|
INSERT NEEDLE BONE CAVITY
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
9813668002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$94.78 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Aetna of VT Commercial |
$203.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$191.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$94.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$191.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$128.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$181.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$173.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$96.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$170.13
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cigna Commercial |
$171.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$171.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$171.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$96.30
|
| Rate for Payer: Multiplan Commercial |
$199.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$181.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$96.30
|
| Rate for Payer: United Healthcare Commercial |
$203.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.30
|
| Rate for Payer: United Healthcare VA CCN |
$96.30
|
|
|
INSERT NEEDLE BONE CAVITY
|
Facility
|
IP
|
$199.56
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
4503668001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$147.69 |
| Max. Negotiated Rate |
$189.58 |
| Rate for Payer: Aetna of VT Commercial |
$189.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$169.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$167.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.65
|
| Rate for Payer: Cash Price |
$99.78
|
| Rate for Payer: Cigna Commercial |
$159.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$159.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$159.65
|
| Rate for Payer: Multiplan Commercial |
$185.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$169.63
|
| Rate for Payer: United Healthcare Commercial |
$189.58
|
|
|
INSERT NEEDLE BONE CAVITY
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
9813668002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$158.38 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Aetna of VT Commercial |
$203.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$158.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$158.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$181.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$179.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$171.20
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cigna Commercial |
$171.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$171.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$171.20
|
| Rate for Payer: Multiplan Commercial |
$199.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$181.90
|
| Rate for Payer: United Healthcare Commercial |
$203.30
|
|
|
INSERT NEEDLE BONE CAVITY
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
9813668001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$54.22 |
| Max. Negotiated Rate |
$201.16 |
| Rate for Payer: Aetna of VT Commercial |
$201.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$191.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$191.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$75.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$138.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$138.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$138.28
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cigna Commercial |
$98.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.22
|
| Rate for Payer: Multiplan Commercial |
$199.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$76.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$54.22
|
| Rate for Payer: United Healthcare Commercial |
$83.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.22
|
| Rate for Payer: United Healthcare VA CCN |
$54.22
|
|
|
INSERT NEEDLE BONE CAVITY
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
9813668001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$94.78 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Aetna of VT Commercial |
$203.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$191.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$94.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$191.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$128.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$181.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$173.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$96.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$170.13
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cigna Commercial |
$171.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$171.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$171.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$96.30
|
| Rate for Payer: Multiplan Commercial |
$199.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$181.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$96.30
|
| Rate for Payer: United Healthcare Commercial |
$203.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.30
|
| Rate for Payer: United Healthcare VA CCN |
$96.30
|
|
|
INSERT NON-TUNNEL CV CATH
|
Facility
|
OP
|
$1,478.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
9823655601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$654.61 |
| Max. Negotiated Rate |
$1,404.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,404.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,324.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$654.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,324.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$889.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,256.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,197.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$665.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,175.01
|
| Rate for Payer: Cash Price |
$739.00
|
| Rate for Payer: Cigna Commercial |
$1,182.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,182.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,182.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$665.10
|
| Rate for Payer: Multiplan Commercial |
$1,374.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,256.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$665.10
|
| Rate for Payer: United Healthcare Commercial |
$1,404.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$665.10
|
| Rate for Payer: United Healthcare VA CCN |
$665.10
|
|
|
INSERT NON-TUNNEL CV CATH
|
Professional
|
Both
|
$1,478.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
9823655601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$1,389.32 |
| Rate for Payer: Aetna of VT Commercial |
$1,389.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,324.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,324.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$383.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$383.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$383.19
|
| Rate for Payer: Cash Price |
$739.00
|
| Rate for Payer: Cash Price |
$739.00
|
| Rate for Payer: Cigna Commercial |
$141.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$319.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$319.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.81
|
| Rate for Payer: Multiplan Commercial |
$1,374.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$109.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$118.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.00
|
| Rate for Payer: United Healthcare VA CCN |
$77.00
|
|
|
INSERT NON-TUNNEL CV CATH
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
9823655501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$459.60 |
| Max. Negotiated Rate |
$589.95 |
| Rate for Payer: Aetna of VT Commercial |
