|
EEG EXTEND MON 41-60 MIN
|
Facility
|
OP
|
$671.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
9869581201
|
|
Hospital Revenue Code
|
986
|
| Min. Negotiated Rate |
$297.19 |
| Max. Negotiated Rate |
$637.45 |
| Rate for Payer: Aetna of VT Commercial |
$637.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$601.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$297.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$601.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$403.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$570.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$543.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$301.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$533.45
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cigna Commercial |
$536.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$536.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$536.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$301.95
|
| Rate for Payer: Multiplan Commercial |
$624.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$570.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$301.95
|
| Rate for Payer: United Healthcare Commercial |
$637.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$301.95
|
| Rate for Payer: United Healthcare VA CCN |
$301.95
|
|
|
EGD CONTROL BLEEDING ANY
|
Professional
|
Both
|
$998.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
9814325501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$184.82 |
| Max. Negotiated Rate |
$938.12 |
| Rate for Payer: Aetna of VT Commercial |
$938.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$894.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$190.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$894.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$258.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$819.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$819.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$212.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$819.25
|
| Rate for Payer: Cash Price |
$499.00
|
| Rate for Payer: Cash Price |
$499.00
|
| Rate for Payer: Cigna Commercial |
$338.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$933.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$933.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$577.33
|
| Rate for Payer: Multiplan Commercial |
$928.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$262.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$184.82
|
| Rate for Payer: United Healthcare Commercial |
$284.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.82
|
| Rate for Payer: United Healthcare VA CCN |
$184.82
|
|
|
EGD CONTROL BLEEDING ANY
|
Facility
|
IP
|
$998.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
9814325501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$738.62 |
| Max. Negotiated Rate |
$948.10 |
| Rate for Payer: Aetna of VT Commercial |
$948.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$738.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$738.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$848.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$838.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$798.40
|
| Rate for Payer: Cash Price |
$499.00
|
| Rate for Payer: Cigna Commercial |
$798.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$798.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$798.40
|
| Rate for Payer: Multiplan Commercial |
$928.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$848.30
|
| Rate for Payer: United Healthcare Commercial |
$948.10
|
|
|
EGD CONTROL BLEEDING ANY
|
Facility
|
OP
|
$998.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
9824325501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$442.01 |
| Max. Negotiated Rate |
$948.10 |
| Rate for Payer: Aetna of VT Commercial |
$948.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$894.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$442.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$894.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$600.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$848.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$808.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$449.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$793.41
|
| Rate for Payer: Cash Price |
$499.00
|
| Rate for Payer: Cigna Commercial |
$798.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$798.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$798.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$449.10
|
| Rate for Payer: Multiplan Commercial |
$928.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$848.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$449.10
|
| Rate for Payer: United Healthcare Commercial |
$948.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$449.10
|
| Rate for Payer: United Healthcare VA CCN |
$449.10
|
|
|
EGD CONTROL BLEEDING ANY
|
Facility
|
OP
|
$998.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
9814325501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$442.01 |
| Max. Negotiated Rate |
$948.10 |
| Rate for Payer: Aetna of VT Commercial |
$948.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$894.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$442.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$894.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$600.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$848.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$808.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$449.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$793.41
|
| Rate for Payer: Cash Price |
$499.00
|
| Rate for Payer: Cigna Commercial |
$798.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$798.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$798.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$449.10
|
| Rate for Payer: Multiplan Commercial |
$928.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$848.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$449.10
|
| Rate for Payer: United Healthcare Commercial |
$948.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$449.10
|
| Rate for Payer: United Healthcare VA CCN |
$449.10
|
|
|
EGD CONTROL BLEEDING ANY
|
Facility
|
IP
|
$998.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
9814325502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$738.62 |
| Max. Negotiated Rate |
$948.10 |
| Rate for Payer: Aetna of VT Commercial |
$948.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$738.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$738.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$848.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$838.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$798.40
|
| Rate for Payer: Cash Price |
$499.00
|
| Rate for Payer: Cigna Commercial |
$798.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$798.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$798.40
|
| Rate for Payer: Multiplan Commercial |
$928.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$848.30
|
| Rate for Payer: United Healthcare Commercial |
$948.10
|
|
|
EGD CONTROL BLEEDING ANY
|
Professional
|
Both
|
$998.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
9824325501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$184.82 |
| Max. Negotiated Rate |
$938.12 |
| Rate for Payer: Aetna of VT Commercial |
