|
AIRWY NASOPHARY 24
|
Facility
|
IP
|
$2.71
|
|
| Hospital Charge Code |
2720043661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna of VT Commercial |
$2.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.17
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna Commercial |
$2.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.17
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.30
|
| Rate for Payer: United Healthcare Commercial |
$2.57
|
|
|
AIRWY NASOPHARY 24
|
Facility
|
OP
|
$2.71
|
|
| Hospital Charge Code |
2720043661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna of VT Commercial |
$2.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.15
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna Commercial |
$2.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.22
|
| Rate for Payer: United Healthcare Commercial |
$2.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.22
|
| Rate for Payer: United Healthcare VA CCN |
$1.22
|
|
|
ALANINE AMINO (ALT) (SGPT)
|
Facility
|
IP
|
$66.88
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
3008446001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$63.54 |
| Rate for Payer: Aetna of VT Commercial |
$63.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$56.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$56.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$53.50
|
| Rate for Payer: Cash Price |
$33.44
|
| Rate for Payer: Cigna Commercial |
$53.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$53.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$53.50
|
| Rate for Payer: Multiplan Commercial |
$62.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.85
|
| Rate for Payer: United Healthcare Commercial |
$63.54
|
|
|
ALANINE AMINO (ALT) (SGPT)
|
Facility
|
OP
|
$66.88
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
3008446001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$63.54 |
| Rate for Payer: Aetna of VT Commercial |
$63.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$26.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$29.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$26.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$40.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$56.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$54.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$53.17
|
| Rate for Payer: Cash Price |
$33.44
|
| Rate for Payer: Cash Price |
$33.44
|
| Rate for Payer: Cigna Commercial |
$53.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$53.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$53.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$30.10
|
| Rate for Payer: Multiplan Commercial |
$62.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$30.10
|
| Rate for Payer: United Healthcare Commercial |
$63.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.30
|
| Rate for Payer: United Healthcare VA CCN |
$30.10
|
|
|
ALBUTEROL (0.083%) 2.5 MG/3 ML
|
Professional
|
Both
|
$1.89
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
636J761301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| 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 |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.09
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.08
|
| Rate for Payer: United Healthcare Commercial |
$0.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.08
|
| Rate for Payer: United Healthcare VA CCN |
$0.08
|
|
|
ALBUTEROL (0.083%) 2.5 MG/3 ML
|
Facility
|
IP
|
$1.89
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
636J761301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of VT Commercial |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.51
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Cigna Commercial |
$1.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.61
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
|
|
ALBUTEROL (0.083%) 2.5 MG/3 ML
|
Facility
|
OP
|
$1.89
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
636J761301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of VT Commercial |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.85
|
| 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 |
$1.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.85
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.85
|
| Rate for Payer: United Healthcare VA CCN |
$0.85
|
|
|
ALBUTEROL INHALER
|
Facility
|
OP
|
$0.01
|
|
| Hospital Charge Code |
2500000570
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
ALBUTEROL INHALER
|
Facility
|
IP
|
$0.01
|
|
| Hospital Charge Code |
2500000570
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
ALBUTEROL INHALER SP
|
Facility
|
IP
|
$153.62
|
|
|
Service Code
|
NDC 173068220
|
| Hospital Charge Code |
2500000005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.69 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna of VT Commercial |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.90
|
| Rate for Payer: Cash Price |
$76.81
|
| Rate for Payer: Cigna Commercial |
$122.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$122.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$122.90
|
| Rate for Payer: Multiplan Commercial |
$142.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.58
|
| Rate for Payer: United Healthcare Commercial |
$145.94
|
|
|
ALBUTEROL INHALER SP
|
Facility
|
OP
|
$153.62
|
|
|
Service Code
|
NDC 173068224
|
| Hospital Charge Code |
2500000005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.04 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna of VT Commercial |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$124.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.13
|
| Rate for Payer: Cash Price |
$76.81
|
| Rate for Payer: Cigna Commercial |
$122.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$122.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$122.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.13
|
| Rate for Payer: Multiplan Commercial |
$142.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.13
