|
CATH VESSEL UMBIL 3.5FR
|
Facility
|
OP
|
$14.01
|
|
| Hospital Charge Code |
2720019771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.21 |
| Max. Negotiated Rate |
$13.31 |
| Rate for Payer: Aetna of VT Commercial |
$13.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$12.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$6.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$12.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$8.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.14
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$13.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.30
|
| Rate for Payer: United Healthcare Commercial |
$13.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.30
|
| Rate for Payer: United Healthcare VA CCN |
$6.30
|
|
|
CAT SCAN FOLLOW-UP STUDY
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
9727638001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$61.56 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Aetna of VT Commercial |
$132.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$61.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$83.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$112.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.50
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$111.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$111.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$111.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$62.55
|
| Rate for Payer: Multiplan Commercial |
$129.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$62.55
|
| Rate for Payer: United Healthcare Commercial |
$132.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.55
|
| Rate for Payer: United Healthcare VA CCN |
$62.55
|
|
|
CAT SCAN FOLLOW-UP STUDY
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
9727638001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$129.27 |
| Max. Negotiated Rate |
$677.47 |
| Rate for Payer: Aetna of VT Commercial |
$130.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$677.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$256.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$677.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$348.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$339.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$339.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$286.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$339.13
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$370.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$400.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$400.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$248.98
|
| Rate for Payer: Multiplan Commercial |
$129.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$248.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$248.98
|
| Rate for Payer: United Healthcare Commercial |
$383.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$248.98
|
| Rate for Payer: United Healthcare VA CCN |
$248.98
|
|
|
CAT SCAN FOLLOW-UP STUDY
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
9727638001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$102.87 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Aetna of VT Commercial |
$132.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$116.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$111.20
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$111.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$111.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$111.20
|
| Rate for Payer: Multiplan Commercial |
$129.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.15
|
| Rate for Payer: United Healthcare Commercial |
$132.05
|
|
|
CAUTERIZATION OF CERVIX
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 57510
|
| Hospital Charge Code |
9825751001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$339.15 |
| Rate for Payer: Aetna of VT Commercial |
$339.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$264.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$264.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$303.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$299.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$285.60
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$285.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$285.60
|
| Rate for Payer: Multiplan Commercial |
$332.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$303.45
|
| Rate for Payer: United Healthcare Commercial |
$339.15
|
|
|
CAUTERIZATION OF CERVIX
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 57510
|
| Hospital Charge Code |
9825751001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$158.12 |
| Max. Negotiated Rate |
$339.15 |
| Rate for Payer: Aetna of VT Commercial |
$339.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$319.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$158.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$319.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$214.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$303.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$289.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$283.81
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$285.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$285.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$160.65
|
| Rate for Payer: Multiplan Commercial |
$332.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$303.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$160.65
|
| Rate for Payer: United Healthcare Commercial |
$339.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$160.65
|
| Rate for Payer: United Healthcare VA CCN |
$160.65
|
|
|
CAUTERIZATION OF CERVIX
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
CPT 57510
|
| Hospital Charge Code |
9825751001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$105.03 |
| Max. Negotiated Rate |
$335.58 |
| Rate for Payer: Aetna of VT Commercial |
$335.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$319.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$108.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$319.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$147.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$287.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$287.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$120.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$287.71
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cigna Commercial |
$185.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$255.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$255.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$155.14
|
| Rate for Payer: Multiplan Commercial |
$332.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.03
|
| Rate for Payer: United Healthcare Commercial |
$161.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.03
