|
CONTROL OF NOSEBLEED
|
Facility
|
OP
|
$206.80
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
4503090101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.59 |
| Max. Negotiated Rate |
$196.46 |
| Rate for Payer: Aetna of VT Commercial |
$196.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$185.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$91.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$185.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$124.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$175.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$167.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$164.41
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cigna Commercial |
$165.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$165.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$165.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.06
|
| Rate for Payer: Multiplan Commercial |
$192.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$93.06
|
| Rate for Payer: United Healthcare Commercial |
$196.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.06
|
| Rate for Payer: United Healthcare VA CCN |
$93.06
|
|
|
CONTROL OF NOSEBLEED
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
9813090501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$386.33 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Aetna of VT Commercial |
$495.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$386.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$386.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$443.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$438.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$417.60
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna Commercial |
$417.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$417.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$417.60
|
| Rate for Payer: Multiplan Commercial |
$485.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$443.70
|
| Rate for Payer: United Healthcare Commercial |
$495.90
|
|
|
CONTROL OF NOSEBLEED
|
Facility
|
OP
|
$328.81
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
4503090501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.63 |
| Max. Negotiated Rate |
$312.37 |
| Rate for Payer: Aetna of VT Commercial |
$312.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$294.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$145.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$294.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$197.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$279.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$266.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$147.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$261.40
|
| Rate for Payer: Cash Price |
$164.40
|
| Rate for Payer: Cigna Commercial |
$263.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$263.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$263.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$147.96
|
| Rate for Payer: Multiplan Commercial |
$305.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$279.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$147.96
|
| Rate for Payer: United Healthcare Commercial |
$312.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.96
|
| Rate for Payer: United Healthcare VA CCN |
$147.96
|
|
|
CONTROL OF NOSEBLEED
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
9813090502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$97.38 |
| Max. Negotiated Rate |
$532.82 |
| Rate for Payer: Aetna of VT Commercial |
$490.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$467.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$100.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$467.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$136.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$437.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$437.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$111.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$437.56
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna Commercial |
$154.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$532.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$532.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$327.68
|
| Rate for Payer: Multiplan Commercial |
$485.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$138.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$97.38
|
| Rate for Payer: United Healthcare Commercial |
$149.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.38
|
| Rate for Payer: United Healthcare VA CCN |
$97.38
|
|
|
CONTROL OF NOSEBLEED
|
Facility
|
IP
|
$328.81
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
4503090501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$243.35 |
| Max. Negotiated Rate |
$312.37 |
| Rate for Payer: Aetna of VT Commercial |
$312.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$243.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$243.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$279.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$276.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$263.05
|
| Rate for Payer: Cash Price |
$164.40
|
| Rate for Payer: Cigna Commercial |
$263.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$263.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$263.05
|
| Rate for Payer: Multiplan Commercial |
$305.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$279.49
|
| Rate for Payer: United Healthcare Commercial |
$312.37
|
|
|
CONTROL OF NOSEBLEED
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
9813090502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$231.19 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Aetna of VT Commercial |
$495.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$467.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$231.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$467.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$314.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$443.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$422.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$234.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$414.99
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna Commercial |
$417.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$417.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$417.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$234.90
|
| Rate for Payer: Multiplan Commercial |
$485.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$443.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$234.90
|
| Rate for Payer: United Healthcare Commercial |
$495.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.90
|
| Rate for Payer: United Healthcare VA CCN |
$234.90
|
|
|
CONTROL OF NOSEBLEED
|
Facility
|
IP
|
$206.80
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
4503090101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$153.05 |
| Max. Negotiated Rate |
$196.46 |
| Rate for Payer: Aetna of VT Commercial |
$196.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$153.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$153.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$175.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$173.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$165.44
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cigna Commercial |
$165.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$165.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$165.44
|
| Rate for Payer: Multiplan Commercial |
$192.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.78
|
| Rate for Payer: United Healthcare Commercial |
$196.46
|
|
|
CONTROL OF NOSEBLEED
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
9813090101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$197.61 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Aetna of VT Commercial |
$253.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$197.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$197.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$226.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$224.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$213.60
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$213.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$213.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$213.60
|
| Rate for Payer: Multiplan Commercial |
$248.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$226.95
|
| Rate for Payer: United Healthcare Commercial |
$253.65
|
|
|
CONTROL OF NOSEBLEED
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
9813090102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$197.61 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Aetna of VT Commercial |
$253.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$197.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$197.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$226.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$224.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$213.60
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$213.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$213.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$213.60
|
| Rate for Payer: Multiplan Commercial |
$248.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$226.95
|
| Rate for Payer: United Healthcare Commercial |
$253.65
|
|
|
CONTROL OF NOSEBLEED
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
9813090102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$118.25 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Aetna of VT Commercial |
$253.65
|
| 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 |
$118.25
|
| 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 |
$160.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$226.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$216.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$120.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$212.26
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$213.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$213.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$213.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.15
|
| Rate for Payer: Multiplan Commercial |
$248.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$226.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$120.15
|
| Rate for Payer: United Healthcare Commercial |
$253.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.15
|
| Rate for Payer: United Healthcare VA CCN |
$120.15
|
|
|
CONTROL OF NOSEBLEED
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
9813090501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$97.38 |
| Max. Negotiated Rate |
$532.82 |
| Rate for Payer: Aetna of VT Commercial |
$490.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$467.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$100.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$467.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$136.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$437.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$437.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$111.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$437.56
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna Commercial |
$154.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$532.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$532.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$327.68
|
| Rate for Payer: Multiplan Commercial |
$485.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$138.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$97.38
|
| Rate for Payer: United Healthcare Commercial |
$149.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.38
|
| Rate for Payer: United Healthcare VA CCN |
$97.38
|
|
|
CONTROL OF NOSEBLEED
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
9813090101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$118.25 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Aetna of VT Commercial |
$253.65
|
| 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 |
$118.25
|
| 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 |
$160.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$226.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$216.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$120.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$212.26
