|
FL FLUOROSCOPY < 1 HOUR
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
CPT 76200
|
| Hospital Charge Code |
3207620001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
FL FLUOROSCOPY < 1 HOUR
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
CPT 76000 26
|
| Hospital Charge Code |
9727600001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$198.34 |
| Rate for Payer: Aetna of VT Commercial |
$198.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$121.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$121.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$18.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$18.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$18.11
|
| Rate for Payer: Cash Price |
$105.50
|
| Rate for Payer: Cash Price |
$105.50
|
| Rate for Payer: Cigna Commercial |
$20.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.06
|
| Rate for Payer: Multiplan Commercial |
$196.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.06
|
| Rate for Payer: United Healthcare Commercial |
$21.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.06
|
| Rate for Payer: United Healthcare VA CCN |
$14.06
|
|
|
FL FLUOROSCOPY < 1 HOUR
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
CPT 76000 26
|
| Hospital Charge Code |
9727600001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$93.45 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Aetna of VT Commercial |
$200.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$189.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$93.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$189.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$127.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$170.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$94.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$167.75
|
| Rate for Payer: Cash Price |
$105.50
|
| Rate for Payer: Cigna Commercial |
$168.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.95
|
| Rate for Payer: Multiplan Commercial |
$196.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$94.95
|
| Rate for Payer: United Healthcare Commercial |
$200.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.95
|
| Rate for Payer: United Healthcare VA CCN |
$94.95
|
|
|
FL FLUOROSCOPY < 1 HOUR
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
CPT 76000 26
|
| Hospital Charge Code |
9727600001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Aetna of VT Commercial |
$200.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$156.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$156.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$177.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$168.80
|
| Rate for Payer: Cash Price |
$105.50
|
| Rate for Payer: Cigna Commercial |
$168.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.80
|
| Rate for Payer: Multiplan Commercial |
$196.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.35
|
| Rate for Payer: United Healthcare Commercial |
$200.45
|
|
|
FL FLUOROSCOPY < 1 HOUR
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
CPT 76200
|
| Hospital Charge Code |
3207620001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
|
|
FL GUIDE NEEDLE PLACMNT ADD ON
|
Facility
|
IP
|
$542.07
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
3207700201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$401.19 |
| Max. Negotiated Rate |
$514.97 |
| Rate for Payer: Aetna of VT Commercial |
$514.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$401.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$401.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$460.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$455.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$433.66
|
| Rate for Payer: Cash Price |
$271.04
|
| Rate for Payer: Cigna Commercial |
$433.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$433.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$433.66
|
| Rate for Payer: Multiplan Commercial |
$504.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$460.76
|
| Rate for Payer: United Healthcare Commercial |
$514.97
|
|
|
FL GUIDE NEEDLE PLACMNT ADD ON
|
Facility
|
OP
|
$542.07
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
3207700201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$240.08 |
| Max. Negotiated Rate |
$514.97 |
| Rate for Payer: Aetna of VT Commercial |
$514.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$388.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$240.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$388.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$326.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$460.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$439.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$243.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$430.95
|
| Rate for Payer: Cash Price |
$271.04
|
| Rate for Payer: Cash Price |
$271.04
|
| Rate for Payer: Cigna Commercial |
$433.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$433.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$433.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$243.93
|
| Rate for Payer: Multiplan Commercial |
$504.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$460.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$243.93
|
| Rate for Payer: United Healthcare Commercial |
$514.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$243.93
|
| Rate for Payer: United Healthcare VA CCN |
$243.93
|
|
|
FL GUIDE NEEDLE PLACMNT ADD ON
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
CPT 77002 26
|
| Hospital Charge Code |
9727700201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$230.17 |
| Max. Negotiated Rate |
$295.45 |
| Rate for Payer: Aetna of VT Commercial |
$295.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$230.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$230.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$264.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$261.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$248.80
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cigna Commercial |
$248.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$248.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$248.80
|
| Rate for Payer: Multiplan Commercial |
$289.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.35
|
| Rate for Payer: United Healthcare Commercial |
$295.45
|
|
|
FL GUIDE NEEDLE PLACMNT ADD ON
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
CPT 77002 26
|
| Hospital Charge Code |
9727700201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$137.74 |
| Max. Negotiated Rate |
$295.45 |
| Rate for Payer: Aetna of VT Commercial |
$295.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$278.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$137.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$278.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$187.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$264.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$251.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$139.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$247.25
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cigna Commercial |
$248.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$248.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$248.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$139.95
|
| Rate for Payer: Multiplan Commercial |
$289.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$139.95
|
| Rate for Payer: United Healthcare Commercial |
$295.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$139.95
|
| Rate for Payer: United Healthcare VA CCN |
$139.95
|
|
|
FL OR C arm
|
Facility
|
IP
|
$459.10
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
3207600001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$339.78 |
| Max. Negotiated Rate |
$436.14 |
| Rate for Payer: Aetna of VT Commercial |
$436.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$339.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$339.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$390.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$385.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$367.28
|
| Rate for Payer: Cash Price |
$229.55
|
| Rate for Payer: Cigna Commercial |
$367.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$367.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$367.28
|
| Rate for Payer: Multiplan Commercial |
$426.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$390.24
