|
4X6CM XWRAP
|
Facility
|
OP
|
$4,342.80
|
|
|
Service Code
|
HCPCS Q4205
|
| Hospital Charge Code |
2780048321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,923.43 |
| Max. Negotiated Rate |
$4,125.66 |
| Rate for Payer: Aetna of VT Commercial |
$4,125.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,890.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,923.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,890.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,614.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,691.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,517.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,954.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,452.53
|
| Rate for Payer: Cash Price |
$2,171.40
|
| Rate for Payer: Cigna Commercial |
$3,474.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,474.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,474.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,954.26
|
| Rate for Payer: Multiplan Commercial |
$4,038.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,691.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,954.26
|
| Rate for Payer: United Healthcare Commercial |
$4,125.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,954.26
|
| Rate for Payer: United Healthcare VA CCN |
$1,954.26
|
|
|
4X6CM XWRAP
|
Facility
|
IP
|
$4,342.80
|
|
|
Service Code
|
HCPCS Q4205
|
| Hospital Charge Code |
2780048321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,214.11 |
| Max. Negotiated Rate |
$4,125.66 |
| Rate for Payer: Aetna of VT Commercial |
$4,125.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,214.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,214.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,691.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,647.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,474.24
|
| Rate for Payer: Cash Price |
$2,171.40
|
| Rate for Payer: Cigna Commercial |
$3,474.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,474.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,474.24
|
| Rate for Payer: Multiplan Commercial |
$4,038.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,691.38
|
| Rate for Payer: United Healthcare Commercial |
$4,125.66
|
|
|
6 MIN WALK TEST
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
9609461802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$32.73 |
| Max. Negotiated Rate |
$289.52 |
| Rate for Payer: Aetna of VT Commercial |
$289.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$275.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$33.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$275.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$45.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$48.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$48.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$48.61
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna Commercial |
$48.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$52.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$52.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$32.73
|
| Rate for Payer: Multiplan Commercial |
$286.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.73
|
| Rate for Payer: United Healthcare Commercial |
$50.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.73
|
| Rate for Payer: United Healthcare VA CCN |
$32.73
|
|
|
6 MIN WALK TEST
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
9609461802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$136.41 |
| Max. Negotiated Rate |
$292.60 |
| Rate for Payer: Aetna of VT Commercial |
$292.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$275.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$136.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$275.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$185.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$261.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$249.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$138.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$244.86
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna Commercial |
$246.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$246.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$246.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$138.60
|
| Rate for Payer: Multiplan Commercial |
$286.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$261.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$292.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.60
|
| Rate for Payer: United Healthcare VA CCN |
$138.60
|
|
|
6 MIN WALK TEST
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
9609461802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$227.95 |
| Max. Negotiated Rate |
$292.60 |
| Rate for Payer: Aetna of VT Commercial |
$292.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$227.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$227.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$261.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$258.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$246.40
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna Commercial |
$246.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$246.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$246.40
|
| Rate for Payer: Multiplan Commercial |
$286.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$261.80
|
| Rate for Payer: United Healthcare Commercial |
$292.60
|
|
|
ABDOM PARACENTESIS DX/THER W/O
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
9824908201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$154.13 |
| Max. Negotiated Rate |
$330.60 |
| Rate for Payer: Aetna of VT Commercial |
$330.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$311.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$154.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$311.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$209.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$295.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$281.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$156.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$276.66
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$278.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$278.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$278.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$156.60
|
| Rate for Payer: Multiplan Commercial |
$323.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$295.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$156.60
|
| Rate for Payer: United Healthcare Commercial |
$330.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.60
|
| Rate for Payer: United Healthcare VA CCN |
$156.60
|
|
|
ABDOM PARACENTESIS DX/THER W/O
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
9824908201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$67.54 |
| Max. Negotiated Rate |
$327.12 |
| Rate for Payer: Aetna of VT Commercial |
$327.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$311.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$311.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$94.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$266.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$266.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$266.28
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$124.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$318.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$318.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.33
|
| Rate for Payer: Multiplan Commercial |
$323.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.54
|
| Rate for Payer: United Healthcare Commercial |
$103.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.54
|
| Rate for Payer: United Healthcare VA CCN |
$67.54
|
|
|
ABDOM PARACENTESIS DX/THER W/O
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
9824908201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$257.55 |
| Max. Negotiated Rate |
$330.60 |
| Rate for Payer: Aetna of VT Commercial |
$330.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$257.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$257.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$295.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$292.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$278.40
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$278.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$278.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$278.40
|
| Rate for Payer: Multiplan Commercial |
$323.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$295.80
|
| Rate for Payer: United Healthcare Commercial |
$330.60
|
|
|
ABD PARACENTESIS
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
9604908202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$154.13 |
| Max. Negotiated Rate |
$330.60 |
| Rate for Payer: Aetna of VT Commercial |
