|
BREATHING CAPACITY TEST
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
9769401001
|
|
Hospital Revenue Code
|
976
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$31.35 |
| Rate for Payer: Aetna of VT Commercial |
$31.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$29.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$29.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$26.23
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$26.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$26.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$26.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.85
|
| Rate for Payer: Multiplan Commercial |
$30.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.85
|
| Rate for Payer: United Healthcare Commercial |
$31.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.85
|
| Rate for Payer: United Healthcare VA CCN |
$14.85
|
|
|
BREATHING CAPACITY TEST
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
9609401002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$36.76 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Aetna of VT Commercial |
$78.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$67.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.98
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.35
|
| Rate for Payer: Multiplan Commercial |
$77.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.35
|
| Rate for Payer: United Healthcare Commercial |
$78.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.35
|
| Rate for Payer: United Healthcare VA CCN |
$37.35
|
|
|
BREATHING CAPACITY TEST
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
9609401001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$326.38 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna of VT Commercial |
$418.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$326.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$326.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$352.80
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$352.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$352.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$352.80
|
| Rate for Payer: Multiplan Commercial |
$410.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$374.85
|
| Rate for Payer: United Healthcare Commercial |
$418.95
|
|
|
BREATHING CAPACITY TEST
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
5109401001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$265.70 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Aetna of VT Commercial |
$341.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$265.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$265.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$305.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$301.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$287.20
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$287.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$287.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$287.20
|
| Rate for Payer: Multiplan Commercial |
$333.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$305.15
|
| Rate for Payer: United Healthcare Commercial |
$341.05
|
|
|
BREATHING CAPACITY TEST
|
Professional
|
Both
|
$358.21
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
4609401001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$336.72 |
| Rate for Payer: Aetna of VT Commercial |
$336.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$320.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$320.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$36.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$57.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.60
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna Commercial |
$39.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.07
|
| Rate for Payer: Multiplan Commercial |
$333.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.07
|
| Rate for Payer: United Healthcare Commercial |
$40.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.07
|
| Rate for Payer: United Healthcare VA CCN |
$26.07
|
|
|
BREATHING CAPACITY TEST
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
5109401001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Aetna of VT Commercial |
$341.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$321.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$159.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$321.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$216.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$305.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$290.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$285.40
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$287.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$287.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$287.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$161.55
|
| Rate for Payer: Multiplan Commercial |
$333.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$305.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.55
|
| Rate for Payer: United Healthcare Commercial |
$341.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.55
|
| Rate for Payer: United Healthcare VA CCN |
$161.55
|
|
|
BREATHING CAPACITY TEST
|
Facility
|
OP
|
$358.21
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
4609401001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$158.65 |
| Max. Negotiated Rate |
$340.30 |
| Rate for Payer: Aetna of VT Commercial |
$340.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$320.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$158.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$320.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$215.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$304.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$290.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$284.78
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna Commercial |
$286.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$286.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$286.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$161.19
|
| Rate for Payer: Multiplan Commercial |
$333.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$304.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.19
|
| Rate for Payer: United Healthcare Commercial |
$340.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.19
|
| Rate for Payer: United Healthcare VA CCN |
$161.19
|
|
|
BRIEF COMUNICAJ TECH-BSD SVC
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 98000
|
| Hospital Charge Code |
9609801601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.97 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of VT Commercial |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$45.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.20
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.90
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
|
|
BRIEF COMUNICAJ TECH-BSD SVC
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
CPT 98016
|
| Hospital Charge Code |
9609801601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$50.76 |
| Rate for Payer: Aetna of VT Commercial |
$50.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$36.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$36.55
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$15.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$15.50
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.21
|
| Rate for Payer: United Healthcare Commercial |
$21.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.21
|
| Rate for Payer: United Healthcare VA CCN |
$14.21
|
|
|
BRIEF COMUNICAJ TECH-BSD SVC
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 98000
|
| Hospital Charge Code |
9609801601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of VT Commercial |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$43.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.93
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$24.30
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$24.30
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.30
|
| Rate for Payer: United Healthcare VA CCN |
$24.30
|
|
|
BRIEF EMOTIONAL/BEHAV ASSMT
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT 96127
|
| Hospital Charge Code |
9189612701
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Aetna of VT Commercial |
$10.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.80