$938.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$894.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$190.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$894.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$258.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$819.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$819.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$212.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$819.25
|
| Rate for Payer: Cash Price |
$499.00
|
| Rate for Payer: Cash Price |
$499.00
|
| Rate for Payer: Cigna Commercial |
$338.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$933.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$933.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$577.33
|
| Rate for Payer: Multiplan Commercial |
$928.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$262.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$184.82
|
| Rate for Payer: United Healthcare Commercial |
$284.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.82
|
| Rate for Payer: United Healthcare VA CCN |
$184.82
|
|
|
EGD CONTROL BLEEDING ANY
|
Professional
|
Both
|
$998.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
9814325502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$184.82 |
| Max. Negotiated Rate |
$938.12 |
| Rate for Payer: Aetna of VT Commercial |
$938.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$894.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$190.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$894.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$258.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$819.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$819.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$212.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$819.25
|
| Rate for Payer: Cash Price |
$499.00
|
| Rate for Payer: Cash Price |
$499.00
|
| Rate for Payer: Cigna Commercial |
$338.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$933.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$933.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$577.33
|
| Rate for Payer: Multiplan Commercial |
$928.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$262.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$184.82
|
| Rate for Payer: United Healthcare Commercial |
$284.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.82
|
| Rate for Payer: United Healthcare VA CCN |
$184.82
|
|
|
EGD CONTROL BLEEDING ANY
|
Facility
|
OP
|
$1,992.78
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
4504325501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$882.60 |
| Max. Negotiated Rate |
$1,893.14 |
| Rate for Payer: Aetna of VT Commercial |
$1,893.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,785.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$882.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,785.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,199.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,693.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,614.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$896.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,584.26
|
| Rate for Payer: Cash Price |
$996.39
|
| Rate for Payer: Cigna Commercial |
$1,594.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,594.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,594.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$896.75
|
| Rate for Payer: Multiplan Commercial |
$1,853.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,693.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$896.75
|
| Rate for Payer: United Healthcare Commercial |
$1,893.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$896.75
|
| Rate for Payer: United Healthcare VA CCN |
$896.75
|
|
|
EGD CONTROL BLEEDING ANY
|
Facility
|
IP
|
$1,992.78
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
4504325501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,474.86 |
| Max. Negotiated Rate |
$1,893.14 |
| Rate for Payer: Aetna of VT Commercial |
$1,893.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,474.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,474.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,693.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,673.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,594.22
|
| Rate for Payer: Cash Price |
$996.39
|
| Rate for Payer: Cigna Commercial |
$1,594.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,594.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,594.22
|
| Rate for Payer: Multiplan Commercial |
$1,853.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,693.86
|
| Rate for Payer: United Healthcare Commercial |
$1,893.14
|
|
|
EGD CONTROL BLEEDING ANY
|
Facility
|
IP
|
$998.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
9824325501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$738.62 |
| Max. Negotiated Rate |
$948.10 |
| Rate for Payer: Aetna of VT Commercial |
$948.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$738.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$738.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$848.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$838.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$798.40
|
| Rate for Payer: Cash Price |
$499.00
|
| Rate for Payer: Cigna Commercial |
$798.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$798.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$798.40
|
| Rate for Payer: Multiplan Commercial |
$928.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$848.30
|
| Rate for Payer: United Healthcare Commercial |
$948.10
|
|
|
EGD CONTROL BLEEDING ANY
|
Facility
|
OP
|
$998.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
9814325502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$442.01 |
| Max. Negotiated Rate |
$948.10 |
| Rate for Payer: Aetna of VT Commercial |
$948.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$894.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$442.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$894.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$600.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$848.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$808.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$449.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$793.41
|
| Rate for Payer: Cash Price |
$499.00
|
| Rate for Payer: Cigna Commercial |
$798.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$798.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$798.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$449.10
|
| Rate for Payer: Multiplan Commercial |
$928.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$848.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$449.10
|
| Rate for Payer: United Healthcare Commercial |
$948.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$449.10
|
| Rate for Payer: United Healthcare VA CCN |
$449.10
|
|
|
EGD DIAGNOSTIC BRUSH WASH
|
Professional
|
Both
|
$586.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
9824323501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$113.56 |
| Max. Negotiated Rate |
$550.84 |
| Rate for Payer: Aetna of VT Commercial |
$550.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$158.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$525.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$525.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$130.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$525.10