|
| Rate for Payer: United Healthcare Commercial |
$436.14
|
|
|
FL OR C arm
|
Facility
|
OP
|
$459.10
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
3207600001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$436.14 |
| Rate for Payer: Aetna of VT Commercial |
$436.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$121.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$203.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$121.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$276.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$390.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$371.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$206.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$364.98
|
| Rate for Payer: Cash Price |
$229.55
|
| Rate for Payer: Cash Price |
$229.55
|
| Rate for Payer: Cigna Commercial |
$367.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$367.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$367.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$206.59
|
| Rate for Payer: Multiplan Commercial |
$426.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$390.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$206.59
|
| Rate for Payer: United Healthcare Commercial |
$436.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$206.59
|
| Rate for Payer: United Healthcare VA CCN |
$206.59
|
|
|
FLOWCYTOMETRY/ TC 1 MARKER
|
Professional
|
Both
|
$319.71
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
3008818401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$377.55 |
| Rate for Payer: Aetna of VT Commercial |
$300.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$377.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$377.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$104.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$103.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$103.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$103.90
|
| Rate for Payer: Cash Price |
$159.85
|
| Rate for Payer: Cash Price |
$159.85
|
| Rate for Payer: Cigna Commercial |
$92.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$120.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$120.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$74.70
|
| Rate for Payer: Multiplan Commercial |
$297.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.70
|
| Rate for Payer: United Healthcare Commercial |
$114.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.70
|
| Rate for Payer: United Healthcare VA CCN |
$74.70
|
|
|
FLOWCYTOMETRY/ TC 1 MARKER
|
Facility
|
OP
|
$319.71
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
3008818401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$377.55 |
| Rate for Payer: Aetna of VT Commercial |
$303.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$377.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$141.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$377.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$192.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$271.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$258.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$143.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$254.17
|
| Rate for Payer: Cash Price |
$159.85
|
| Rate for Payer: Cash Price |
$159.85
|
| Rate for Payer: Cigna Commercial |
$255.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$255.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$255.77
|
| Rate for Payer: Martins Point Health Care Commercial |
$143.87
|
| Rate for Payer: Multiplan Commercial |
$297.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$271.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$143.87
|
| Rate for Payer: United Healthcare Commercial |
$303.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.70
|
| Rate for Payer: United Healthcare VA CCN |
$143.87
|
|
|
FLOWCYTOMETRY/ TC 1 MARKER
|
Facility
|
IP
|
$319.71
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
3008818401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$236.62 |
| Max. Negotiated Rate |
$303.72 |
| Rate for Payer: Aetna of VT Commercial |
$303.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$236.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$236.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$271.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$268.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$255.77
|
| Rate for Payer: Cash Price |
$159.85
|
| Rate for Payer: Cigna Commercial |
$255.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$255.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$255.77
|
| Rate for Payer: Multiplan Commercial |
$297.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$271.75
|
| Rate for Payer: United Healthcare Commercial |
$303.72
|
|
|
FLOWCYTOMETRY/TC ADD-ON
|
Facility
|
OP
|
$122.79
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
3008818501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$116.65 |
| Rate for Payer: Aetna of VT Commercial |
$116.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$114.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$114.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$104.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$99.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$55.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$97.62
|
| Rate for Payer: Cash Price |
$61.40
|
| Rate for Payer: Cash Price |
$61.40
|
| Rate for Payer: Cigna Commercial |
$98.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$98.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$98.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$55.26
|
| Rate for Payer: Multiplan Commercial |
$114.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$104.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$55.26
|
| Rate for Payer: United Healthcare Commercial |
$116.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.84
|
| Rate for Payer: United Healthcare VA CCN |
$55.26
|
|
|
FLOWCYTOMETRY/TC ADD-ON
|
Professional
|
Both
|
$122.79
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
3008818501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna of VT Commercial |
$115.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$114.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$114.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$30.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$39.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$39.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$25.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$39.39
|
| Rate for Payer: Cash Price |
$61.40
|
| Rate for Payer: Cash Price |
$61.40
|
| Rate for Payer: Cigna Commercial |
$28.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$34.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$34.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$21.85
|
| Rate for Payer: Multiplan Commercial |
$114.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.84
|
| Rate for Payer: United Healthcare Commercial |
$33.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.84
|
| Rate for Payer: United Healthcare VA CCN |
$21.84
|
|
|
FLOWCYTOMETRY/TC ADD-ON
|
Facility
|
IP
|
$122.79
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
3008818501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$90.88 |
| Max. Negotiated Rate |
$116.65 |
| Rate for Payer: Aetna of VT Commercial |
$116.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$90.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$90.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$104.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$103.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$98.23
|
| Rate for Payer: Cash Price |
$61.40
|
| Rate for Payer: Cigna Commercial |
$98.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$98.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$98.23
|
| Rate for Payer: Multiplan Commercial |
$114.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$104.37
|
| Rate for Payer: United Healthcare Commercial |
$116.65
|
|
|
FL THER NMA RDCTJ INTUS/OBSTRJ
|
Facility
|
OP
|
$1,240.80
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
3207428301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$549.55 |
| Max. Negotiated Rate |
$1,178.76 |
| Rate for Payer: Aetna of VT Commercial |
