|
CLOSURE OF SPLIT WOUND
|
Facility
|
OP
|
$382.58
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
4501202101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.44 |
| Max. Negotiated Rate |
$363.45 |
| Rate for Payer: Aetna of VT Commercial |
$363.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$342.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$169.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$342.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$230.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$325.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$309.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$172.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$304.15
|
| Rate for Payer: Cash Price |
$191.29
|
| Rate for Payer: Cigna Commercial |
$306.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$306.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$306.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$172.16
|
| Rate for Payer: Multiplan Commercial |
$355.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$325.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$172.16
|
| Rate for Payer: United Healthcare Commercial |
$363.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.16
|
| Rate for Payer: United Healthcare VA CCN |
$172.16
|
|
|
CLOSURE OF SPLIT WOUND
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
9811202001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$177.72 |
| Max. Negotiated Rate |
$654.24 |
| Rate for Payer: Aetna of VT Commercial |
$654.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$183.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$248.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$398.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$398.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$204.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$398.75
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$323.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$461.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$461.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$282.43
|
| Rate for Payer: Multiplan Commercial |
$647.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$252.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$177.72
|
| Rate for Payer: United Healthcare Commercial |
$273.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.72
|
| Rate for Payer: United Healthcare VA CCN |
$177.72
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
9821202101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$308.26 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Aetna of VT Commercial |
$661.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$308.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$591.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$563.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$313.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$553.32
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$313.20
|
| Rate for Payer: Multiplan Commercial |
$647.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$591.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$313.20
|
| Rate for Payer: United Healthcare Commercial |
$661.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.20
|
| Rate for Payer: United Healthcare VA CCN |
$313.20
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
9601202002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$308.26 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Aetna of VT Commercial |
$661.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$308.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$591.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$563.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$313.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$553.32
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$313.20
|
| Rate for Payer: Multiplan Commercial |
$647.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$591.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$313.20
|
| Rate for Payer: United Healthcare Commercial |
$661.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.20
|
| Rate for Payer: United Healthcare VA CCN |
$313.20
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
5101202001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$202.05 |
| Max. Negotiated Rate |
$259.35 |
| Rate for Payer: Aetna of VT Commercial |
$259.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$202.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$202.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$232.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$229.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$218.40
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cigna Commercial |
$218.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$218.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$253.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$232.05
|
| Rate for Payer: United Healthcare Commercial |
$259.35
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
9601202002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$515.11 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Aetna of VT Commercial |
$661.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$515.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$515.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$591.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$584.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$556.80
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.80
|
| Rate for Payer: Multiplan Commercial |
$647.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$591.60
|
| Rate for Payer: United Healthcare Commercial |
$661.20
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
9811202101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$308.26 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Aetna of VT Commercial |
$661.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$308.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$591.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$563.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$313.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$553.32
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$313.20
|
| Rate for Payer: Multiplan Commercial |
$647.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$591.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$313.20
|
| Rate for Payer: United Healthcare Commercial |
$661.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.20
|
| Rate for Payer: United Healthcare VA CCN |
$313.20
|
|
|
CLOSURE OF SPLIT WOUND
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
9811202101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$132.33 |
| Max. Negotiated Rate |
$654.24 |
| Rate for Payer: Aetna of VT Commercial |
$654.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$136.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$185.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$235.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$235.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$152.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$235.86
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$243.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$272.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$272.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$166.06
|
| Rate for Payer: Multiplan Commercial |
$647.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$132.33
|
| Rate for Payer: United Healthcare Commercial |
$203.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.33
|
| Rate for Payer: United Healthcare VA CCN |
$132.33
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
9821202001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$308.26 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Aetna of VT Commercial |
$661.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$308.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$591.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$563.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$313.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$553.32
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$313.20