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna Commercial |
$8.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$10.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.35
|
| Rate for Payer: United Healthcare Commercial |
$10.45
|
|
|
BRIEF EMOTIONAL/BEHAV ASSMT
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
CPT 96127
|
| Hospital Charge Code |
9189612701
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$10.34 |
| Rate for Payer: Aetna of VT Commercial |
$10.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$6.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7.21
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna Commercial |
$5.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.34
|
| Rate for Payer: Multiplan Commercial |
$10.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.34
|
| Rate for Payer: United Healthcare Commercial |
$6.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.34
|
| Rate for Payer: United Healthcare VA CCN |
$4.34
|
|
|
BRIEF EMOTIONAL/BEHAV ASSMT
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT 96127
|
| Hospital Charge Code |
9189612701
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Aetna of VT Commercial |
$10.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$9.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$9.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$6.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.74
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna Commercial |
$8.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$10.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.95
|
| Rate for Payer: United Healthcare Commercial |
$10.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.95
|
| Rate for Payer: United Healthcare VA CCN |
$4.95
|
|
|
BRUCELLA ANTIBODY
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
3008662201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
|
|
BRUCELLA ANTIBODY
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
3008662201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$44.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$44.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.93
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
BRUCELLA ANTIBODY
|
Professional
|
Both
|
$108.49
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
3008662201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$101.98 |
| Rate for Payer: Aetna of VT Commercial |
$101.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$44.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$44.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$12.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$15.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$15.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$10.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$15.27
|
| Rate for Payer: Cash Price |
$54.24
|
| Rate for Payer: Cash Price |
$54.24
|
| Rate for Payer: Cigna Commercial |
$10.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$100.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.93
|
| Rate for Payer: United Healthcare Commercial |
$13.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.93
|
| Rate for Payer: United Healthcare VA CCN |
$8.93
|
|
|
BUMETANIDE 1 MG/4 ML VIAL
|
Facility
|
OP
|
$6.08
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
636J193901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$5.78 |
| Rate for Payer: Aetna of VT Commercial |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.83
|
| Rate for Payer: Cash Price |
$3.04
|
| Rate for Payer: Cash Price |
$3.04
|
| Rate for Payer: Cigna Commercial |
$4.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.74
|
| Rate for Payer: Multiplan Commercial |
$5.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.74
|
| Rate for Payer: United Healthcare Commercial |
$5.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.74
|
| Rate for Payer: United Healthcare VA CCN |
$2.74
|
|
|
BUMETANIDE 1 MG/4 ML VIAL
|
Facility
|
IP
|
$6.08
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
636J193901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$5.78 |
| Rate for Payer: Aetna of VT Commercial |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.86
|
| Rate for Payer: Cash Price |
$3.04
|
| Rate for Payer: Cigna Commercial |
$4.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.86
|
| Rate for Payer: Multiplan Commercial |
$5.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.17
|
| Rate for Payer: United Healthcare Commercial |
$5.78
|
|
|
BUMETANIDE 2.5 MG/10 ML VIAL
|
Facility
|
IP
|
$6.60
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
636J193902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: Aetna of VT Commercial |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5.28
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$5.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$6.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.61
|
| Rate for Payer: United Healthcare Commercial |
$6.27
|
|
|
BUMETANIDE 2.5 MG/10 ML VIAL
|
Facility
|
OP
|
$6.60
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
636J193902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: Aetna of VT Commercial |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5.25
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$5.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.97
|
| Rate for Payer: Multiplan Commercial |
$6.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.97
|
| Rate for Payer: United Healthcare Commercial |
$6.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.97
|
| Rate for Payer: United Healthcare VA CCN |
$2.97
|
|
|
BUPIVACAINE 0.5% 50ML MDV
|
Facility
|
OP
|
$4.93
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
636J066507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna of VT Commercial |
$4.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3.92
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cigna Commercial |
$3.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.22
|
| Rate for Payer: Multiplan Commercial |
$4.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.22
|
| Rate for Payer: United Healthcare Commercial |
$4.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.22
|
| Rate for Payer: United Healthcare VA CCN |
$2.22
|
|
|
BUPIVACAINE 0.5% 50ML MDV
|
Professional
|
Both
|
$4.93
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
636J066507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Aetna of VT Commercial |
$4.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$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 New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.01
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cash Price |
$2.46
|
| 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 |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$4.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
BUPIVACAINE 0.5% 50ML MDV
|
Facility
|
IP
|
$4.93
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
636J066507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna of VT Commercial |
$4.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3.94
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cigna Commercial |
$3.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3.94
|
| Rate for Payer: Multiplan Commercial |
$4.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.19
|
| Rate for Payer: United Healthcare Commercial |
$4.68
|
|
|
BUPIVACAINE-MPF 0.25% 10 ML VI
|
Professional
|
Both
|
$14.80
|
|
| Hospital Charge Code |
2500000043
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$13.91 |
| Rate for Payer: Aetna of VT Commercial |
$13.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$13.26
|
| Rate for Payer: Cash Price |
$7.40
|
| Rate for Payer: Multiplan Commercial |
$13.76
|
| Rate for Payer: United Healthcare Commercial |
$12.58
|
| Rate for Payer: United Healthcare VA CCN |
$5.92
|
|
|
BUPIVACAINE-MPF 0.25%10ML VIAL
|
Facility
|
IP
|
$11.01
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
636J066502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of VT Commercial |
$10.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.81
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna Commercial |
$8.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.81
|
| Rate for Payer: Multiplan Commercial |
$10.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.36
|
| Rate for Payer: United Healthcare Commercial |
$10.46
|
|
