 |
| Max. Negotiated Rate |
$1,138.97 |
| Rate for Payer: Aetna of VT Commercial |
$1,138.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,074.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$531.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,074.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$721.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,019.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$971.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$539.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$953.14
|
| Rate for Payer: Cash Price |
$599.46
|
| Rate for Payer: Cigna Commercial |
$959.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$959.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$959.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$539.51
|
| Rate for Payer: Multiplan Commercial |
$1,115.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,019.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$539.51
|
| Rate for Payer: United Healthcare Commercial |
$1,138.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$539.51
|
| Rate for Payer: United Healthcare VA CCN |
$539.51
|
|
|
VASCULAR STUDY
|
Facility
|
OP
|
$979.61
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
9219397601
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$433.87 |
| Max. Negotiated Rate |
$930.63 |
| Rate for Payer: Aetna of VT Commercial |
$930.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$877.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$433.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$877.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$589.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$832.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$793.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$440.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$778.79
|
| Rate for Payer: Cash Price |
$489.80
|
| Rate for Payer: Cigna Commercial |
$783.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$783.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$783.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$440.82
|
| Rate for Payer: Multiplan Commercial |
$911.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$832.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$440.82
|
| Rate for Payer: United Healthcare Commercial |
$930.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$440.82
|
| Rate for Payer: United Healthcare VA CCN |
$440.82
|
|
|
VASCULAR STUDY
|
Facility
|
IP
|
$979.61
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
9219397601
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$725.01 |
| Max. Negotiated Rate |
$930.63 |
| Rate for Payer: Aetna of VT Commercial |
$930.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$725.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$725.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$832.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$822.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$783.69
|
| Rate for Payer: Cash Price |
$489.80
|
| Rate for Payer: Cigna Commercial |
$783.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$783.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$783.69
|
| Rate for Payer: Multiplan Commercial |
$911.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$832.67
|
| Rate for Payer: United Healthcare Commercial |
$930.63
|
|
|
VASCULAR STUDY PRO FEE
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
9729397601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$384.11 |
| Max. Negotiated Rate |
$493.05 |
| Rate for Payer: Aetna of VT Commercial |
$493.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$384.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$384.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$441.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$435.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$415.20
|
| Rate for Payer: Cash Price |
$259.50
|
| Rate for Payer: Cigna Commercial |
$415.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$415.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$415.20
|
| Rate for Payer: Multiplan Commercial |
$482.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$441.15
|
| Rate for Payer: United Healthcare Commercial |
$493.05
|
|
|
VASCULAR STUDY PRO FEE
|
Professional
|
Both
|
$519.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
9729397601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$140.76 |
| Max. Negotiated Rate |
$498.74 |
| Rate for Payer: Aetna of VT Commercial |
$487.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$498.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$155.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$498.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$211.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$279.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$279.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$173.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$279.40
|
| Rate for Payer: Cash Price |
$259.50
|
| Rate for Payer: Cash Price |
$259.50
|
| Rate for Payer: Cigna Commercial |
$181.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$243.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$243.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$140.76
|
| Rate for Payer: Multiplan Commercial |
$482.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$214.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$151.03
|
| Rate for Payer: United Healthcare Commercial |
$232.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.03
|
| Rate for Payer: United Healthcare VA CCN |
$151.03
|
|
|
VASCULAR STUDY PRO FEE
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
9729397601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$229.87 |
| Max. Negotiated Rate |
$493.05 |
| Rate for Payer: Aetna of VT Commercial |
$493.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$464.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$229.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$464.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$312.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$441.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$420.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$233.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$412.61
|
| Rate for Payer: Cash Price |
$259.50
|
| Rate for Payer: Cigna Commercial |
$415.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$415.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$415.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$233.55
|
| Rate for Payer: Multiplan Commercial |
$482.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$441.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$233.55
|
| Rate for Payer: United Healthcare Commercial |
$493.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.55
|
| Rate for Payer: United Healthcare VA CCN |
$233.55
|
|
|
VBAC CARE AFTER DELIVERY
|
Facility
|
OP
|
$2,435.00
|
|
|
Service Code
|
CPT 59614
|
| Hospital Charge Code |
9695961401
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$1,078.46 |
| Max. Negotiated Rate |
$2,313.25 |
| Rate for Payer: Aetna of VT Commercial |
$2,313.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,181.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,078.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,181.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,465.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,069.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,972.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,095.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,935.83
|
| Rate for Payer: Cash Price |
$1,217.50
|
| Rate for Payer: Cigna Commercial |
$1,948.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,948.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,948.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,095.75
|
| Rate for Payer: Multiplan Commercial |
$2,264.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,069.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,095.75
|
| Rate for Payer: United Healthcare Commercial |
$2,313.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,095.75
|
| Rate for Payer: United Healthcare VA CCN |
$1,095.75
|
|
|
VBAC CARE AFTER DELIVERY
|
Facility
|
IP
|
$2,435.00
|
|
|
Service Code
|
CPT 59614
|
| Hospital Charge Code |
9695961401
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$1,802.14 |
| Max. Negotiated Rate |
$2,313.25 |
| Rate for Payer: Aetna of VT Commercial |
$2,313.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,802.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,802.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,069.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,045.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,948.00
|
| Rate for Payer: Cash Price |
$1,217.50
|
| Rate for Payer: Cigna Commercial |
$1,948.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,948.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,948.00
|
| Rate for Payer: Multiplan Commercial |
$2,264.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,069.75