|
| Rate for Payer: Cash Price |
$293.00
|
| Rate for Payer: Cash Price |
$293.00
|
| Rate for Payer: Cigna Commercial |
$208.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$439.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$439.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$270.63
|
| Rate for Payer: Multiplan Commercial |
$544.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$161.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$113.56
|
| Rate for Payer: United Healthcare Commercial |
$174.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.56
|
| Rate for Payer: United Healthcare VA CCN |
$113.56
|
|
|
EGD DIAGNOSTIC BRUSH WASH
|
Facility
|
OP
|
$586.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
9824323501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$259.54 |
| Max. Negotiated Rate |
$556.70 |
| Rate for Payer: Aetna of VT Commercial |
$556.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$259.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$352.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$498.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$474.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$263.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$465.87
|
| Rate for Payer: Cash Price |
$293.00
|
| Rate for Payer: Cigna Commercial |
$468.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$468.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$468.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$263.70
|
| Rate for Payer: Multiplan Commercial |
$544.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$498.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$263.70
|
| Rate for Payer: United Healthcare Commercial |
$556.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$263.70
|
| Rate for Payer: United Healthcare VA CCN |
$263.70
|
|
|
EGD DIAGNOSTIC BRUSH WASH
|
Facility
|
IP
|
$586.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
9824323501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$433.70 |
| Max. Negotiated Rate |
$556.70 |
| Rate for Payer: Aetna of VT Commercial |
$556.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$433.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$433.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$498.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$492.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$468.80
|
| Rate for Payer: Cash Price |
$293.00
|
| Rate for Payer: Cigna Commercial |
$468.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$468.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$468.80
|
| Rate for Payer: Multiplan Commercial |
$544.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$498.10
|
| Rate for Payer: United Healthcare Commercial |
$556.70
|
|
|
EGD LESION ABLATION
|
Professional
|
Both
|
$1,690.00
|
|
|
Service Code
|
CPT 43270
|
| Hospital Charge Code |
9824327001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$206.82 |
| Max. Negotiated Rate |
$1,588.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,588.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,514.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$213.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,514.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$289.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,000.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,000.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$237.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,000.49
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cigna Commercial |
$379.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,087.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,087.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$672.25
|
| Rate for Payer: Multiplan Commercial |
$1,571.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$293.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$206.82
|
| Rate for Payer: United Healthcare Commercial |
$318.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$206.82
|
| Rate for Payer: United Healthcare VA CCN |
$206.82
|
|
|
EGD LESION ABLATION
|
Facility
|
IP
|
$1,690.00
|
|
|
Service Code
|
CPT 43270
|
| Hospital Charge Code |
9824327001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,250.77 |
| Max. Negotiated Rate |
$1,605.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,605.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,250.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,250.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,436.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,419.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,352.00
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cigna Commercial |
$1,352.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,352.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,352.00
|
| Rate for Payer: Multiplan Commercial |
$1,571.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,436.50
|
| Rate for Payer: United Healthcare Commercial |
$1,605.50
|
|
|
EGD LESION ABLATION
|
Facility
|
OP
|
$1,690.00
|
|
|
Service Code
|
CPT 43270
|
| Hospital Charge Code |
9824327001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$748.50 |
| Max. Negotiated Rate |
$1,605.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,605.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,514.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$748.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,514.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,017.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,436.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,368.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$760.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,343.55
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cigna Commercial |
$1,352.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,352.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,352.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$760.50
|
| Rate for Payer: Multiplan Commercial |
$1,571.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,436.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$760.50
|
| Rate for Payer: United Healthcare Commercial |
$1,605.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$760.50
|
| Rate for Payer: United Healthcare VA CCN |
$760.50
|
|
|
EGD PLACE GASTROSTOMY TUBE
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
9824324601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$183.15 |
| Max. Negotiated Rate |
$819.68 |
| Rate for Payer: Aetna of VT Commercial |
$819.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$781.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$188.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$781.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$256.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$349.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$349.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$210.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$349.44
|
| Rate for Payer: Cash Price |
$436.00
|
| Rate for Payer: Cash Price |
$436.00
|
| Rate for Payer: Cigna Commercial |
$336.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$305.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$305.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$183.15
