|
CHLAMYDIA IGM ANTIBODY
|
Facility
|
IP
|
$134.10
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
3008663201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.25 |
| Max. Negotiated Rate |
$127.39 |
| Rate for Payer: Aetna of VT Commercial |
$127.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$112.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$107.28
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cigna Commercial |
$107.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$107.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$107.28
|
| Rate for Payer: Multiplan Commercial |
$124.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$113.98
|
| Rate for Payer: United Healthcare Commercial |
$127.39
|
|
|
CHLMYD TRACH DNA AMP PROBE
|
Professional
|
Both
|
$161.78
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
3008749101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$152.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.98
|
| Rate for Payer: Cash Price |
$80.89
|
| Rate for Payer: Cash Price |
$80.89
|
| Rate for Payer: Cigna Commercial |
$42.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$35.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$35.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.60
|
| Rate for Payer: Multiplan Commercial |
$150.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$53.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$35.09
|
|
|
CHLMYD TRACH DNA AMP PROBE
|
Facility
|
OP
|
$161.78
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
3008749101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$153.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$71.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$97.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$137.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$131.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$72.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$128.62
|
| Rate for Payer: Cash Price |
$80.89
|
| Rate for Payer: Cash Price |
$80.89
|
| Rate for Payer: Cigna Commercial |
$129.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$129.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$129.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$72.80
|
| Rate for Payer: Multiplan Commercial |
$150.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$137.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$72.80
|
| Rate for Payer: United Healthcare Commercial |
$153.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$72.80
|
|
|
CHLMYD TRACH DNA AMP PROBE
|
Facility
|
IP
|
$161.78
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
3008749101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.73 |
| Max. Negotiated Rate |
$153.69 |
| Rate for Payer: Aetna of VT Commercial |
$153.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$119.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$119.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$137.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$135.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.42
|
| Rate for Payer: Cash Price |
$80.89
|
| Rate for Payer: Cigna Commercial |
$129.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$129.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$129.42
|
| Rate for Payer: Multiplan Commercial |
$150.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$137.51
|
| Rate for Payer: United Healthcare Commercial |
$153.69
|
|
|
CHLORIDE BLD
|
Facility
|
OP
|
$47.20
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
3008243501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$44.84 |
| Rate for Payer: Aetna of VT Commercial |
$44.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$22.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$22.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$28.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$40.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$38.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$37.52
|
| Rate for Payer: Cash Price |
$23.60
|
| Rate for Payer: Cash Price |
$23.60
|
| Rate for Payer: Cigna Commercial |
$37.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$37.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$37.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$21.24
|
| Rate for Payer: Multiplan Commercial |
$43.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.24
|
| Rate for Payer: United Healthcare Commercial |
$44.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.60
|
| Rate for Payer: United Healthcare VA CCN |
$21.24
|
|
|
CHLORIDE BLD
|
Facility
|
IP
|
$47.20
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
3008243501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.93 |
| Max. Negotiated Rate |
$44.84 |
| Rate for Payer: Aetna of VT Commercial |
$44.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$34.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$34.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$40.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$39.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$37.76
|
| Rate for Payer: Cash Price |
$23.60
|
| Rate for Payer: Cigna Commercial |
$37.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$37.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$37.76
|
| Rate for Payer: Multiplan Commercial |
$43.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.12
|
| Rate for Payer: United Healthcare Commercial |
$44.84
|
|
|
CHLORIDE URINE
|
Facility
|
IP
|
$41.36
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
3008243601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.61 |
| Max. Negotiated Rate |
$39.29 |
| Rate for Payer: Aetna of VT Commercial |
$39.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$30.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$30.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.09
|
| Rate for Payer: Cash Price |
$20.68
|
| Rate for Payer: Cigna Commercial |
$33.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.09
|
| Rate for Payer: Multiplan Commercial |
$38.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.16
|
| Rate for Payer: United Healthcare Commercial |
$39.29
|
|
|
CHLORIDE URINE
|
Facility
|
OP
|
$41.36
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
3008243601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$39.29 |
| Rate for Payer: Aetna of VT Commercial |
$39.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$28.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$28.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$24.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$33.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$32.88
|
| Rate for Payer: Cash Price |
$20.68
|
| Rate for Payer: Cash Price |
$20.68
|
| Rate for Payer: Cigna Commercial |
$33.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.61
|
| Rate for Payer: Multiplan Commercial |
$38.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.61
|
| Rate for Payer: United Healthcare Commercial |
$39.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.75
|
| Rate for Payer: United Healthcare VA CCN |
$18.61
|
|
|
CHLORPROMAZINE HCL 100 MG TAB
|
Facility
|
IP
|
$2.54
|
|
|
Service Code
|
NDC 6233273831
|
| Hospital Charge Code |
2500000594
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna of VT Commercial |
$2.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.03
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna Commercial |
$2.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$2.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.16
|
| Rate for Payer: United Healthcare Commercial |
$2.41
|
|
|
CHLORPROMAZINE HCL 100 MG TAB
|
Facility
|
OP
|
$2.54
|
|
|
Service Code
|
NDC 6233273831
|
| Hospital Charge Code |
2500000594
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna of VT Commercial |
$2.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.02
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna Commercial |
$2.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$2.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.14
|
| Rate for Payer: United Healthcare Commercial |
$2.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.14
|
| Rate for Payer: United Healthcare VA CCN |
$1.14
|
|
|
CHOLECYSTECTOM W/CHOLANGIOGRAP
|
Facility
|
OP
|
$3,026.00
|
|
|
Service Code
|
CPT 47605
|