|
| Rate for Payer: United Healthcare Commercial |
$2,313.25
|
|
|
VBAC CARE AFTER DELIVERY
|
Professional
|
Both
|
$2,435.00
|
|
|
Service Code
|
CPT 59614
|
| Hospital Charge Code |
9695961401
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$1,037.62 |
| Max. Negotiated Rate |
$2,288.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,288.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,181.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,068.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,181.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,452.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,586.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,586.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,193.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,586.69
|
| Rate for Payer: Cash Price |
$1,217.50
|
| Rate for Payer: Cash Price |
$1,217.50
|
| Rate for Payer: Cigna Commercial |
$1,137.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,807.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,807.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,037.62
|
| Rate for Payer: Multiplan Commercial |
$2,264.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,473.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,037.62
|
| Rate for Payer: United Healthcare Commercial |
$1,596.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,037.62
|
| Rate for Payer: United Healthcare VA CCN |
$1,037.62
|
|
|
VBAC DELIVERY
|
Facility
|
IP
|
$4,997.00
|
|
|
Service Code
|
CPT 59610
|
| Hospital Charge Code |
9695961001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$3,698.28 |
| Max. Negotiated Rate |
$4,747.15 |
| Rate for Payer: Aetna of VT Commercial |
$4,747.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,698.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,698.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,247.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,197.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,997.60
|
| Rate for Payer: Cash Price |
$2,498.50
|
| Rate for Payer: Cigna Commercial |
$3,997.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,997.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,997.60
|
| Rate for Payer: Multiplan Commercial |
$4,647.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,247.45
|
| Rate for Payer: United Healthcare Commercial |
$4,747.15
|
|
|
VBAC DELIVERY
|
Facility
|
OP
|
$4,997.00
|
|
|
Service Code
|
CPT 59610
|
| Hospital Charge Code |
9695961001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$2,213.17 |
| Max. Negotiated Rate |
$4,747.15 |
| Rate for Payer: Aetna of VT Commercial |
$4,747.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,476.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,213.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,476.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,008.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,247.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,047.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,248.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,972.61
|
| Rate for Payer: Cash Price |
$2,498.50
|
| Rate for Payer: Cigna Commercial |
$3,997.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,997.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,997.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,248.65
|
| Rate for Payer: Multiplan Commercial |
$4,647.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,247.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,248.65
|
| Rate for Payer: United Healthcare Commercial |
$4,747.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,248.65
|
| Rate for Payer: United Healthcare VA CCN |
$2,248.65
|
|
|
VBAC DELIVERY
|
Professional
|
Both
|
$4,997.00
|
|
|
Service Code
|
CPT 59610
|
| Hospital Charge Code |
9695961001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$2,278.50 |
| Max. Negotiated Rate |
$4,697.18 |
| Rate for Payer: Aetna of VT Commercial |
$4,697.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,476.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,346.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,476.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,189.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,895.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,895.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,620.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,895.31
|
| Rate for Payer: Cash Price |
$2,498.50
|
| Rate for Payer: Cash Price |
$2,498.50
|
| Rate for Payer: Cigna Commercial |
$2,505.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,923.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,923.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,278.50
|
| Rate for Payer: Multiplan Commercial |
$4,647.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,235.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,278.50
|
| Rate for Payer: United Healthcare Commercial |
$3,505.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,278.50
|
| Rate for Payer: United Healthcare VA CCN |
$2,278.50
|
|
|
VBAC DELIVERY ONLY
|
Facility
|
OP
|
$947.14
|
|
|
Service Code
|
CPT 59612
|
| Hospital Charge Code |
7225961201
|
|
Hospital Revenue Code
|
722
|
| Min. Negotiated Rate |
$419.49 |
| Max. Negotiated Rate |
$899.78 |
| Rate for Payer: Aetna of VT Commercial |
$899.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$848.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$419.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$848.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$570.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$805.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$767.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$426.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$752.98
|
| Rate for Payer: Cash Price |
$473.57
|
| Rate for Payer: Cigna Commercial |
$757.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$757.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$757.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$426.21
|
| Rate for Payer: Multiplan Commercial |
$880.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$805.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$426.21
|
| Rate for Payer: United Healthcare Commercial |
$899.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$426.21
|
| Rate for Payer: United Healthcare VA CCN |
$426.21
|
|
|
VBAC DELIVERY ONLY
|
Facility
|
OP
|
$2,316.00
|
|
|
Service Code
|
CPT 59612
|
| Hospital Charge Code |
9695961201
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$1,025.76 |
| Max. Negotiated Rate |
$2,200.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,200.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,074.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,025.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,074.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,394.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,968.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,875.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,042.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,841.22
|
| Rate for Payer: Cash Price |
$1,158.00
|
| Rate for Payer: Cigna Commercial |
$1,852.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,852.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,852.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,042.20
|
| Rate for Payer: Multiplan Commercial |
$2,153.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,968.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,042.20
|
| Rate for Payer: United Healthcare Commercial |
$2,200.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,042.20
|
| Rate for Payer: United Healthcare VA CCN |
$1,042.20
|
|
|
VBAC DELIVERY ONLY
|
Professional
|
Both
|
$947.14
|
|
|
Service Code
|
CPT 59612
|
| Hospital Charge Code |
7225961201
|
|
Hospital Revenue Code
|
722
|
| Min. Negotiated Rate |
$801.86 |
| Max. Negotiated Rate |
$1,441.50 |
| Rate for Payer: Aetna of VT Commercial |
$890.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$848.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$825.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$848.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,122.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,441.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,441.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$922.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,441.50
|
| Rate for Payer: Cash Price |
$473.57
|
| Rate for Payer: Cash Price |
$473.57
|
| Rate for Payer: Cigna Commercial |
$879.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,398.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,398.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$951.90
|
| Rate for Payer: Multiplan Commercial |
$880.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,138.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$801.86
|
| Rate for Payer: United Healthcare Commercial |
$1,233.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$801.86
|
| Rate for Payer: United Healthcare VA CCN |
$801.86
|
|
