|
INSERT ELECTRD/PM CATH SNGL
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
9813321002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$254.67 |
| Max. Negotiated Rate |
$546.25 |
| Rate for Payer: Aetna of VT Commercial |
$546.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$515.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$254.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$515.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$346.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$488.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$465.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$258.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$457.12
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$460.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$460.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$460.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$258.75
|
| Rate for Payer: Multiplan Commercial |
$534.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$488.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$258.75
|
| Rate for Payer: United Healthcare Commercial |
$546.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$258.75
|
| Rate for Payer: United Healthcare VA CCN |
$258.75
|
|
|
INSERT ELECTRD/PM CATH SNGL
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
9813321001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$425.56 |
| Max. Negotiated Rate |
$546.25 |
| Rate for Payer: Aetna of VT Commercial |
$546.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$425.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$425.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$488.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$483.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$460.00
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$460.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$460.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$534.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$488.75
|
| Rate for Payer: United Healthcare Commercial |
$546.25
|
|
|
INSERT ELECTRD/PM CATH SNGL
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
9823321001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$425.56 |
| Max. Negotiated Rate |
$546.25 |
| Rate for Payer: Aetna of VT Commercial |
$546.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$425.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$425.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$488.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$483.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$460.00
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$460.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$460.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$534.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$488.75
|
| Rate for Payer: United Healthcare Commercial |
$546.25
|
|
|
INSERT ELECTRD/PM CATH SNGL
|
Facility
|
OP
|
$5,250.65
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
4503321001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,325.51 |
| Max. Negotiated Rate |
$4,988.12 |
| Rate for Payer: Aetna of VT Commercial |
$4,988.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,704.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,325.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,704.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,160.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,463.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,253.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,362.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,174.27
|
| Rate for Payer: Cash Price |
$2,625.32
|
| Rate for Payer: Cigna Commercial |
$4,200.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,200.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,200.52
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,362.79
|
| Rate for Payer: Multiplan Commercial |
$4,883.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,463.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,362.79
|
| Rate for Payer: United Healthcare Commercial |
$4,988.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,362.79
|
| Rate for Payer: United Healthcare VA CCN |
$2,362.79
|
|
|
INSERT ELECTRD/PM CATH SNGL
|
Facility
|
IP
|
$5,250.65
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
4503321001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,886.01 |
| Max. Negotiated Rate |
$4,988.12 |
| Rate for Payer: Aetna of VT Commercial |
$4,988.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,886.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,886.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,463.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,410.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,200.52
|
| Rate for Payer: Cash Price |
$2,625.32
|
| Rate for Payer: Cigna Commercial |
$4,200.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,200.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,200.52
|
| Rate for Payer: Multiplan Commercial |
$4,883.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,463.05
|
| Rate for Payer: United Healthcare Commercial |
$4,988.12
|
|
|
INSERT ELECTRD/PM CATH SNGL
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
9813321001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$143.26 |
| Max. Negotiated Rate |
$540.50 |
| Rate for Payer: Aetna of VT Commercial |
$540.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$515.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$147.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$515.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$200.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$307.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$307.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$164.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$307.28
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$260.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$243.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$243.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$143.26
|
| Rate for Payer: Multiplan Commercial |
$534.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$203.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$143.26
|
| Rate for Payer: United Healthcare Commercial |
$220.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$143.26
|
| Rate for Payer: United Healthcare VA CCN |
$143.26
|
|
|
INSERT ELECTRD/PM CATH SNGL
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
9813321002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$425.56 |
| Max. Negotiated Rate |
$546.25 |
| Rate for Payer: Aetna of VT Commercial |
$546.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$425.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$425.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$488.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$483.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$460.00
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$460.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$460.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$534.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$488.75
|
| Rate for Payer: United Healthcare Commercial |
$546.25
|
|
|
INSERT ELECTRD/PM CATH SNGL
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
9813321002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$143.26 |
| Max. Negotiated Rate |
$540.50 |
| Rate for Payer: Aetna of VT Commercial |
$540.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$515.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$147.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$515.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$200.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$307.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$307.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$164.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$307.28
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$260.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$243.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$243.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$143.26
|
| Rate for Payer: Multiplan Commercial |
$534.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$203.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$143.26
|
| Rate for Payer: United Healthcare Commercial |
$220.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$143.26
|
| Rate for Payer: United Healthcare VA CCN |
$143.26
|
|
|
INSERT ELECTRD/PM CATH SNGL
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
9823321001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$254.67 |
| Max. Negotiated Rate |
$546.25 |
| Rate for Payer: Aetna of VT Commercial |