|
| Rate for Payer: Multiplan Commercial |
$647.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$591.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$313.20
|
| Rate for Payer: United Healthcare Commercial |
$661.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.20
|
| Rate for Payer: United Healthcare VA CCN |
$313.20
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
OP
|
$272.20
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
4501202001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.56 |
| Max. Negotiated Rate |
$258.59 |
| Rate for Payer: Aetna of VT Commercial |
$258.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$243.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$120.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$243.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$163.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$122.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.40
|
| Rate for Payer: Cash Price |
$136.10
|
| Rate for Payer: Cigna Commercial |
$217.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$122.49
|
| Rate for Payer: Multiplan Commercial |
$253.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$231.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$122.49
|
| Rate for Payer: United Healthcare Commercial |
$258.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.49
|
| Rate for Payer: United Healthcare VA CCN |
$122.49
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
9821202101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$515.11 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Aetna of VT Commercial |
$661.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$515.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$515.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$591.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$584.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$556.80
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.80
|
| Rate for Payer: Multiplan Commercial |
$647.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$591.60
|
| Rate for Payer: United Healthcare Commercial |
$661.20
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
9601202001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$429.17 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Aetna of VT Commercial |
$920.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$868.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$429.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$868.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$583.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$823.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$784.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$770.36
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$775.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$775.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$775.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$436.05
|
| Rate for Payer: Multiplan Commercial |
$901.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$823.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$436.05
|
| Rate for Payer: United Healthcare Commercial |
$920.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$436.05
|
| Rate for Payer: United Healthcare VA CCN |
$436.05
|
|
|
CLOT FACTOR IX PTC/CHRSTMAS
|
Facility
|
IP
|
$327.14
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
3008525001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$242.12 |
| Max. Negotiated Rate |
$310.78 |
| Rate for Payer: Aetna of VT Commercial |
$310.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$242.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$242.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$278.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$274.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$261.71
|
| Rate for Payer: Cash Price |
$163.57
|
| Rate for Payer: Cigna Commercial |
$261.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$261.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$261.71
|
| Rate for Payer: Multiplan Commercial |
$304.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$278.07
|
| Rate for Payer: United Healthcare Commercial |
$310.78
|
|
|
CLOT FACTOR IX PTC/CHRSTMAS
|
Facility
|
OP
|
$327.14
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
3008525001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$310.78 |
| Rate for Payer: Aetna of VT Commercial |
$310.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$144.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$196.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$278.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$264.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$147.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$260.08
|
| Rate for Payer: Cash Price |
$163.57
|
| Rate for Payer: Cash Price |
$163.57
|
| Rate for Payer: Cigna Commercial |
$261.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$261.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$261.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$147.21
|
| Rate for Payer: Multiplan Commercial |
$304.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$278.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$147.21
|
| Rate for Payer: United Healthcare Commercial |
$310.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.04
|
| Rate for Payer: United Healthcare VA CCN |
$147.21
|
|
|
CLOT FACTOR IX PTC/CHRSTMAS
|
Professional
|
Both
|
$327.14
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
3008525001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$307.51 |
| Rate for Payer: Aetna of VT Commercial |
$307.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$19.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$26.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$32.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$32.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$21.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$32.55
|
| Rate for Payer: Cash Price |
$163.57
|
| Rate for Payer: Cash Price |
$163.57
|
| Rate for Payer: Cigna Commercial |
$23.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.77
|
| Rate for Payer: Multiplan Commercial |
$304.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.04
|
| Rate for Payer: United Healthcare Commercial |
$29.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.04
|
| Rate for Payer: United Healthcare VA CCN |
$19.04
|
|
|
CLOT FACTOR VIII MULTIMETRIC
|
Facility
|
IP
|
$136.71
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
3008524701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.18 |
| Max. Negotiated Rate |
$129.87 |
| Rate for Payer: Aetna of VT Commercial |
$129.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$101.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$101.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$116.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$109.37
|
| Rate for Payer: Cash Price |
$68.36
|
| Rate for Payer: Cigna Commercial |
$109.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$109.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$109.37
|
| Rate for Payer: Multiplan Commercial |
$127.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$116.20
|
| Rate for Payer: United Healthcare Commercial |
$129.87
|
|
|
CLOT FACTOR VIII MULTIMETRIC
|
Facility
|
OP
|
$136.71
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
3008524701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$129.87 |
| Rate for Payer: Aetna of VT Commercial |
$129.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$60.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$82.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$116.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.68
|
| Rate for Payer: Cash Price |
$68.36
|
| Rate for Payer: Cash Price |
$68.36
|
| Rate for Payer: Cigna Commercial |
$109.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$109.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$109.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$61.52
|
| Rate for Payer: Multiplan Commercial |
$127.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$116.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$61.52
|