|
| Rate for Payer: United Healthcare Commercial |
$145.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.13
|
| Rate for Payer: United Healthcare VA CCN |
$69.13
|
|
|
ALBUTEROL INHALER SP
|
Facility
|
IP
|
$153.62
|
|
|
Service Code
|
NDC 9999999919
|
| Hospital Charge Code |
2500000005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.69 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna of VT Commercial |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.90
|
| Rate for Payer: Cash Price |
$76.81
|
| Rate for Payer: Cigna Commercial |
$122.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$122.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$122.90
|
| Rate for Payer: Multiplan Commercial |
$142.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.58
|
| Rate for Payer: United Healthcare Commercial |
$145.94
|
|
|
ALBUTEROL INHALER SP
|
Facility
|
OP
|
$153.62
|
|
|
Service Code
|
NDC 173068220
|
| Hospital Charge Code |
2500000005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.04 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna of VT Commercial |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$124.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.13
|
| Rate for Payer: Cash Price |
$76.81
|
| Rate for Payer: Cigna Commercial |
$122.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$122.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$122.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.13
|
| Rate for Payer: Multiplan Commercial |
$142.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.13
|
| Rate for Payer: United Healthcare Commercial |
$145.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.13
|
| Rate for Payer: United Healthcare VA CCN |
$69.13
|
|
|
ALBUTEROL INHALER SP
|
Facility
|
OP
|
$153.62
|
|
|
Service Code
|
NDC 9999999919
|
| Hospital Charge Code |
2500000005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.04 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna of VT Commercial |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$124.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.13
|
| Rate for Payer: Cash Price |
$76.81
|
| Rate for Payer: Cigna Commercial |
$122.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$122.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$122.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.13
|
| Rate for Payer: Multiplan Commercial |
$142.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.13
|
| Rate for Payer: United Healthcare Commercial |
$145.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.13
|
| Rate for Payer: United Healthcare VA CCN |
$69.13
|
|
|
ALBUTEROL INHALER SP
|
Facility
|
IP
|
$153.62
|
|
| Hospital Charge Code |
2500000005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.69 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna of VT Commercial |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.90
|
| Rate for Payer: Cash Price |
$76.81
|
| Rate for Payer: Cigna Commercial |
$122.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$122.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$122.90
|
| Rate for Payer: Multiplan Commercial |
$142.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.58
|
| Rate for Payer: United Healthcare Commercial |
$145.94
|
|
|
ALBUTEROL INHALER SP
|
Facility
|
IP
|
$153.62
|
|
|
Service Code
|
NDC 173068224
|
| Hospital Charge Code |
2500000005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.69 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna of VT Commercial |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.90
|
| Rate for Payer: Cash Price |
$76.81
|
| Rate for Payer: Cigna Commercial |
$122.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$122.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$122.90
|
| Rate for Payer: Multiplan Commercial |
$142.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.58
|
| Rate for Payer: United Healthcare Commercial |
$145.94
|
|
|
ALBUTEROL INHALER SP
|
Facility
|
OP
|
$153.62
|
|
| Hospital Charge Code |
2500000005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68.04 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna of VT Commercial |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$124.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.13
|
| Rate for Payer: Cash Price |
$76.81
|
| Rate for Payer: Cigna Commercial |
$122.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$122.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$122.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.13
|
| Rate for Payer: Multiplan Commercial |
$142.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.13
|
| Rate for Payer: United Healthcare Commercial |
$145.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.13
|
| Rate for Payer: United Healthcare VA CCN |
$69.13
|
|
|
ALCOHOLS BIOMARKERS 1OR 2
|
Facility
|
IP
|
$167.51
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
3008032101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.97 |
| Max. Negotiated Rate |
$159.13 |
| Rate for Payer: Aetna of VT Commercial |
$159.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$123.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$123.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$142.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$140.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$134.01
|
| Rate for Payer: Cash Price |
$83.75
|
| Rate for Payer: Cigna Commercial |
$134.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.01
|
| Rate for Payer: Multiplan Commercial |
$155.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.38
|
| Rate for Payer: United Healthcare Commercial |
$159.13
|
|
|
ALCOHOLS BIOMARKERS 1OR 2
|
Professional
|
Both
|
$167.51
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
3008032101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$157.46 |
| Rate for Payer: Aetna of VT Commercial |
$157.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$150.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$150.07