|
| Rate for Payer: United Healthcare VA CCN |
$105.03
|
|
|
CBT 1ST HOUR
|
Facility
|
IP
|
$279.18
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
4109464401
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$206.62 |
| Max. Negotiated Rate |
$265.22 |
| Rate for Payer: Aetna of VT Commercial |
$265.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$206.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$206.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$237.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$234.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$223.34
|
| Rate for Payer: Cash Price |
$139.59
|
| Rate for Payer: Cigna Commercial |
$223.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$223.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$223.34
|
| Rate for Payer: Multiplan Commercial |
$259.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$237.30
|
| Rate for Payer: United Healthcare Commercial |
$265.22
|
|
|
CBT 1ST HOUR
|
Facility
|
OP
|
$279.18
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
4109464401
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$123.65 |
| Max. Negotiated Rate |
$265.22 |
| Rate for Payer: Aetna of VT Commercial |
$265.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$250.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$123.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$250.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$168.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$237.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$226.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$125.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$221.95
|
| Rate for Payer: Cash Price |
$139.59
|
| Rate for Payer: Cigna Commercial |
$223.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$223.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$223.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$125.63
|
| Rate for Payer: Multiplan Commercial |
$259.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$237.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$125.63
|
| Rate for Payer: United Healthcare Commercial |
$265.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.63
|
| Rate for Payer: United Healthcare VA CCN |
$125.63
|
|
|
CBT EACH ADDL HOUR
|
Facility
|
OP
|
$194.91
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
4109464501
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$86.33 |
| Max. Negotiated Rate |
$185.16 |
| Rate for Payer: Aetna of VT Commercial |
$185.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$174.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$86.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$174.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$117.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$165.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$157.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$87.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$154.95
|
| Rate for Payer: Cash Price |
$97.46
|
| Rate for Payer: Cigna Commercial |
$155.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$87.71
|
| Rate for Payer: Multiplan Commercial |
$181.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$87.71
|
| Rate for Payer: United Healthcare Commercial |
$185.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.71
|
| Rate for Payer: United Healthcare VA CCN |
$87.71
|
|
|
CBT EACH ADDL HOUR
|
Facility
|
IP
|
$194.91
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
4109464501
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$144.25 |
| Max. Negotiated Rate |
$185.16 |
| Rate for Payer: Aetna of VT Commercial |
$185.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$144.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$144.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$165.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$163.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.93
|
| Rate for Payer: Cash Price |
$97.46
|
| Rate for Payer: Cigna Commercial |
$155.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.93
|
| Rate for Payer: Multiplan Commercial |
$181.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.67
|
| Rate for Payer: United Healthcare Commercial |
$185.16
|
|
|
CCP ANTIBODY
|
Professional
|
Both
|
$230.58
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
3008620001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Aetna of VT Commercial |
$216.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.13
|
| Rate for Payer: Cash Price |
$115.29
|
| Rate for Payer: Cash Price |
$115.29
|
| Rate for Payer: Cigna Commercial |
$15.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.95
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.95
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.77
|
| Rate for Payer: Multiplan Commercial |
$214.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.95
|
| Rate for Payer: United Healthcare Commercial |
$19.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.95
|
| Rate for Payer: United Healthcare VA CCN |
$12.95
|
|
|
CCP ANTIBODY
|
Facility
|
OP
|
$230.58
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
3008620001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$219.05 |
| Rate for Payer: Aetna of VT Commercial |
$219.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$102.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$138.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$186.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$183.31
|
| Rate for Payer: Cash Price |
$115.29
|
| Rate for Payer: Cash Price |
$115.29
|
| Rate for Payer: Cigna Commercial |
$184.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$184.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$184.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$103.76
|
| Rate for Payer: Multiplan Commercial |
$214.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.76
|
| Rate for Payer: United Healthcare Commercial |
$219.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.95
|
| Rate for Payer: United Healthcare VA CCN |
$103.76
|
|
|
CCP ANTIBODY
|
Facility
|
IP
|
$230.58
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
3008620001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$170.65 |
| Max. Negotiated Rate |
$219.05 |
| Rate for Payer: Aetna of VT Commercial |
$219.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$170.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$170.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$193.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$184.46
|
| Rate for Payer: Cash Price |
$115.29
|
| Rate for Payer: Cigna Commercial |
$184.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$184.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$184.46
|
| Rate for Payer: Multiplan Commercial |
$214.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.99
|
| Rate for Payer: United Healthcare Commercial |