| Hospital Charge Code |
9824760501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,340.22 |
| Max. Negotiated Rate |
$2,874.70 |
| Rate for Payer: Aetna of VT Commercial |
$2,874.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,710.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,340.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,710.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,821.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,572.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,451.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,361.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,405.67
|
| Rate for Payer: Cash Price |
$1,513.00
|
| Rate for Payer: Cigna Commercial |
$2,420.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,420.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,420.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,361.70
|
| Rate for Payer: Multiplan Commercial |
$2,814.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,572.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,361.70
|
| Rate for Payer: United Healthcare Commercial |
$2,874.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,361.70
|
| Rate for Payer: United Healthcare VA CCN |
$1,361.70
|
|
|
CHOLECYSTECTOM W/CHOLANGIOGRAP
|
Facility
|
IP
|
$3,026.00
|
|
|
Service Code
|
CPT 47605
|
| Hospital Charge Code |
9824760501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,239.54 |
| Max. Negotiated Rate |
$2,874.70 |
| Rate for Payer: Aetna of VT Commercial |
$2,874.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,239.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,239.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,572.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,541.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,420.80
|
| Rate for Payer: Cash Price |
$1,513.00
|
| Rate for Payer: Cigna Commercial |
$2,420.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,420.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,420.80
|
| Rate for Payer: Multiplan Commercial |
$2,814.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,572.10
|
| Rate for Payer: United Healthcare Commercial |
$2,874.70
|
|
|
CHOLECYSTECTOM W/CHOLANGIOGRAP
|
Professional
|
Both
|
$3,026.00
|
|
|
Service Code
|
CPT 47605
|
| Hospital Charge Code |
9824760501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,027.84 |
| Max. Negotiated Rate |
$2,844.44 |
| Rate for Payer: Aetna of VT Commercial |
$2,844.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,710.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,058.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,710.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,438.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,508.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,508.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,182.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,508.01
|
| Rate for Payer: Cash Price |
$1,513.00
|
| Rate for Payer: Cash Price |
$1,513.00
|
| Rate for Payer: Cigna Commercial |
$1,879.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,752.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,752.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,027.84
|
| Rate for Payer: Multiplan Commercial |
$2,814.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,459.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,027.84
|
| Rate for Payer: United Healthcare Commercial |
$1,581.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,027.84
|
| Rate for Payer: United Healthcare VA CCN |
$1,027.84
|
|
|
CHOLECYSTECTOMY
|
Facility
|
OP
|
$2,754.00
|
|
|
Service Code
|
CPT 47600
|
| Hospital Charge Code |
9824760001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,219.75 |
| Max. Negotiated Rate |
$2,616.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,616.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,467.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,219.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,467.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,657.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,340.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,230.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,239.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,189.43
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Cigna Commercial |
$2,203.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,203.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,203.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,239.30
|
| Rate for Payer: Multiplan Commercial |
$2,561.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,340.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,239.30
|
| Rate for Payer: United Healthcare Commercial |
$2,616.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,239.30
|
| Rate for Payer: United Healthcare VA CCN |
$1,239.30
|
|
|
CHOLECYSTECTOMY
|
Professional
|
Both
|
$2,754.00
|
|
|
Service Code
|
CPT 47600
|
| Hospital Charge Code |
9824760001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$978.43 |
| Max. Negotiated Rate |
$2,588.76 |
| Rate for Payer: Aetna of VT Commercial |
$2,588.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,467.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,007.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,467.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,369.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,401.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,401.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,125.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,401.88
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Cigna Commercial |
$1,786.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,666.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,666.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$978.43
|
| Rate for Payer: Multiplan Commercial |
$2,561.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,389.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$978.43
|
| Rate for Payer: United Healthcare Commercial |
$1,505.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$978.43
|
| Rate for Payer: United Healthcare VA CCN |
$978.43
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$2,754.00
|
|
|
Service Code
|
CPT 47600
|
| Hospital Charge Code |
9824760001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,038.24 |
| Max. Negotiated Rate |
$2,616.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,616.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,038.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,038.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,340.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,313.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,203.20
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Cigna Commercial |
$2,203.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,203.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,203.20
|
| Rate for Payer: Multiplan Commercial |
$2,561.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,340.90
|
| Rate for Payer: United Healthcare Commercial |
$2,616.30
|
|
|
CHORIONIC GONADOTROPIN TEST
|
Facility
|
OP
|
$224.80
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
3008470201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$213.56 |
| Rate for Payer: Aetna of VT Commercial |
$213.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$99.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$135.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$191.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$182.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$101.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$178.72
|
| Rate for Payer: Cash Price |
$112.40
|
| Rate for Payer: Cash Price |
$112.40
|
| Rate for Payer: Cigna Commercial |
$179.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$179.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$179.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$101.16
|
| Rate for Payer: Multiplan Commercial |
$209.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$191.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$101.16
|
| Rate for Payer: United Healthcare Commercial |
$213.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.05
|