$330.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$311.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$154.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$311.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$209.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$295.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$281.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$156.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$276.66
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$278.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$278.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$278.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$156.60
|
| Rate for Payer: Multiplan Commercial |
$323.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$295.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$156.60
|
| Rate for Payer: United Healthcare Commercial |
$330.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.60
|
| Rate for Payer: United Healthcare VA CCN |
$156.60
|
|
|
ABD PARACENTESIS
|
Professional
|
Both
|
$720.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
5104908201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.54 |
| Max. Negotiated Rate |
$676.80 |
| Rate for Payer: Aetna of VT Commercial |
$676.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$645.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$645.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$94.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$266.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$266.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$266.28
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$124.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$318.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$318.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.33
|
| Rate for Payer: Multiplan Commercial |
$669.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.54
|
| Rate for Payer: United Healthcare Commercial |
$103.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.54
|
| Rate for Payer: United Healthcare VA CCN |
$67.54
|
|
|
ABD PARACENTESIS
|
Professional
|
Both
|
$1,068.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
9604908201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$67.54 |
| Max. Negotiated Rate |
$1,003.92 |
| Rate for Payer: Aetna of VT Commercial |
$1,003.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$956.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$956.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$94.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$266.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$266.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$266.28
|
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Cigna Commercial |
$124.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$318.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$318.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.33
|
| Rate for Payer: Multiplan Commercial |
$993.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.54
|
| Rate for Payer: United Healthcare Commercial |
$103.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.54
|
| Rate for Payer: United Healthcare VA CCN |
$67.54
|
|
|
ABD PARACENTESIS
|
Facility
|
IP
|
$1,068.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
9604908201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$790.43 |
| Max. Negotiated Rate |
$1,014.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,014.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$790.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$790.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$907.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$897.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$854.40
|
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Cigna Commercial |
$854.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$854.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$854.40
|
| Rate for Payer: Multiplan Commercial |
$993.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$907.80
|
| Rate for Payer: United Healthcare Commercial |
$1,014.60
|
|
|
ABD PARACENTESIS
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
5104908201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$318.89 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna of VT Commercial |
$684.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$645.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$318.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$645.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$433.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$612.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$583.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$324.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$572.40
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$576.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$576.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$576.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$324.00
|
| Rate for Payer: Multiplan Commercial |
$669.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$612.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$324.00
|
| Rate for Payer: United Healthcare Commercial |
$684.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.00
|
| Rate for Payer: United Healthcare VA CCN |
$324.00
|
|
|
ABD PARACENTESIS
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
9814908201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$257.55 |
| Max. Negotiated Rate |
$330.60 |
| Rate for Payer: Aetna of VT Commercial |
$330.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$257.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$257.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$295.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$292.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$278.40
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$278.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$278.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$278.40
|
| Rate for Payer: Multiplan Commercial |
$323.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$295.80
|
| Rate for Payer: United Healthcare Commercial |
$330.60
|
|
|
ABD PARACENTESIS
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
9604908202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$67.54 |
| Max. Negotiated Rate |
$327.12 |
| Rate for Payer: Aetna of VT Commercial |
$327.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$311.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$311.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$94.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$266.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$266.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$266.28
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$124.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$318.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$318.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.33
|
| Rate for Payer: Multiplan Commercial |
$323.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.54
|
| Rate for Payer: United Healthcare Commercial |
$103.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.54
|
| Rate for Payer: United Healthcare VA CCN |
$67.54
|
|
|
ABD PARACENTESIS
|
Facility
|
OP
|
$719.66
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
4504908201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$318.74 |
| Max. Negotiated Rate |
$683.68 |
| Rate for Payer: Aetna of VT Commercial |
$683.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$644.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$318.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$644.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$433.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$611.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$582.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$323.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$572.13
|
| Rate for Payer: Cash Price |
$359.83
|
| Rate for Payer: Cigna Commercial |
$575.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$575.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$575.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$323.85
|
| Rate for Payer: Multiplan Commercial |
$669.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$611.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$323.85
|
| Rate for Payer: United Healthcare Commercial |
$683.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$323.85
|
| Rate for Payer: United Healthcare VA CCN |
$323.85
|
|
|
ABD PARACENTESIS
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
9814908202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$154.13 |
| Max. Negotiated Rate |
$330.60 |
| Rate for Payer: Aetna of VT Commercial |