| Rate for Payer: United Healthcare Commercial |
$129.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.94
|
| Rate for Payer: United Healthcare VA CCN |
$61.52
|
|
|
CLOT FACTOR VIII MULTIMETRIC
|
Professional
|
Both
|
$136.71
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
3008524701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$128.51 |
| Rate for Payer: Aetna of VT Commercial |
$128.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$39.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$39.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$39.21
|
| Rate for Payer: Cash Price |
$68.36
|
| Rate for Payer: Cash Price |
$68.36
|
| Rate for Payer: Cigna Commercial |
$27.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$22.62
|
| Rate for Payer: Multiplan Commercial |
$127.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.94
|
| Rate for Payer: United Healthcare Commercial |
$35.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.94
|
| Rate for Payer: United Healthcare VA CCN |
$22.94
|
|
|
CLOT FACTOR VIII VW ANTIGEN
|
Facility
|
OP
|
$273.23
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
3008524601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$259.57 |
| Rate for Payer: Aetna of VT Commercial |
$259.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$121.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$164.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$232.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$221.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$122.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$217.22
|
| Rate for Payer: Cash Price |
$136.62
|
| Rate for Payer: Cash Price |
$136.62
|
| Rate for Payer: Cigna Commercial |
$218.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$218.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$218.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$122.95
|
| Rate for Payer: Multiplan Commercial |
$254.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$232.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$122.95
|
| Rate for Payer: United Healthcare Commercial |
$259.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.94
|
| Rate for Payer: United Healthcare VA CCN |
$122.95
|
|
|
CLOT FACTOR VIII VW ANTIGEN
|
Professional
|
Both
|
$273.23
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
3008524601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$256.84 |
| Rate for Payer: Aetna of VT Commercial |
$256.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$39.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$39.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$39.21
|
| Rate for Payer: Cash Price |
$136.62
|
| Rate for Payer: Cash Price |
$136.62
|
| Rate for Payer: Cigna Commercial |
$27.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$22.62
|
| Rate for Payer: Multiplan Commercial |
$254.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.94
|
| Rate for Payer: United Healthcare Commercial |
$35.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.94
|
| Rate for Payer: United Healthcare VA CCN |
$22.94
|
|
|
CLOT FACTOR VIII VW ANTIGEN
|
Facility
|
IP
|
$273.23
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
3008524601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$202.22 |
| Max. Negotiated Rate |
$259.57 |
| Rate for Payer: Aetna of VT Commercial |
$259.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$202.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$202.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$232.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$229.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$218.58
|
| Rate for Payer: Cash Price |
$136.62
|
| Rate for Payer: Cigna Commercial |
$218.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$218.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$218.58
|
| Rate for Payer: Multiplan Commercial |
$254.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$232.25
|
| Rate for Payer: United Healthcare Commercial |
$259.57
|
|
|
CLOT FACTOR VIII VW RISTOCTN
|
Facility
|
OP
|
$277.26
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
3008524501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$263.40 |
| Rate for Payer: Aetna of VT Commercial |
$263.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$122.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$166.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$235.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$224.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$124.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$220.42
|
| Rate for Payer: Cash Price |
$138.63
|
| Rate for Payer: Cash Price |
$138.63
|
| Rate for Payer: Cigna Commercial |
$221.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$221.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$221.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$124.77
|
| Rate for Payer: Multiplan Commercial |
$257.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$235.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$124.77
|
| Rate for Payer: United Healthcare Commercial |
$263.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.94
|
| Rate for Payer: United Healthcare VA CCN |
$124.77
|
|
|
CLOT FACTOR VIII VW RISTOCTN
|
Facility
|
IP
|
$277.26
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
3008524501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$205.20 |
| Max. Negotiated Rate |
$263.40 |
| Rate for Payer: Aetna of VT Commercial |
$263.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$205.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$205.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$235.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$232.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$221.81
|
| Rate for Payer: Cash Price |
$138.63
|
| Rate for Payer: Cigna Commercial |
$221.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$221.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$221.81
|
| Rate for Payer: Multiplan Commercial |
$257.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$235.67
|
| Rate for Payer: United Healthcare Commercial |
$263.40
|
|
|
CLOT FACTOR VIII VW RISTOCTN
|
Professional
|
Both
|
$277.26
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
3008524501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$260.62 |
| Rate for Payer: Aetna of VT Commercial |
$260.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$39.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$39.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$39.21
|
| Rate for Payer: Cash Price |
$138.63
|
| Rate for Payer: Cash Price |
$138.63
|
| Rate for Payer: Cigna Commercial |
$27.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$22.62
|
| Rate for Payer: Multiplan Commercial |
$257.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.94
|
| Rate for Payer: United Healthcare Commercial |
$35.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.94
|
| Rate for Payer: United Healthcare VA CCN |
$22.94
|
|
|
CLOT INHIBIT PROT C ACTIVITY
|
Facility
|
OP
|
$249.97
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
3008530301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$237.47 |
| Rate for Payer: Aetna of VT Commercial |
$237.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$68.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$110.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$68.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$150.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$212.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$202.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$198.73
|
| Rate for Payer: Cash Price |
$124.98
|
| Rate for Payer: Cash Price |
$124.98
|
| Rate for Payer: Cigna Commercial |
$199.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$199.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$199.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$112.49
|
| Rate for Payer: Multiplan Commercial |
$232.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$212.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.49
|
| Rate for Payer: United Healthcare Commercial |
$237.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.84
|
| Rate for Payer: United Healthcare VA CCN |
$112.49
|
|
