|
CONTRAST PROHANCE 5ML
|
Facility
|
IP
|
$39.18
|
|
| Hospital Charge Code |
2780061941
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$37.22 |
| Rate for Payer: Aetna of VT Commercial |
$37.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$29.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$29.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$33.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$32.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$31.34
|
| Rate for Payer: Cash Price |
$19.59
|
| Rate for Payer: Cigna Commercial |
$31.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$31.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$31.34
|
| Rate for Payer: Multiplan Commercial |
$36.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.30
|
| Rate for Payer: United Healthcare Commercial |
$37.22
|
|
|
CONTRAST PROHANCE 5ML
|
Facility
|
OP
|
$39.18
|
|
| Hospital Charge Code |
2780061941
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$37.22 |
| Rate for Payer: Aetna of VT Commercial |
$37.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$35.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$17.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$35.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$23.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$33.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$31.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$17.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$31.15
|
| Rate for Payer: Cash Price |
$19.59
|
| Rate for Payer: Cigna Commercial |
$31.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$31.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$31.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.63
|
| Rate for Payer: Multiplan Commercial |
$36.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$17.63
|
| Rate for Payer: United Healthcare Commercial |
$37.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.63
|
| Rate for Payer: United Healthcare VA CCN |
$17.63
|
|
|
CONTRAST X-RAY BLADDER
|
Facility
|
IP
|
$1,605.80
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
3207443002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,188.45 |
| Max. Negotiated Rate |
$1,525.51 |
| Rate for Payer: Aetna of VT Commercial |
$1,525.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,188.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,188.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,364.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,348.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,284.64
|
| Rate for Payer: Cash Price |
$802.90
|
| Rate for Payer: Cigna Commercial |
$1,284.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,284.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,284.64
|
| Rate for Payer: Multiplan Commercial |
$1,493.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,364.93
|
| Rate for Payer: United Healthcare Commercial |
$1,525.51
|
|
|
CONTRAST X-RAY BLADDER
|
Facility
|
OP
|
$1,605.80
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
3207443002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.94 |
| Max. Negotiated Rate |
$1,525.51 |
| Rate for Payer: Aetna of VT Commercial |
$1,525.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$711.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$966.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,364.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,300.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$722.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,276.61
|
| Rate for Payer: Cash Price |
$802.90
|
| Rate for Payer: Cash Price |
$802.90
|
| Rate for Payer: Cigna Commercial |
$1,284.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,284.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,284.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$722.61
|
| Rate for Payer: Multiplan Commercial |
$1,493.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,364.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$722.61
|
| Rate for Payer: United Healthcare Commercial |
$1,525.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$722.61
|
| Rate for Payer: United Healthcare VA CCN |
$722.61
|
|
|
CONTRAST X-RAY BLADDER
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
9727443001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of VT Commercial |
$66.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$56.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.65
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.50
|
| Rate for Payer: United Healthcare Commercial |
$66.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.50
|
| Rate for Payer: United Healthcare VA CCN |
$31.50
|
|
|
CONTRAST X-RAY BLADDER
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
9727443001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$39.44 |
| Max. Negotiated Rate |
$113.94 |
| Rate for Payer: Aetna of VT Commercial |
$65.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$40.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$55.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$81.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$81.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$45.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$81.81
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$59.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$63.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$63.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$39.44
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.44
|
| Rate for Payer: United Healthcare Commercial |
$60.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.44
|
| Rate for Payer: United Healthcare VA CCN |
$39.44
|
|
|
CONTRAST X-RAY BLADDER
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
9727443001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$51.81 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of VT Commercial |
$66.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.50
|
| Rate for Payer: United Healthcare Commercial |
$66.50
|
|
|
CONTRAST X-RAY OF HIP
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
9727352501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$79.98 |
| Max. Negotiated Rate |
$677.47 |
| Rate for Payer: Aetna of VT Commercial |
$80.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$677.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$256.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$677.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$348.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$339.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$339.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$286.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$339.13
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$370.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$400.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$400.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$248.98
|
| Rate for Payer: Multiplan Commercial |
$79.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$248.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$248.98
|
| Rate for Payer: United Healthcare Commercial |
$383.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$248.98
|
| Rate for Payer: United Healthcare VA CCN |
$248.98
|
|
|
CONTRAST X-RAY OF HIP
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
9727352501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$38.09 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Aetna of VT Commercial |
$81.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$77.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$77.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$51.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$69.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$38.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$68.37
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$68.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$68.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$68.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$38.70
|
| Rate for Payer: Multiplan Commercial |
$79.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.70
|
| Rate for Payer: United Healthcare Commercial |
$81.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.70
|
| Rate for Payer: United Healthcare VA CCN |
$38.70
|
|
|
CONTRAST X-RAY OF HIP
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