|
| Rate for Payer: Cash Price |
$83.75
|
| Rate for Payer: Cash Price |
$83.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.87
|
| Rate for Payer: Multiplan Commercial |
$155.78
|
| Rate for Payer: United Healthcare Commercial |
$142.38
|
| Rate for Payer: United Healthcare VA CCN |
$67.00
|
|
|
ALCOHOLS BIOMARKERS 1OR 2
|
Facility
|
OP
|
$167.51
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
3008032101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.19 |
| Max. Negotiated Rate |
$159.13 |
| Rate for Payer: Aetna of VT Commercial |
$159.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$150.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$74.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$150.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$100.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$142.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$135.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$75.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.17
|
| Rate for Payer: Cash Price |
$83.75
|
| Rate for Payer: Cigna Commercial |
$134.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$75.38
|
| Rate for Payer: Multiplan Commercial |
$155.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$75.38
|
| Rate for Payer: United Healthcare Commercial |
$159.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.38
|
| Rate for Payer: United Healthcare VA CCN |
$75.38
|
|
|
ALKALOIDS NOS
|
Professional
|
Both
|
$151.47
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
3008032301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.35 |
| Max. Negotiated Rate |
$155.69 |
| Rate for Payer: Aetna of VT Commercial |
$142.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.32
|
| Rate for Payer: Cash Price |
$75.74
|
| Rate for Payer: Cash Price |
$75.74
|
| Rate for Payer: Cigna Commercial |
$29.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$20.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$20.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$155.69
|
| Rate for Payer: Multiplan Commercial |
$140.87
|
| Rate for Payer: United Healthcare Commercial |
$128.75
|
| Rate for Payer: United Healthcare VA CCN |
$60.59
|
|
|
ALKALOIDS NOS
|
Facility
|
IP
|
$151.47
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
3008032301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$112.10 |
| Max. Negotiated Rate |
$143.90 |
| Rate for Payer: Aetna of VT Commercial |
$143.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$128.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$127.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$121.18
|
| Rate for Payer: Cash Price |
$75.74
|
| Rate for Payer: Cigna Commercial |
$121.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$121.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$121.18
|
| Rate for Payer: Multiplan Commercial |
$140.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$128.75
|
| Rate for Payer: United Healthcare Commercial |
$143.90
|
|
|
ALKALOIDS NOS
|
Facility
|
OP
|
$151.47
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
3008032301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.09 |
| Max. Negotiated Rate |
$143.90 |
| Rate for Payer: Aetna of VT Commercial |
$143.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$67.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$91.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$128.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$122.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$68.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$120.42
|
| Rate for Payer: Cash Price |
$75.74
|
| Rate for Payer: Cash Price |
$75.74
|
| Rate for Payer: Cigna Commercial |
$121.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$121.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$121.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$68.16
|
| Rate for Payer: Multiplan Commercial |
$140.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$128.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$68.16
|
| Rate for Payer: United Healthcare Commercial |
$143.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.16
|
| Rate for Payer: United Healthcare VA CCN |
$68.16
|
|
|
ALLERGEN SPECIFIC IGG
|
Facility
|
OP
|
$142.31
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
3008600101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$135.19 |
| Rate for Payer: Aetna of VT Commercial |
$135.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$63.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$85.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$115.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.14
|
| Rate for Payer: Cash Price |
$71.16
|
| Rate for Payer: Cash Price |
$71.16
|
| Rate for Payer: Cigna Commercial |
$113.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$64.04
|
| Rate for Payer: Multiplan Commercial |
$132.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.04
|
| Rate for Payer: United Healthcare Commercial |
$135.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: United Healthcare VA CCN |
$64.04
|
|
|
ALLERGEN SPECIFIC IGG
|
Professional
|
Both
|
$142.31
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
3008600101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$133.77 |
| Rate for Payer: Aetna of VT Commercial |
$133.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$10.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$8.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$12.75
|
| Rate for Payer: Cash Price |
$71.16
|
| Rate for Payer: Cash Price |
$71.16
|
| Rate for Payer: Cigna Commercial |
$9.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.71
|
| Rate for Payer: Multiplan Commercial |
$132.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$7.82
|
| Rate for Payer: United Healthcare Commercial |
$12.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: United Healthcare VA CCN |
$7.82
|
|
