|
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
|
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
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
9603150002
|
|
Hospital Revenue Code
|
960
|
| 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
|
|
|
INSERT INTRAUTERINE DEVICE
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
9605830001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$183.80 |
| Max. Negotiated Rate |
$394.25 |
| Rate for Payer: Aetna of VT Commercial |
$394.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$371.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$183.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$371.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$249.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$352.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$336.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$186.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$329.93
|
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$332.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$332.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$186.75
|
| Rate for Payer: Multiplan Commercial |
$385.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$352.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$186.75
|
| Rate for Payer: United Healthcare Commercial |
$394.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.75
|
| Rate for Payer: United Healthcare VA CCN |
$186.75
|
|
|
INSERT INTRAUTERINE DEVICE
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
9605830001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$307.14 |
| Max. Negotiated Rate |
$394.25 |
| Rate for Payer: Aetna of VT Commercial |
$394.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$307.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$307.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$352.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$348.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$332.00
|
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$332.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$332.00
|
| Rate for Payer: Multiplan Commercial |
$385.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$352.75
|
| Rate for Payer: United Healthcare Commercial |
$394.25
|
|
|
INSERT INTRAUTERINE DEVICE
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
9825830001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$194.65 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Aetna of VT Commercial |
$249.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$194.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$194.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$223.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$210.40
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$210.40
|
| Rate for Payer: Multiplan Commercial |
$244.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$223.55
|
| Rate for Payer: United Healthcare Commercial |
$249.85
|
|
|
INSERT INTRAUTERINE DEVICE
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
9605830002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$194.65 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Aetna of VT Commercial |
$249.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$194.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$194.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$223.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$210.40
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$210.40
|
| Rate for Payer: Multiplan Commercial |
$244.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$223.55
|
| Rate for Payer: United Healthcare Commercial |
$249.85
|
|
|
INSERT INTRAUTERINE DEVICE
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
5105830001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Aetna of VT Commercial |
$144.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$127.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$121.60
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$121.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$121.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$121.60
|
| Rate for Payer: Multiplan Commercial |
$141.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$129.20
|
| Rate for Payer: United Healthcare Commercial |
$144.40
|
|
|
INSERT INTRAUTERINE DEVICE
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
5105830001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$171.16 |
| Rate for Payer: Aetna of VT Commercial |
$142.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$136.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$136.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$171.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$171.16
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$167.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$167.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$103.09
|
| Rate for Payer: Multiplan Commercial |
$141.36
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare VA CCN |
$49.66
|
|
|
INSERT INTRAUTERINE DEVICE
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
9605830001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$390.10 |
| Rate for Payer: Aetna of VT Commercial |
$390.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$371.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$371.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$171.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$171.16
|
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Cigna Commercial |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$167.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$167.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$103.09
|
| Rate for Payer: Multiplan Commercial |
$385.95
|
| Rate for Payer: United Healthcare Commercial |
$352.75
|
| Rate for Payer: United Healthcare VA CCN |
$49.66
|
|
|
INSERT INTRAUTERINE DEVICE
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
9605830002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$247.22 |
| Rate for Payer: Aetna of VT Commercial |
$247.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$171.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$171.16
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$167.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$167.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$103.09
|
| Rate for Payer: Multiplan Commercial |
$244.59
|
| Rate for Payer: United Healthcare Commercial |
$223.55
|
| Rate for Payer: United Healthcare VA CCN |
$49.66
|
|
|
INSERT INTRAUTERINE DEVICE
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
9605830002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$116.48 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Aetna of VT Commercial |
$249.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$158.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$223.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$213.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$209.09
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$210.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$118.35
|
| Rate for Payer: Multiplan Commercial |
$244.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$223.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$118.35
|
| Rate for Payer: United Healthcare Commercial |
$249.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.35
|
| Rate for Payer: United Healthcare VA CCN |
$118.35
|
|
|
INSERT INTRAUTERINE DEVICE
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
9825830001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$247.22 |
| Rate for Payer: Aetna of VT Commercial |
$247.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$171.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$171.16
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$167.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$167.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$103.09
|
| Rate for Payer: Multiplan Commercial |
$244.59
|
| Rate for Payer: United Healthcare Commercial |
$223.55
|
| Rate for Payer: United Healthcare VA CCN |
$49.66
|
|
|
INSERT INTRAUTERINE DEVICE
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
9825830001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$116.48 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Aetna of VT Commercial |
$249.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$158.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$223.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$213.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$209.09
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$210.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$118.35
|
| Rate for Payer: Multiplan Commercial |
$244.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$223.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$118.35
|
| Rate for Payer: United Healthcare Commercial |
$249.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.35
|
| Rate for Payer: United Healthcare VA CCN |
$118.35
|
|
|
INSERT INTRAUTERINE DEVICE
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
5105830001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.32 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Aetna of VT Commercial |
$144.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$136.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$67.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$136.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$123.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$68.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$120.84
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$121.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$121.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$121.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$68.40
|
| Rate for Payer: Multiplan Commercial |
$141.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$129.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$68.40