9727352501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$63.65 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Aetna of VT Commercial |
$81.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$68.80
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$68.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$68.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$68.80
|
| Rate for Payer: Multiplan Commercial |
$79.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.10
|
| Rate for Payer: United Healthcare Commercial |
$81.70
|
|
|
CONTRAST X-RAY OF SHOULDER
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
9727304001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$59.21 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna of VT Commercial |
$76.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$67.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$64.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.00
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.00
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
|
|
CONTRAST X-RAY OF SHOULDER
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
9727304001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$677.47 |
| Rate for Payer: Aetna of VT Commercial |
$75.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$677.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$256.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$677.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$348.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$339.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$339.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$286.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$339.13
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$370.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$400.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$400.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$248.98
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$248.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$248.98
|
| Rate for Payer: United Healthcare Commercial |
$383.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$248.98
|
| Rate for Payer: United Healthcare VA CCN |
$248.98
|
|
|
CONTRAST X-RAY OF SHOULDER
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
9727304001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$35.43 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna of VT Commercial |
$76.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$48.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$63.60
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$64.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.00
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.00
|
| Rate for Payer: United Healthcare VA CCN |
$36.00
|
|
|
CONTROL NOSE/THROAT BLEEDING
|
Professional
|
Both
|
$1,039.00
|
|
|
Service Code
|
CPT 42970
|
| Hospital Charge Code |
9814297002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$389.27 |
| Max. Negotiated Rate |
$976.66 |
| Rate for Payer: Aetna of VT Commercial |
$976.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$930.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$400.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$930.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$544.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$652.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$652.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$447.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$652.24
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cigna Commercial |
$620.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$641.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$641.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$389.27
|
| Rate for Payer: Multiplan Commercial |
$966.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$552.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$389.27
|
| Rate for Payer: United Healthcare Commercial |
$598.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$389.27
|
| Rate for Payer: United Healthcare VA CCN |
$389.27
|
|
|
CONTROL NOSE/THROAT BLEEDING
|
Facility
|
IP
|
$5,339.08
|
|
|
Service Code
|
CPT 42970
|
| Hospital Charge Code |
4504297001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,951.45 |
| Max. Negotiated Rate |
$5,072.13 |
| Rate for Payer: Aetna of VT Commercial |
$5,072.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,951.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,951.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,538.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,484.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,271.26
|
| Rate for Payer: Cash Price |
$2,669.54
|
| Rate for Payer: Cigna Commercial |
$4,271.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,271.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,271.26
|
| Rate for Payer: Multiplan Commercial |
$4,965.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,538.22
|
| Rate for Payer: United Healthcare Commercial |
$5,072.13
|
|
|
CONTROL NOSE/THROAT BLEEDING
|
Facility
|
OP
|
$5,339.08
|
|
|
Service Code
|
CPT 42970
|
| Hospital Charge Code |
4504297001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,364.68 |
| Max. Negotiated Rate |
$5,072.13 |
| Rate for Payer: Aetna of VT Commercial |
$5,072.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,783.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,364.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,783.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,214.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,538.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,324.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,402.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,244.57
|
| Rate for Payer: Cash Price |
$2,669.54
|
| Rate for Payer: Cigna Commercial |
$4,271.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,271.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,271.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,402.59
|
| Rate for Payer: Multiplan Commercial |
$4,965.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,538.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,402.59
|
| Rate for Payer: United Healthcare Commercial |
$5,072.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,402.59
|
| Rate for Payer: United Healthcare VA CCN |
$2,402.59
|
|
|
CONTROL NOSE/THROAT BLEEDING
|
Facility
|
OP
|
$1,039.00
|
|
|
Service Code
|
CPT 42970
|
| Hospital Charge Code |
9824297001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$460.17 |
| Max. Negotiated Rate |
$987.05 |
| Rate for Payer: Aetna of VT Commercial |
$987.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$930.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$460.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$930.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$625.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$883.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$841.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$467.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$826.00
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cigna Commercial |
$831.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$831.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$831.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$467.55
|
| Rate for Payer: Multiplan Commercial |
$966.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$883.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$467.55
|
| Rate for Payer: United Healthcare Commercial |
$987.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$467.55
|
| Rate for Payer: United Healthcare VA CCN |
$467.55
|
|
|
CONTROL NOSE/THROAT BLEEDING
|
Professional
|
Both
|
$1,039.00
|
|
|
Service Code
|
CPT 42970
|
| Hospital Charge Code |
9824297001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$389.27 |
| Max. Negotiated Rate |
$976.66 |
| Rate for Payer: Aetna of VT Commercial |
$976.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$930.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$400.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$930.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$544.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$652.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$652.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$447.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$652.24
