|
INSERT AND REMOVE BONE PIN
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
9812065002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$172.29 |
| Max. Negotiated Rate |
$369.55 |
| Rate for Payer: Aetna of VT Commercial |
$369.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$348.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$172.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$348.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$234.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$330.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$315.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$175.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$309.25
|
| Rate for Payer: Cash Price |
$194.50
|
| Rate for Payer: Cigna Commercial |
$311.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$311.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$311.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$175.05
|
| Rate for Payer: Multiplan Commercial |
$361.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$330.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$175.05
|
| Rate for Payer: United Healthcare Commercial |
$369.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$175.05
|
| Rate for Payer: United Healthcare VA CCN |
$175.05
|
|
|
INSERT AND REMOVE BONE PIN
|
Professional
|
Both
|
$389.00
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
9812065001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$159.77 |
| Max. Negotiated Rate |
$379.91 |
| Rate for Payer: Aetna of VT Commercial |
$365.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$348.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$164.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$348.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$223.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$379.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$379.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$183.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$379.91
|
| Rate for Payer: Cash Price |
$194.50
|
| Rate for Payer: Cash Price |
$194.50
|
| Rate for Payer: Cigna Commercial |
$300.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$364.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$364.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$222.08
|
| Rate for Payer: Multiplan Commercial |
$361.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$226.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$159.77
|
| Rate for Payer: United Healthcare Commercial |
$245.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.77
|
| Rate for Payer: United Healthcare VA CCN |
$159.77
|
|
|
INSERT AND REMOVE BONE PIN
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
9822065001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$287.90 |
| Max. Negotiated Rate |
$369.55 |
| Rate for Payer: Aetna of VT Commercial |
$369.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$287.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$287.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$330.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$326.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$311.20
|
| Rate for Payer: Cash Price |
$194.50
|
| Rate for Payer: Cigna Commercial |
$311.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$311.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$311.20
|
| Rate for Payer: Multiplan Commercial |
$361.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$330.65
|
| Rate for Payer: United Healthcare Commercial |
$369.55
|
|
|
INSERT AND REMOVE BONE PIN
|
Facility
|
IP
|
$7,830.82
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
4502065001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,795.59 |
| Max. Negotiated Rate |
$7,439.28 |
| Rate for Payer: Aetna of VT Commercial |
$7,439.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,795.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,795.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,656.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,577.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,264.66
|
| Rate for Payer: Cash Price |
$3,915.41
|
| Rate for Payer: Cigna Commercial |
$6,264.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,264.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,264.66
|
| Rate for Payer: Multiplan Commercial |
$7,282.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,656.20
|
| Rate for Payer: United Healthcare Commercial |
$7,439.28
|
|
|
INSERT AND REMOVE BONE PIN
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
9812065002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$287.90 |
| Max. Negotiated Rate |
$369.55 |
| Rate for Payer: Aetna of VT Commercial |
$369.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$287.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$287.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$330.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$326.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$311.20
|
| Rate for Payer: Cash Price |
$194.50
|
| Rate for Payer: Cigna Commercial |
$311.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$311.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$311.20
|
| Rate for Payer: Multiplan Commercial |
$361.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$330.65
|
| Rate for Payer: United Healthcare Commercial |
$369.55
|
|
|
INSERT AND REMOVE BONE PIN
|
Facility
|
OP
|
$7,830.82
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
4502065001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,468.27 |
| Max. Negotiated Rate |
$7,439.28 |
| Rate for Payer: Aetna of VT Commercial |
$7,439.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7,015.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,468.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7,015.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,714.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,656.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,342.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,523.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,225.50
|
| Rate for Payer: Cash Price |
$3,915.41
|
| Rate for Payer: Cigna Commercial |
$6,264.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,264.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,264.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,523.87
|
| Rate for Payer: Multiplan Commercial |
$7,282.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,656.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,523.87
|
| Rate for Payer: United Healthcare Commercial |
$7,439.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,523.87
|
| Rate for Payer: United Healthcare VA CCN |
$3,523.87
|
|
|
INSERT AND REMOVE BONE PIN
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
9812065001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$172.29 |
| Max. Negotiated Rate |
$369.55 |
| Rate for Payer: Aetna of VT Commercial |
$369.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$348.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$172.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$348.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$234.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$330.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$315.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$175.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$309.25
|
| Rate for Payer: Cash Price |
$194.50
|
| Rate for Payer: Cigna Commercial |
$311.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$311.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$311.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$175.05
|
| Rate for Payer: Multiplan Commercial |
$361.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$330.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$175.05