$219.05
|
|
|
C DIFF AMPLIFIED PROBE
|
Professional
|
Both
|
$221.02
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
3008749301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna of VT Commercial |
$207.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$183.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$183.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$54.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$54.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$54.83
|
| Rate for Payer: Cash Price |
$110.51
|
| Rate for Payer: Cash Price |
$110.51
|
| Rate for Payer: Cigna Commercial |
$45.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$37.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$37.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.75
|
| Rate for Payer: Multiplan Commercial |
$205.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.27
|
| Rate for Payer: United Healthcare Commercial |
$57.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Healthcare VA CCN |
$37.27
|
|
|
C DIFF AMPLIFIED PROBE
|
Facility
|
OP
|
$221.02
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
3008749301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$209.97 |
| Rate for Payer: Aetna of VT Commercial |
$209.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$183.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$97.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$183.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$133.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$179.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$175.71
|
| Rate for Payer: Cash Price |
$110.51
|
| Rate for Payer: Cash Price |
$110.51
|
| Rate for Payer: Cigna Commercial |
$176.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$99.46
|
| Rate for Payer: Multiplan Commercial |
$205.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.46
|
| Rate for Payer: United Healthcare Commercial |
$209.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Healthcare VA CCN |
$99.46
|
|
|
C DIFF AMPLIFIED PROBE
|
Facility
|
IP
|
$221.02
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
3008749301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.58 |
| Max. Negotiated Rate |
$209.97 |
| Rate for Payer: Aetna of VT Commercial |
$209.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$185.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.82
|
| Rate for Payer: Cash Price |
$110.51
|
| Rate for Payer: Cigna Commercial |
$176.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.82
|
| Rate for Payer: Multiplan Commercial |
$205.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.87
|
| Rate for Payer: United Healthcare Commercial |
$209.97
|
|
|
CEFTRIAXONE 1 GRAM VIAL
|
Professional
|
Both
|
$1.87
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
636J069601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna of VT Commercial |
$1.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.49
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.45
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.45
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.43
|
| Rate for Payer: United Healthcare Commercial |
$0.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.43
|
| Rate for Payer: United Healthcare VA CCN |
$0.43
|
|
|
CEFTRIAXONE 1 GRAM VIAL
|
Facility
|
IP
|
$1.87
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
636J069601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna of VT Commercial |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.50
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Cigna Commercial |
$1.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$1.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.59
|
| Rate for Payer: United Healthcare Commercial |
$1.78
|
|
|
CEFTRIAXONE 1 GRAM VIAL
|
Facility
|
OP
|
$1.87
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
636J069601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna of VT Commercial |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.49
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Cigna Commercial |
$1.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$1.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.84
|
| Rate for Payer: United Healthcare Commercial |
$1.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.84
|
| Rate for Payer: United Healthcare VA CCN |
$0.84
|
|
|
CEFTRIAXONE 250 MG VIAL
|
Facility
|
OP
|
$1.35
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
636J069603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.35
|
|
|
CEFTRIAXONE 250 MG VIAL
|
Professional
|
Both
|
$7.37
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
636J069603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$6.93 |
| Rate for Payer: Aetna of VT Commercial |
$6.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.49
|
| Rate for Payer: Cash Price |
$3.68
|
| Rate for Payer: Cash Price |
$3.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.45
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.45
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$6.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.43
|
| Rate for Payer: United Healthcare Commercial |
$0.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.43
|
| Rate for Payer: United Healthcare VA CCN |
$0.43
|
|
|
CEFTRIAXONE 500 MG VIAL
|
Facility
|
OP
|
$4.25
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
636J069604
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna of VT Commercial |
$4.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3.38
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$3.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.91
|
| Rate for Payer: United Healthcare Commercial |
$4.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.91
|
| Rate for Payer: United Healthcare VA CCN |
$1.91
|
|
|
CEFTRIAXONE 500 MG VIAL
|
Professional
|
Both
|
$4.25
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
636J069604
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna of VT Commercial |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.49
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.45
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.45
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$3.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.43
|
| Rate for Payer: United Healthcare Commercial |
$0.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.43
|
| Rate for Payer: United Healthcare VA CCN |
$0.43
|
|
|
CEFTRIAXONE 500 MG VIAL
|
Facility
|
IP
|
$4.25
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
636J069604
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna of VT Commercial |
$4.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3.40
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$3.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.61
|
| Rate for Payer: United Healthcare Commercial |
$4.04
|
|