|
| Rate for Payer: Multiplan Commercial |
$810.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$260.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$183.15
|
| Rate for Payer: United Healthcare Commercial |
$281.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$183.15
|
| Rate for Payer: United Healthcare VA CCN |
$183.15
|
|
|
EGD PLACE GASTROSTOMY TUBE
|
Facility
|
OP
|
$872.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
9824324601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$386.21 |
| Max. Negotiated Rate |
$828.40 |
| Rate for Payer: Aetna of VT Commercial |
$828.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$781.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$386.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$781.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$524.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$741.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$706.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$693.24
|
| Rate for Payer: Cash Price |
$436.00
|
| Rate for Payer: Cigna Commercial |
$697.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$697.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$697.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$392.40
|
| Rate for Payer: Multiplan Commercial |
$810.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$741.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$392.40
|
| Rate for Payer: United Healthcare Commercial |
$828.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$392.40
|
| Rate for Payer: United Healthcare VA CCN |
$392.40
|
|
|
EGD PLACE GASTROSTOMY TUBE
|
Facility
|
IP
|
$872.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
9824324601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$645.37 |
| Max. Negotiated Rate |
$828.40 |
| Rate for Payer: Aetna of VT Commercial |
$828.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$645.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$645.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$741.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$732.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$697.60
|
| Rate for Payer: Cash Price |
$436.00
|
| Rate for Payer: Cigna Commercial |
$697.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$697.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$697.60
|
| Rate for Payer: Multiplan Commercial |
$810.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$741.20
|
| Rate for Payer: United Healthcare Commercial |
$828.40
|
|
|
EGD REMOVE FOREIGN BODY
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
9824324701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$373.81 |
| Max. Negotiated Rate |
$801.80 |
| Rate for Payer: Aetna of VT Commercial |
$801.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$756.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$373.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$756.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$508.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$717.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$683.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$379.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$670.98
|
| Rate for Payer: Cash Price |
$422.00
|
| Rate for Payer: Cigna Commercial |
$675.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$675.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$675.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$379.80
|
| Rate for Payer: Multiplan Commercial |
$784.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$717.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$379.80
|
| Rate for Payer: United Healthcare Commercial |
$801.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.80
|
| Rate for Payer: United Healthcare VA CCN |
$379.80
|
|
|
EGD REMOVE FOREIGN BODY
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
9824324701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$624.64 |
| Max. Negotiated Rate |
$801.80 |
| Rate for Payer: Aetna of VT Commercial |
$801.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$624.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$624.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$717.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$708.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$675.20
|
| Rate for Payer: Cash Price |
$422.00
|
| Rate for Payer: Cigna Commercial |
$675.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$675.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$675.20
|
| Rate for Payer: Multiplan Commercial |
$784.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$717.40
|
| Rate for Payer: United Healthcare Commercial |
$801.80
|
|
|
EGD REMOVE FOREIGN BODY
|
Professional
|
Both
|
$844.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
9824324701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$162.55 |
| Max. Negotiated Rate |
$793.36 |
| Rate for Payer: Aetna of VT Commercial |
$793.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$756.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$167.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$756.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$227.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$682.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$682.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$186.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$682.75
|
| Rate for Payer: Cash Price |
$422.00
|
| Rate for Payer: Cash Price |
$422.00
|
| Rate for Payer: Cigna Commercial |
$298.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$582.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$582.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$358.48
|
| Rate for Payer: Multiplan Commercial |
$784.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$230.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$162.55
|
| Rate for Payer: United Healthcare Commercial |
$250.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.55
|
| Rate for Payer: United Healthcare VA CCN |
$162.55
|
|
|
EGD REMOVE LESION SNARE
|
Facility
|
OP
|
$927.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
9824325101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$410.57 |
| Max. Negotiated Rate |
$880.65 |
| Rate for Payer: Aetna of VT Commercial |
$880.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$830.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$410.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$830.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$558.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$787.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$750.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$417.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$736.97
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$741.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$741.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$741.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$417.15
|
| Rate for Payer: Multiplan Commercial |
$862.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$787.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$417.15
|
| Rate for Payer: United Healthcare Commercial |
$880.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$417.15
|
| Rate for Payer: United Healthcare VA CCN |
$417.15
|
|