|
| Rate for Payer: United Healthcare Commercial |
$369.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$175.05
|
| Rate for Payer: United Healthcare VA CCN |
$175.05
|
|
|
INSERT BLADDER CATH COMPLEX
|
Facility
|
IP
|
$631.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
9605170301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$467.00 |
| Max. Negotiated Rate |
$599.45 |
| Rate for Payer: Aetna of VT Commercial |
$599.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$467.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$467.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$536.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$530.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$504.80
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cigna Commercial |
$504.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$504.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$504.80
|
| Rate for Payer: Multiplan Commercial |
$586.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$536.35
|
| Rate for Payer: United Healthcare Commercial |
$599.45
|
|
|
INSERT BLADDER CATH COMPLEX
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
5105170301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$217.59 |
| Max. Negotiated Rate |
$279.30 |
| Rate for Payer: Aetna of VT Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$217.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$217.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$249.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$246.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$235.20
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$235.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$235.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$273.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$249.90
|
| Rate for Payer: United Healthcare Commercial |
$279.30
|
|
|
INSERT BLADDER CATH COMPLEX
|
Facility
|
OP
|
$631.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
9605170301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$279.47 |
| Max. Negotiated Rate |
$599.45 |
| Rate for Payer: Aetna of VT Commercial |
$599.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$565.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$279.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$565.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$379.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$536.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$511.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$283.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$501.64
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cigna Commercial |
$504.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$504.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$504.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$283.95
|
| Rate for Payer: Multiplan Commercial |
$586.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$536.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$283.95
|
| Rate for Payer: United Healthcare Commercial |
$599.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.95
|
| Rate for Payer: United Healthcare VA CCN |
$283.95
|
|
|
INSERT BLADDER CATH COMPLEX
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
9605170302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Aetna of VT Commercial |
$320.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$202.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$272.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$151.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$267.92
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$269.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$151.65
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$151.65
|
| Rate for Payer: United Healthcare Commercial |
$320.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.65
|
| Rate for Payer: United Healthcare VA CCN |
$151.65
|
|
|
INSERT BLADDER CATH COMPLEX
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
9605170302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$70.63 |
| Max. Negotiated Rate |
$316.78 |
| Rate for Payer: Aetna of VT Commercial |
$316.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$98.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$249.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$249.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$249.53
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$122.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$227.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$227.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$140.01
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.63
|
| Rate for Payer: United Healthcare Commercial |
$108.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.63
|
| Rate for Payer: United Healthcare VA CCN |
$70.63
|
|
|
INSERT BLADDER CATH COMPLEX
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
9605170302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$249.41 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Aetna of VT Commercial |
$320.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$249.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$249.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$269.60
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$269.60
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.45
|
| Rate for Payer: United Healthcare Commercial |
$320.15
|
|
|
INSERT BLADDER CATH COMPLEX
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
9825170301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$70.63 |
| Max. Negotiated Rate |
$316.78 |
| Rate for Payer: Aetna of VT Commercial |
$316.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$98.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$249.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$249.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$249.53
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$122.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$227.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$227.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$140.01
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.63
|
| Rate for Payer: United Healthcare Commercial |
$108.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.63
|
| Rate for Payer: United Healthcare VA CCN |
$70.63
|
|
|
INSERT BLADDER CATH COMPLEX
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
9695170301
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Aetna of VT Commercial |
$320.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$202.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$272.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$151.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$267.92
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$269.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$151.65
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$151.65
|
| Rate for Payer: United Healthcare Commercial |
$320.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.65
|
| Rate for Payer: United Healthcare VA CCN |
$151.65
|
|
|
INSERT BLADDER CATH COMPLEX
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
9695170301
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$249.41 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Aetna of VT Commercial |
$320.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$249.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$249.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$269.60
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$269.60
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.45
|
| Rate for Payer: United Healthcare Commercial |
$320.15