|
| Rate for Payer: United Healthcare Commercial |
$144.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.40
|
| Rate for Payer: United Healthcare VA CCN |
$68.40
|
|
|
INSERTION CATHETER ARTERY
|
Professional
|
Both
|
$373.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
9813662002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$350.62 |
| Rate for Payer: Aetna of VT Commercial |
$350.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$334.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$41.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$334.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$56.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$78.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.82
|
| Rate for Payer: Cash Price |
$186.50
|
| Rate for Payer: Cash Price |
$186.50
|
| Rate for Payer: Cigna Commercial |
$74.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$40.44
|
| Rate for Payer: Multiplan Commercial |
$346.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.43
|
| Rate for Payer: United Healthcare Commercial |
$62.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.43
|
| Rate for Payer: United Healthcare VA CCN |
$40.43
|
|
|
INSERTION CATHETER ARTERY
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
9813662002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Aetna of VT Commercial |
$354.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$334.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$165.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$334.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$224.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$317.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$302.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$167.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$296.54
|
| Rate for Payer: Cash Price |
$186.50
|
| Rate for Payer: Cigna Commercial |
$298.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$298.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$298.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$167.85
|
| Rate for Payer: Multiplan Commercial |
$346.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$317.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$167.85
|
| Rate for Payer: United Healthcare Commercial |
$354.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$167.85
|
| Rate for Payer: United Healthcare VA CCN |
$167.85
|
|
|
INSERTION CATHETER ARTERY
|
Facility
|
IP
|
$327.93
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
4503662001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$242.70 |
| Max. Negotiated Rate |
$311.53 |
| Rate for Payer: Aetna of VT Commercial |
$311.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$242.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$242.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$278.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$275.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$262.34
|
| Rate for Payer: Cash Price |
$163.96
|
| Rate for Payer: Cigna Commercial |
$262.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$262.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$262.34
|
| Rate for Payer: Multiplan Commercial |
$304.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$278.74
|
| Rate for Payer: United Healthcare Commercial |
$311.53
|
|
|
INSERTION CATHETER ARTERY
|
Professional
|
Both
|
$373.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
9813662001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$350.62 |
| Rate for Payer: Aetna of VT Commercial |
$350.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$334.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$41.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$334.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$56.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$78.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.82
|
| Rate for Payer: Cash Price |
$186.50
|
| Rate for Payer: Cash Price |
$186.50
|
| Rate for Payer: Cigna Commercial |
$74.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$40.44
|
| Rate for Payer: Multiplan Commercial |
$346.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.43
|
| Rate for Payer: United Healthcare Commercial |
$62.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.43
|
| Rate for Payer: United Healthcare VA CCN |
$40.43
|
|
|
INSERTION CATHETER ARTERY
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
9823662001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$276.06 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Aetna of VT Commercial |
$354.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$317.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$313.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$298.40
|
| Rate for Payer: Cash Price |
$186.50
|
| Rate for Payer: Cigna Commercial |
$298.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$298.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$298.40
|
| Rate for Payer: Multiplan Commercial |
$346.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$317.05
|
| Rate for Payer: United Healthcare Commercial |
$354.35
|
|
|
INSERTION CATHETER ARTERY
|
Facility
|
OP
|
$178.57
|
|
|
Service Code
|
CPT 36660
|
| Hospital Charge Code |
3603666001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$79.09 |
| Max. Negotiated Rate |
$169.64 |
| Rate for Payer: Aetna of VT Commercial |
$169.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$159.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$159.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$151.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$141.96
|
| Rate for Payer: Cash Price |
$89.28
|
| Rate for Payer: Cigna Commercial |
$142.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$142.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$142.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.36
|
| Rate for Payer: Multiplan Commercial |
$166.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.36
|
| Rate for Payer: United Healthcare Commercial |
$169.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.36
|
| Rate for Payer: United Healthcare VA CCN |
$80.36
|
|
|
INSERTION CATHETER ARTERY
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
9813662001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$276.06 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Aetna of VT Commercial |
$354.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$317.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$313.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$298.40
|
| Rate for Payer: Cash Price |
$186.50
|
| Rate for Payer: Cigna Commercial |
$298.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$298.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$298.40
|
| Rate for Payer: Multiplan Commercial |
$346.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$317.05
|
| Rate for Payer: United Healthcare Commercial |
$354.35
|
|
|
INSERTION CATHETER ARTERY
|
Professional
|
Both
|
$373.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
9823662001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$350.62 |
| Rate for Payer: Aetna of VT Commercial |
$350.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$334.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$41.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$334.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$56.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$78.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.82
|
| Rate for Payer: Cash Price |
$186.50
|
| Rate for Payer: Cash Price |
$186.50
|
| Rate for Payer: Cigna Commercial |
$74.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$40.44
|
| Rate for Payer: Multiplan Commercial |
$346.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.43
|
| Rate for Payer: United Healthcare Commercial |
$62.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.43
|
| Rate for Payer: United Healthcare VA CCN |
$40.43
|
|
|
INSERTION CATHETER ARTERY
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
9813662002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$276.06 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Aetna of VT Commercial |
$354.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$317.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$313.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$298.40
|
| Rate for Payer: Cash Price |
$186.50
|
| Rate for Payer: Cigna Commercial |
$298.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$298.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$298.40
|
| Rate for Payer: Multiplan Commercial |
$346.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$317.05
|
| Rate for Payer: United Healthcare Commercial |
$354.35
|
|
|
INSERTION CATHETER ARTERY
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
9823662001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Aetna of VT Commercial |
$354.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$334.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$165.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$334.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$224.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$317.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$302.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$167.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$296.54
|
| Rate for Payer: Cash Price |
$186.50
|
| Rate for Payer: Cigna Commercial |
$298.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$298.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$298.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$167.85
|
| Rate for Payer: Multiplan Commercial |
$346.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$317.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$167.85
|
| Rate for Payer: United Healthcare Commercial |
$354.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$167.85
|
| Rate for Payer: United Healthcare VA CCN |
$167.85
|
|