| Rate for Payer: United Healthcare VA CCN |
$101.16
|
|
|
CHORIONIC GONADOTROPIN TEST
|
Facility
|
IP
|
$224.80
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
3008470201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.37 |
| Max. Negotiated Rate |
$213.56 |
| Rate for Payer: Aetna of VT Commercial |
$213.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$166.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$166.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$191.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$188.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$179.84
|
| Rate for Payer: Cash Price |
$112.40
|
| Rate for Payer: Cigna Commercial |
$179.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$179.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$179.84
|
| Rate for Payer: Multiplan Commercial |
$209.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$191.08
|
| Rate for Payer: United Healthcare Commercial |
$213.56
|
|
|
CHRNC CARE MGMT PHYS 1ST 30
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
CPT 99491
|
| Hospital Charge Code |
5109949101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.75 |
| Max. Negotiated Rate |
$221.84 |
| Rate for Payer: Aetna of VT Commercial |
$221.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$99.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$121.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$121.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$121.05
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cigna Commercial |
$77.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$130.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$130.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.39
|
| Rate for Payer: Multiplan Commercial |
$219.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.75
|
| Rate for Payer: United Healthcare Commercial |
$108.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.75
|
| Rate for Payer: United Healthcare VA CCN |
$70.75
|
|
|
CHRNC CARE MGMT PHYS 1ST 30
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT 99491
|
| Hospital Charge Code |
5109949101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$104.52 |
| Max. Negotiated Rate |
$224.20 |
| Rate for Payer: Aetna of VT Commercial |
$224.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$211.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$104.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$211.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$142.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$200.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$191.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$106.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$187.62
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cigna Commercial |
$188.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$188.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$188.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$219.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$200.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$106.20
|
| Rate for Payer: United Healthcare Commercial |
$224.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$106.20
|
| Rate for Payer: United Healthcare VA CCN |
$106.20
|
|
|
CHRNC CARE MGMT PHYS 1ST 30
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT 99491
|
| Hospital Charge Code |
9609949102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$104.52 |
| Max. Negotiated Rate |
$224.20 |
| Rate for Payer: Aetna of VT Commercial |
$224.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$211.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$104.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$211.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$142.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$200.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$191.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$106.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$187.62
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cigna Commercial |
$188.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$188.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$188.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$219.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$200.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$106.20
|
| Rate for Payer: United Healthcare Commercial |
$224.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$106.20
|
| Rate for Payer: United Healthcare VA CCN |
$106.20
|
|
|
CHRNC CARE MGMT PHYS 1ST 30
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 99491
|
| Hospital Charge Code |
5109949101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$174.66 |
| Max. Negotiated Rate |
$224.20 |
| Rate for Payer: Aetna of VT Commercial |
$224.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$174.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$174.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$200.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$198.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$188.80
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cigna Commercial |
$188.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$188.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$188.80
|
| Rate for Payer: Multiplan Commercial |
$219.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$200.60
|
| Rate for Payer: United Healthcare Commercial |
$224.20
|
|
|
CHRNC CARE MGMT PHYS 1ST 30
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 99491
|
| Hospital Charge Code |
9609949102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$174.66 |
| Max. Negotiated Rate |
$224.20 |
| Rate for Payer: Aetna of VT Commercial |
$224.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$174.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$174.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$200.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$198.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$188.80
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cigna Commercial |
$188.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$188.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$188.80
|
| Rate for Payer: Multiplan Commercial |
$219.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$200.60
|
| Rate for Payer: United Healthcare Commercial |
$224.20
|
|
|
CHRNC CARE MGMT PHYS 1ST 30
|
Professional
|
Both
|
$472.00
|
|
|
Service Code
|
CPT 99491
|
| Hospital Charge Code |
9609949101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$70.75 |
| Max. Negotiated Rate |
$443.68 |
| Rate for Payer: Aetna of VT Commercial |
$443.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$99.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$121.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$121.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$121.05
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cigna Commercial |
$77.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$130.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$130.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.39
|
| Rate for Payer: Multiplan Commercial |
$438.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.75
|
| Rate for Payer: United Healthcare Commercial |
$108.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.75
|
| Rate for Payer: United Healthcare VA CCN |
$70.75
|
|
|
CHRNC CARE MGMT PHYS 1ST 30
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT 99491
|
| Hospital Charge Code |
9609949101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$349.33 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Aetna of VT Commercial |
$448.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$349.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$349.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$401.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$396.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$377.60
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cigna Commercial |
$377.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$377.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$377.60
|
| Rate for Payer: Multiplan Commercial |
$438.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$401.20
|
| Rate for Payer: United Healthcare Commercial |
$448.40
|
|