|
|
|
INSERT BLADDER CATH COMPLEX
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
9815170302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$70.63 |
| Max. Negotiated Rate |
$316.78 |
| Rate for Payer: Aetna of VT Commercial |
$316.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$98.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$249.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$249.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$249.53
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$122.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$227.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$227.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$140.01
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.63
|
| Rate for Payer: United Healthcare Commercial |
$108.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.63
|
| Rate for Payer: United Healthcare VA CCN |
$70.63
|
|
|
INSERT BLADDER CATH COMPLEX
|
Professional
|
Both
|
$631.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
9605170301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$70.63 |
| Max. Negotiated Rate |
$593.14 |
| Rate for Payer: Aetna of VT Commercial |
$593.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$565.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$565.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$98.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$249.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$249.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$249.53
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cigna Commercial |
$122.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$227.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$227.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$140.01
|
| Rate for Payer: Multiplan Commercial |
$586.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.63
|
| Rate for Payer: United Healthcare Commercial |
$108.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.63
|
| Rate for Payer: United Healthcare VA CCN |
$70.63
|
|
|
INSERT BLADDER CATH COMPLEX
|
Facility
|
IP
|
$293.66
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
4505170301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.34 |
| Max. Negotiated Rate |
$278.98 |
| Rate for Payer: Aetna of VT Commercial |
$278.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$217.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$217.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$249.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$246.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$234.93
|
| Rate for Payer: Cash Price |
$146.83
|
| Rate for Payer: Cigna Commercial |
$234.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$234.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$234.93
|
| Rate for Payer: Multiplan Commercial |
$273.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$249.61
|
| Rate for Payer: United Healthcare Commercial |
$278.98
|
|
|
INSERT BLADDER CATH COMPLEX
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
9815170302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$249.41 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Aetna of VT Commercial |
$320.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$249.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$249.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$269.60
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$269.60
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.45
|
| Rate for Payer: United Healthcare Commercial |
$320.15
|
|
|
INSERT BLADDER CATH COMPLEX
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
5105170301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$130.21 |
| Max. Negotiated Rate |
$279.30 |
| Rate for Payer: Aetna of VT Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$263.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$130.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$263.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$176.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$249.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$238.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$233.73
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$235.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$235.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$235.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$132.30
|
| Rate for Payer: Multiplan Commercial |
$273.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$249.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$132.30
|
| Rate for Payer: United Healthcare Commercial |
$279.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.30
|
| Rate for Payer: United Healthcare VA CCN |
$132.30
|
|
|
INSERT BLADDER CATH COMPLEX
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
9815170301
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Aetna of VT Commercial |
$320.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$202.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$272.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$151.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$267.92
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$269.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$151.65
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$151.65
|
| Rate for Payer: United Healthcare Commercial |
$320.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.65
|
| Rate for Payer: United Healthcare VA CCN |
$151.65
|
|
|
INSERT BLADDER CATH COMPLEX
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
9815170301
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$70.63 |
| Max. Negotiated Rate |
$316.78 |
| Rate for Payer: Aetna of VT Commercial |
$316.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$98.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$249.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$249.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$249.53
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$122.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$227.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$227.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$140.01
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.63
|
| Rate for Payer: United Healthcare Commercial |
$108.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.63
|
| Rate for Payer: United Healthcare VA CCN |
$70.63
|
|
|
INSERT BLADDER CATH COMPLEX
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
9815170301
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$249.41 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Aetna of VT Commercial |
$320.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$249.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$249.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$269.60
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$269.60
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.45
|
| Rate for Payer: United Healthcare Commercial |
$320.15
|
|
|
INSERT BLADDER CATH COMPLEX
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
9815170302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Aetna of VT Commercial |
$320.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$202.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$272.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$151.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$267.92
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$269.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$151.65
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$151.65
|
| Rate for Payer: United Healthcare Commercial |
$320.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.65
|
| Rate for Payer: United Healthcare VA CCN |
$151.65
|
|