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$213.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$213.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$213.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.15
|
| Rate for Payer: Multiplan Commercial |
$248.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$226.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$120.15
|
| Rate for Payer: United Healthcare Commercial |
$253.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.15
|
| Rate for Payer: United Healthcare VA CCN |
$120.15
|
|
|
CONTROL OF NOSEBLEED
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
9813090501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$231.19 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Aetna of VT Commercial |
$495.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$467.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$231.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$467.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$314.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$443.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$422.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$234.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$414.99
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna Commercial |
$417.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$417.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$417.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$234.90
|
| Rate for Payer: Multiplan Commercial |
$485.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$443.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$234.90
|
| Rate for Payer: United Healthcare Commercial |
$495.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.90
|
| Rate for Payer: United Healthcare VA CCN |
$234.90
|
|
|
CONTROL OF NOSEBLEED
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
9813090502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$386.33 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Aetna of VT Commercial |
$495.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$386.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$386.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$443.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$438.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$417.60
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna Commercial |
$417.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$417.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$417.60
|
| Rate for Payer: Multiplan Commercial |
$485.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$443.70
|
| Rate for Payer: United Healthcare Commercial |
$495.90
|
|
|
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
|
|
|
CONTROL OF NOSEBLEED COMPLEX
|
Facility
|
OP
|
$274.01
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
4503090301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.36 |
| Max. Negotiated Rate |
$260.31 |
| Rate for Payer: Aetna of VT Commercial |
$260.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$245.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$121.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$245.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$164.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$232.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$221.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$123.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$217.84
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$219.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$219.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$219.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$123.30
|
| Rate for Payer: Multiplan Commercial |
$254.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$232.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$123.30
|
| Rate for Payer: United Healthcare Commercial |
$260.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.30
|
| Rate for Payer: United Healthcare VA CCN |
$123.30
|
|
|
CONTROL OF NOSEBLEED COMPLEX
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
9813090301
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$359.69 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of VT Commercial |
$461.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$359.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$359.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$413.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$408.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$388.80
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$388.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$388.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$388.80
|
| Rate for Payer: Multiplan Commercial |
$451.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$413.10
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
|
|
CONTROL OF NOSEBLEED COMPLEX
|
Facility
|
IP
|
$274.01
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
4503090301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.79 |
| Max. Negotiated Rate |
$260.31 |
| Rate for Payer: Aetna of VT Commercial |
$260.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$202.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$202.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$232.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$230.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$219.21
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$219.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$219.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$219.21
|
| Rate for Payer: Multiplan Commercial |
$254.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$232.91
|
| Rate for Payer: United Healthcare Commercial |
$260.31
|
|
|
CONTROL OF NOSEBLEED COMPLEX
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
9813090301
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$215.25 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of VT Commercial |
$461.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$435.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$215.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$435.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$292.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$413.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$393.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$218.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$386.37
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$388.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$388.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$388.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$218.70
|
| Rate for Payer: Multiplan Commercial |
$451.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$413.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$218.70
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$218.70
|
| Rate for Payer: United Healthcare VA CCN |
$218.70
|
|
|
CONTROL OF NOSEBLEED COMPLEX
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
9813090302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$215.25 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of VT Commercial |
$461.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$435.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$215.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$435.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$292.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$413.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$393.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$218.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$386.37
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$388.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$388.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$388.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$218.70
|
| Rate for Payer: Multiplan Commercial |
$451.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$413.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$218.70
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$218.70
|
| Rate for Payer: United Healthcare VA CCN |
$218.70
|
|
|
CONTROL OF NOSEBLEED COMPLEX
|
Professional
|
Both
|
$486.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
9813090302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$70.72 |
| Max. Negotiated Rate |
$456.84 |
| Rate for Payer: Aetna of VT Commercial |
$456.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$435.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$435.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$99.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$305.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$305.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$305.56
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$112.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$371.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$371.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$228.11
|
| Rate for Payer: Multiplan Commercial |
$451.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.72
|
| Rate for Payer: United Healthcare Commercial |
$108.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.72
|
| Rate for Payer: United Healthcare VA CCN |
$70.72
|
|
|
CONTROL OF NOSEBLEED COMPLEX
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
9813090302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$359.69 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of VT Commercial |
$461.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$359.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$359.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$413.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$408.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$388.80
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$388.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$388.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$388.80
|
| Rate for Payer: Multiplan Commercial |
$451.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$413.10
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
|
|
CONTROL OF NOSEBLEED COMPLEX
|
Professional
|
Both
|
$486.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
9813090301
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$70.72 |
| Max. Negotiated Rate |
$456.84 |
| Rate for Payer: Aetna of VT Commercial |
$456.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$435.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$435.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$99.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$305.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$305.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$305.56
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$112.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$371.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$371.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$228.11
|
| Rate for Payer: Multiplan Commercial |
$451.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.72
|
| Rate for Payer: United Healthcare Commercial |
$108.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.72
|
| Rate for Payer: United Healthcare VA CCN |
$70.72
|
|
|
CONVENTIONAL KA INST SET
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
2720075491
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna of VT Commercial |
$99.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$94.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$46.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$94.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$63.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.47
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$97.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.25
|
| Rate for Payer: United Healthcare Commercial |
$99.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.25
|
| Rate for Payer: United Healthcare VA CCN |
$47.25
|
|
|
CONVENTIONAL KA INST SET
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
2720075491
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.71 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna of VT Commercial |
$99.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$77.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$77.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.00
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$97.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$99.75
|
|