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cigna Commercial |
$620.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$641.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$641.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$389.27
|
| Rate for Payer: Multiplan Commercial |
$966.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$552.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$389.27
|
| Rate for Payer: United Healthcare Commercial |
$598.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$389.27
|
| Rate for Payer: United Healthcare VA CCN |
$389.27
|
|
|
CONTROL NOSE/THROAT BLEEDING
|
Facility
|
IP
|
$1,039.00
|
|
|
Service Code
|
CPT 42970
|
| Hospital Charge Code |
9824297001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$768.96 |
| Max. Negotiated Rate |
$987.05 |
| Rate for Payer: Aetna of VT Commercial |
$987.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$768.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$768.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$883.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$872.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$831.20
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cigna Commercial |
$831.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$831.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$831.20
|
| Rate for Payer: Multiplan Commercial |
$966.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$883.15
|
| Rate for Payer: United Healthcare Commercial |
$987.05
|
|
|
CONTROL NOSE/THROAT BLEEDING
|
Facility
|
IP
|
$1,039.00
|
|
|
Service Code
|
CPT 42970
|
| Hospital Charge Code |
9814297002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$768.96 |
| Max. Negotiated Rate |
$987.05 |
| Rate for Payer: Aetna of VT Commercial |
$987.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$768.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$768.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$883.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$872.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$831.20
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cigna Commercial |
$831.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$831.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$831.20
|
| Rate for Payer: Multiplan Commercial |
$966.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$883.15
|
| Rate for Payer: United Healthcare Commercial |
$987.05
|
|
|
CONTROL NOSE/THROAT BLEEDING
|
Facility
|
OP
|
$1,039.00
|
|
|
Service Code
|
CPT 42970
|
| Hospital Charge Code |
9814297001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$460.17 |
| Max. Negotiated Rate |
$987.05 |
| Rate for Payer: Aetna of VT Commercial |
$987.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$930.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$460.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$930.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$625.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$883.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$841.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$467.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$826.00
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cigna Commercial |
$831.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$831.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$831.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$467.55
|
| Rate for Payer: Multiplan Commercial |
$966.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$883.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$467.55
|
| Rate for Payer: United Healthcare Commercial |
$987.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$467.55
|
| Rate for Payer: United Healthcare VA CCN |
$467.55
|
|
|
CONTROL NOSE/THROAT BLEEDING
|
Facility
|
IP
|
$1,039.00
|
|
|
Service Code
|
CPT 42970
|
| Hospital Charge Code |
9814297001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$768.96 |
| Max. Negotiated Rate |
$987.05 |
| Rate for Payer: Aetna of VT Commercial |
$987.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$768.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$768.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$883.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$872.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$831.20
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cigna Commercial |
$831.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$831.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$831.20
|
| Rate for Payer: Multiplan Commercial |
$966.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$883.15
|
| Rate for Payer: United Healthcare Commercial |
$987.05
|
|
|
CONTROL NOSE/THROAT BLEEDING
|
Professional
|
Both
|
$1,039.00
|
|
|
Service Code
|
CPT 42970
|
| Hospital Charge Code |
9814297001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$389.27 |
| Max. Negotiated Rate |
$976.66 |
| Rate for Payer: Aetna of VT Commercial |
$976.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$930.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$400.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$930.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$544.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$652.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$652.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$447.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$652.24
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cigna Commercial |
$620.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$641.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$641.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$389.27
|
| Rate for Payer: Multiplan Commercial |
$966.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$552.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$389.27
|
| Rate for Payer: United Healthcare Commercial |
$598.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$389.27
|
| Rate for Payer: United Healthcare VA CCN |
$389.27
|
|
|
CONTROL NOSE/THROAT BLEEDING
|
Facility
|
OP
|
$1,039.00
|
|
|
Service Code
|
CPT 42970
|
| Hospital Charge Code |
9814297002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$460.17 |
| Max. Negotiated Rate |
$987.05 |
| Rate for Payer: Aetna of VT Commercial |
$987.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$930.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$460.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$930.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$625.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$883.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$841.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$467.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$826.00
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cigna Commercial |
$831.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$831.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$831.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$467.55
|
| Rate for Payer: Multiplan Commercial |
$966.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$883.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$467.55
|
| Rate for Payer: United Healthcare Commercial |
$987.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$467.55
|
| Rate for Payer: United Healthcare VA CCN |
$467.55
|
|
|
CONTROL OF NOSEBLEED
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
9813090102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$51.77 |
| Max. Negotiated Rate |
$250.98 |
| Rate for Payer: Aetna of VT Commercial |
$250.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$239.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$53.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$239.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$72.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$194.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$194.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$194.68
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$82.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$240.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$240.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$147.49
|
| Rate for Payer: Multiplan Commercial |
$248.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.77
|
| Rate for Payer: United Healthcare Commercial |
$79.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.77
|
| Rate for Payer: United Healthcare VA CCN |
$51.77
|
|