$330.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$311.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$154.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$311.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$209.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$295.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$281.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$156.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$276.66
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$278.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$278.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$278.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$156.60
|
| Rate for Payer: Multiplan Commercial |
$323.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$295.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$156.60
|
| Rate for Payer: United Healthcare Commercial |
$330.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.60
|
| Rate for Payer: United Healthcare VA CCN |
$156.60
|
|
|
ABD PARACENTESIS
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
9814908201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$67.54 |
| Max. Negotiated Rate |
$327.12 |
| Rate for Payer: Aetna of VT Commercial |
$327.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$311.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$311.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$94.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$266.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$266.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$266.28
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$124.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$318.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$318.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.33
|
| Rate for Payer: Multiplan Commercial |
$323.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.54
|
| Rate for Payer: United Healthcare Commercial |
$103.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.54
|
| Rate for Payer: United Healthcare VA CCN |
$67.54
|
|
|
ABD PARACENTESIS
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
9814908201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$154.13 |
| Max. Negotiated Rate |
$330.60 |
| Rate for Payer: Aetna of VT Commercial |
$330.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$311.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$154.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$311.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$209.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$295.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$281.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$156.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$276.66
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$278.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$278.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$278.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$156.60
|
| Rate for Payer: Multiplan Commercial |
$323.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$295.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$156.60
|
| Rate for Payer: United Healthcare Commercial |
$330.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.60
|
| Rate for Payer: United Healthcare VA CCN |
$156.60
|
|
|
ABD PARACENTESIS
|
Facility
|
IP
|
$719.66
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
4504908201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$532.62 |
| Max. Negotiated Rate |
$683.68 |
| Rate for Payer: Aetna of VT Commercial |
$683.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$532.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$532.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$611.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$604.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$575.73
|
| Rate for Payer: Cash Price |
$359.83
|
| Rate for Payer: Cigna Commercial |
$575.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$575.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$575.73
|
| Rate for Payer: Multiplan Commercial |
$669.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$611.71
|
| Rate for Payer: United Healthcare Commercial |
$683.68
|
|
|
ABD PARACENTESIS
|
Facility
|
OP
|
$1,068.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
9604908201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$473.02 |
| Max. Negotiated Rate |
$1,014.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,014.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$956.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$473.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$956.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$642.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$907.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$865.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$480.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$849.06
|
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Cigna Commercial |
$854.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$854.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$854.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$480.60
|
| Rate for Payer: Multiplan Commercial |
$993.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$907.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$480.60
|
| Rate for Payer: United Healthcare Commercial |
$1,014.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$480.60
|
| Rate for Payer: United Healthcare VA CCN |
$480.60
|
|
|
ABD PARACENTESIS
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
9814908202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$257.55 |
| Max. Negotiated Rate |
$330.60 |
| Rate for Payer: Aetna of VT Commercial |
$330.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$257.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$257.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$295.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$292.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$278.40
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$278.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$278.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$278.40
|
| Rate for Payer: Multiplan Commercial |
$323.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$295.80
|
| Rate for Payer: United Healthcare Commercial |
$330.60
|
|
|
ABD PARACENTESIS
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
9604908202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$257.55 |
| Max. Negotiated Rate |
$330.60 |
| Rate for Payer: Aetna of VT Commercial |
$330.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$257.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$257.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$295.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$292.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$278.40
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$278.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$278.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$278.40
|
| Rate for Payer: Multiplan Commercial |
$323.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$295.80
|
| Rate for Payer: United Healthcare Commercial |
$330.60
|
|
|
ABD PARACENTESIS
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
5104908201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$532.87 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna of VT Commercial |
$684.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$532.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$532.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$612.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$604.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$576.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$576.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$576.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$576.00
|
| Rate for Payer: Multiplan Commercial |
$669.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$612.00
|
| Rate for Payer: United Healthcare Commercial |
$684.00
|
|
|
ABD PARACENTESIS
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
9814908202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$67.54 |
| Max. Negotiated Rate |
$327.12 |
| Rate for Payer: Aetna of VT Commercial |
$327.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$311.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$311.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$94.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$266.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$266.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$266.28
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$124.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$318.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$318.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.33
|
| Rate for Payer: Multiplan Commercial |
$323.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.54
|
| Rate for Payer: United Healthcare Commercial |
$103.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.54
|
| Rate for Payer: United Healthcare VA CCN |
$67.54
|
|