$546.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$515.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$254.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$515.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$346.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$488.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$465.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$258.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$457.12
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$460.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$460.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$460.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$258.75
|
| Rate for Payer: Multiplan Commercial |
$534.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$488.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$258.75
|
| Rate for Payer: United Healthcare Commercial |
$546.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$258.75
|
| Rate for Payer: United Healthcare VA CCN |
$258.75
|
|
|
INSERT EMERGENCY AIRWAY
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
5103150001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$129.33 |
| Max. Negotiated Rate |
$445.56 |
| Rate for Payer: Aetna of VT Commercial |
$445.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$424.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$133.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$424.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$181.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$174.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$174.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$148.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$174.31
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$204.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$129.33
|
| Rate for Payer: Multiplan Commercial |
$440.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$183.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$129.33
|
| Rate for Payer: United Healthcare Commercial |
$198.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.33
|
| Rate for Payer: United Healthcare VA CCN |
$129.33
|
|
|
INSERT EMERGENCY AIRWAY
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
9813150002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$279.76 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna of VT Commercial |
$359.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$279.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$279.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$321.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$317.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$302.40
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$302.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$302.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$302.40
|
| Rate for Payer: Multiplan Commercial |
$351.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$321.30
|
| Rate for Payer: United Healthcare Commercial |
$359.10
|
|
|
INSERT EMERGENCY AIRWAY
|
Facility
|
OP
|
$473.95
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
4103150001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$209.91 |
| Max. Negotiated Rate |
$450.25 |
| Rate for Payer: Aetna of VT Commercial |
$450.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$424.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$209.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$424.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$285.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$402.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$383.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$213.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$376.79
|
| Rate for Payer: Cash Price |
$236.98
|
| Rate for Payer: Cigna Commercial |
$379.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$379.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$379.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$213.28
|
| Rate for Payer: Multiplan Commercial |
$440.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$402.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$213.28
|
| Rate for Payer: United Healthcare Commercial |
$450.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$213.28
|
| Rate for Payer: United Healthcare VA CCN |
$213.28
|
|
|
INSERT EMERGENCY AIRWAY
|
Facility
|
OP
|
$473.95
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
4503150001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$209.91 |
| Max. Negotiated Rate |
$450.25 |
| Rate for Payer: Aetna of VT Commercial |
$450.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$424.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$209.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$424.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$285.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$402.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$383.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$213.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$376.79
|
| Rate for Payer: Cash Price |
$236.98
|
| Rate for Payer: Cigna Commercial |
$379.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$379.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$379.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$213.28
|
| Rate for Payer: Multiplan Commercial |
$440.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$402.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$213.28
|
| Rate for Payer: United Healthcare Commercial |
$450.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$213.28
|
| Rate for Payer: United Healthcare VA CCN |
$213.28
|
|
|
INSERT EMERGENCY AIRWAY
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
9813150001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$167.42 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna of VT Commercial |
$359.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$167.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$227.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$321.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$306.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$300.51
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$302.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$302.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$302.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$170.10
|
| Rate for Payer: Multiplan Commercial |
$351.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$321.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$170.10
|
| Rate for Payer: United Healthcare Commercial |
$359.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$170.10
|
| Rate for Payer: United Healthcare VA CCN |
$170.10
|
|
|
INSERT EMERGENCY AIRWAY
|
Facility
|
IP
|
$852.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
9603150001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$630.57 |
| Max. Negotiated Rate |
$809.40 |
| Rate for Payer: Aetna of VT Commercial |
$809.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$630.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$630.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$724.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$715.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$681.60
|
| Rate for Payer: Cash Price |
$426.00
|
| Rate for Payer: Cigna Commercial |
$681.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$681.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$681.60
|
| Rate for Payer: Multiplan Commercial |
$792.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$724.20
|
| Rate for Payer: United Healthcare Commercial |
$809.40
|
|
|
INSERT EMERGENCY AIRWAY
|
Facility
|
IP
|
$473.95
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
4103150001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$350.77 |
| Max. Negotiated Rate |
$450.25 |
| Rate for Payer: Aetna of VT Commercial |
$450.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$350.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$350.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$402.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$398.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$379.16
|
| Rate for Payer: Cash Price |
$236.98
|
| Rate for Payer: Cigna Commercial |
$379.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$379.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$379.16
|
| Rate for Payer: Multiplan Commercial |
$440.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$402.86
|
| Rate for Payer: United Healthcare Commercial |
$450.25
|
|
|
INSERT EMERGENCY AIRWAY
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
9813150001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$279.76 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna of VT Commercial |
$359.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$279.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$279.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$321.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$317.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$302.40