$1,178.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$677.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$549.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$677.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$746.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,054.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,005.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$558.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$986.44
|
| Rate for Payer: Cash Price |
$620.40
|
| Rate for Payer: Cash Price |
$620.40
|
| Rate for Payer: Cigna Commercial |
$992.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$992.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$992.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$558.36
|
| Rate for Payer: Multiplan Commercial |
$1,153.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,054.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$558.36
|
| Rate for Payer: United Healthcare Commercial |
$1,178.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$558.36
|
| Rate for Payer: United Healthcare VA CCN |
$558.36
|
|
|
FL THER NMA RDCTJ INTUS/OBSTRJ
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
CPT 74283 26
|
| Hospital Charge Code |
9727428301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$161.22 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna of VT Commercial |
$345.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$326.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$161.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$326.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$309.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$294.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$163.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$289.38
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cigna Commercial |
$291.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$291.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$291.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$163.80
|
| Rate for Payer: Multiplan Commercial |
$338.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$309.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$163.80
|
| Rate for Payer: United Healthcare Commercial |
$345.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$163.80
|
| Rate for Payer: United Healthcare VA CCN |
$163.80
|
|
|
FL THER NMA RDCTJ INTUS/OBSTRJ
|
Facility
|
IP
|
$1,240.80
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
3207428301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$918.32 |
| Max. Negotiated Rate |
$1,178.76 |
| Rate for Payer: Aetna of VT Commercial |
$1,178.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$918.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$918.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,054.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,042.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$992.64
|
| Rate for Payer: Cash Price |
$620.40
|
| Rate for Payer: Cigna Commercial |
$992.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$992.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$992.64
|
| Rate for Payer: Multiplan Commercial |
$1,153.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,054.68
|
| Rate for Payer: United Healthcare Commercial |
$1,178.76
|
|
|
FL THER NMA RDCTJ INTUS/OBSTRJ
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
CPT 74283 26
|
| Hospital Charge Code |
9727428301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$95.28 |
| Max. Negotiated Rate |
$677.47 |
| Rate for Payer: Aetna of VT Commercial |
$342.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$677.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$98.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$677.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$133.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$152.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$109.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$152.96
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cigna Commercial |
$142.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$95.28
|
| Rate for Payer: Multiplan Commercial |
$338.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$95.28
|
| Rate for Payer: United Healthcare Commercial |
$146.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.28
|
| Rate for Payer: United Healthcare VA CCN |
$95.28
|
|
|
FL THER NMA RDCTJ INTUS/OBSTRJ
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
CPT 74283 26
|
| Hospital Charge Code |
9727428301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$269.40 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna of VT Commercial |
$345.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$269.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$269.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$309.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$305.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$291.20
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cigna Commercial |
$291.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$291.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$291.20
|
| Rate for Payer: Multiplan Commercial |
$338.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$309.40
|
| Rate for Payer: United Healthcare Commercial |
$345.80
|
|
|
FLUID PRESSURE MUSCLE
|
Professional
|
Both
|
$742.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
9822095001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$83.15 |
| Max. Negotiated Rate |
$697.48 |
| Rate for Payer: Aetna of VT Commercial |
$697.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$664.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$85.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$664.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$116.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$384.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$384.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$384.70
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$157.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$396.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$396.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$244.08
|
| Rate for Payer: Multiplan Commercial |
$690.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.15
|
| Rate for Payer: United Healthcare Commercial |
$127.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.15
|
| Rate for Payer: United Healthcare VA CCN |
$83.15
|
|
|
FLUID PRESSURE MUSCLE
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
9812095001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$549.15 |
| Max. Negotiated Rate |
$704.90 |
| Rate for Payer: Aetna of VT Commercial |
$704.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$549.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$549.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$630.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$623.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$593.60
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$593.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$593.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$593.60
|
| Rate for Payer: Multiplan Commercial |
$690.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$630.70
|
| Rate for Payer: United Healthcare Commercial |
$704.90
|
|
|
FLUID PRESSURE MUSCLE
|
Facility
|
OP
|
$816.65
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
4502095001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$361.69 |
| Max. Negotiated Rate |
$775.82 |
| Rate for Payer: Aetna of VT Commercial |
$775.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$731.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$361.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$731.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$491.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$694.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$661.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$367.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$649.24
|
| Rate for Payer: Cash Price |
$408.32
|
| Rate for Payer: Cigna Commercial |
$653.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$653.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$653.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$367.49
|
| Rate for Payer: Multiplan Commercial |
$759.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$694.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$367.49
|
| Rate for Payer: United Healthcare Commercial |
$775.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.49
|
| Rate for Payer: United Healthcare VA CCN |
$367.49
|
|