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$302.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$302.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$302.40
|
| Rate for Payer: Multiplan Commercial |
$351.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$321.30
|
| Rate for Payer: United Healthcare Commercial |
$359.10
|
|
|
INSERT EMERGENCY AIRWAY
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
9813150002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$167.42 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna of VT Commercial |
$359.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$167.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$227.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$321.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$306.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$300.51
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$302.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$302.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$302.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$170.10
|
| Rate for Payer: Multiplan Commercial |
$351.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$321.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$170.10
|
| Rate for Payer: United Healthcare Commercial |
$359.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$170.10
|
| Rate for Payer: United Healthcare VA CCN |
$170.10
|
|
|
INSERT EMERGENCY AIRWAY
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
5103150001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$350.81 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Aetna of VT Commercial |
$450.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$350.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$350.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$402.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$398.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$379.20
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$379.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$379.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$379.20
|
| Rate for Payer: Multiplan Commercial |
$440.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$402.90
|
| Rate for Payer: United Healthcare Commercial |
$450.30
|
|
|
INSERT EMERGENCY AIRWAY
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
9603150002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$167.42 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna of VT Commercial |
$359.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$167.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$227.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$321.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$306.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$300.51
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$302.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$302.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$302.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$170.10
|
| Rate for Payer: Multiplan Commercial |
$351.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$321.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$170.10
|
| Rate for Payer: United Healthcare Commercial |
$359.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$170.10
|
| Rate for Payer: United Healthcare VA CCN |
$170.10
|
|
|
INSERT EMERGENCY AIRWAY
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
9603150002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$279.76 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna of VT Commercial |
$359.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$279.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$279.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$321.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$317.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$302.40
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$302.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$302.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$302.40
|
| Rate for Payer: Multiplan Commercial |
$351.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$321.30
|
| Rate for Payer: United Healthcare Commercial |
$359.10
|
|
|
INSERT EMERGENCY AIRWAY
|
Professional
|
Both
|
$852.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
9603150001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$129.33 |
| Max. Negotiated Rate |
$800.88 |
| Rate for Payer: Aetna of VT Commercial |
$800.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$763.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$133.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$763.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$181.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$174.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$174.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$148.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$174.31
|
| Rate for Payer: Cash Price |
$426.00
|
| Rate for Payer: Cash Price |
$426.00
|
| Rate for Payer: Cigna Commercial |
$204.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$129.33
|
| Rate for Payer: Multiplan Commercial |
$792.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$183.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$129.33
|
| Rate for Payer: United Healthcare Commercial |
$198.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.33
|
| Rate for Payer: United Healthcare VA CCN |
$129.33
|
|
|
INSERT EMERGENCY AIRWAY
|
Facility
|
OP
|
$852.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
9603150001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$377.35 |
| Max. Negotiated Rate |
$809.40 |
| Rate for Payer: Aetna of VT Commercial |
$809.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$763.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$377.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$763.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$512.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$724.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$690.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$383.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$677.34
|
| Rate for Payer: Cash Price |
$426.00
|
| Rate for Payer: Cigna Commercial |
$681.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$681.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$681.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$383.40
|
| Rate for Payer: Multiplan Commercial |
$792.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$724.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$383.40
|
| Rate for Payer: United Healthcare Commercial |
$809.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$383.40
|
| Rate for Payer: United Healthcare VA CCN |
$383.40
|
|
|
INSERT EMERGENCY AIRWAY
|
Facility
|
IP
|
$473.95
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
4503150001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$350.77 |
| Max. Negotiated Rate |
$450.25 |
| Rate for Payer: Aetna of VT Commercial |
$450.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$350.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$350.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$402.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$398.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$379.16
|
| Rate for Payer: Cash Price |
$236.98
|
| Rate for Payer: Cigna Commercial |
$379.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$379.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$379.16
|
| Rate for Payer: Multiplan Commercial |
$440.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$402.86
|
| Rate for Payer: United Healthcare Commercial |
$450.25
|
|
|
INSERT EMERGENCY AIRWAY
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
9813150002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$129.33 |
| Max. Negotiated Rate |
$355.32 |
| Rate for Payer: Aetna of VT Commercial |
$355.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$133.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$181.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$174.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$174.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$148.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$174.31
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$204.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$129.33
|
| Rate for Payer: Multiplan Commercial |
$351.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$183.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$129.33
|
| Rate for Payer: United Healthcare Commercial |
$198.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.33
|
| Rate for Payer: United Healthcare VA CCN |
$129.33
|
|