$589.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$459.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$459.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$527.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$521.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$496.80
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$496.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$496.80
|
| Rate for Payer: Multiplan Commercial |
$577.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$527.85
|
| Rate for Payer: United Healthcare Commercial |
$589.95
|
|
|
INSERT NON-TUNNEL CV CATH
|
Facility
|
IP
|
$1,478.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
9823655601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,093.87 |
| Max. Negotiated Rate |
$1,404.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,404.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,093.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,093.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,256.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,241.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,182.40
|
| Rate for Payer: Cash Price |
$739.00
|
| Rate for Payer: Cigna Commercial |
$1,182.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,182.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,182.40
|
| Rate for Payer: Multiplan Commercial |
$1,374.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,256.30
|
| Rate for Payer: United Healthcare Commercial |
$1,404.10
|
|
|
INSERT NON-TUNNEL CV CATH
|
Facility
|
IP
|
$3,134.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
9603655601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,319.47 |
| Max. Negotiated Rate |
$2,977.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,977.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,319.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,319.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,663.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,632.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,507.20
|
| Rate for Payer: Cash Price |
$1,567.00
|
| Rate for Payer: Cigna Commercial |
$2,507.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,507.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,507.20
|
| Rate for Payer: Multiplan Commercial |
$2,914.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,663.90
|
| Rate for Payer: United Healthcare Commercial |
$2,977.30
|
|
|
INSERT NON-TUNNEL CV CATH
|
Professional
|
Both
|
$1,657.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
5103655601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$1,557.58 |
| Rate for Payer: Aetna of VT Commercial |
$1,557.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,484.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,484.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$383.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$383.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$383.19
|
| Rate for Payer: Cash Price |
$828.50
|
| Rate for Payer: Cash Price |
$828.50
|
| Rate for Payer: Cigna Commercial |
$141.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$319.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$319.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.81
|
| Rate for Payer: Multiplan Commercial |
$1,541.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$109.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$118.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.00
|
| Rate for Payer: United Healthcare VA CCN |
$77.00
|
|
|
INSERT NON-TUNNEL CV CATH
|
Professional
|
Both
|
$1,478.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
9603655602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$1,389.32 |
| Rate for Payer: Aetna of VT Commercial |
$1,389.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,324.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,324.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$383.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$383.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$383.19
|
| Rate for Payer: Cash Price |
$739.00
|
| Rate for Payer: Cash Price |
$739.00
|
| Rate for Payer: Cigna Commercial |
$141.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$319.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$319.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.81
|
| Rate for Payer: Multiplan Commercial |
$1,374.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$109.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$118.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.00
|
| Rate for Payer: United Healthcare VA CCN |
$77.00
|
|
|
INSERT NON-TUNNEL CV CATH
|
Facility
|
OP
|
$1,478.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
9603655602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$654.61 |
| Max. Negotiated Rate |
$1,404.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,404.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,324.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$654.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,324.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$889.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,256.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,197.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$665.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,175.01
|
| Rate for Payer: Cash Price |
$739.00
|
| Rate for Payer: Cigna Commercial |
$1,182.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,182.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,182.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$665.10
|
| Rate for Payer: Multiplan Commercial |
$1,374.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,256.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$665.10
|
| Rate for Payer: United Healthcare Commercial |
$1,404.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$665.10
|
| Rate for Payer: United Healthcare VA CCN |
$665.10
|
|
|
INSERT NON-TUNNEL CV CATH
|
Facility
|
IP
|
$1,478.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
9603655602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,093.87 |
| Max. Negotiated Rate |
$1,404.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,404.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,093.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,093.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,256.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,241.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,182.40
|
| Rate for Payer: Cash Price |
$739.00
|
| Rate for Payer: Cigna Commercial |
$1,182.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,182.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,182.40
|
| Rate for Payer: Multiplan Commercial |
$1,374.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,256.30
|
| Rate for Payer: United Healthcare Commercial |
$1,404.10
|
|
|
INSERT NON-TUNNEL CV CATH
|
Facility
|
OP
|
$1,657.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
5103655601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$733.89 |
| Max. Negotiated Rate |
$1,574.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,574.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,484.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$733.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,484.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$997.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,408.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,342.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$745.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,317.32
|
| Rate for Payer: Cash Price |
$828.50
|
| Rate for Payer: Cigna Commercial |
$1,325.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,325.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,325.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$745.65
|
| Rate for Payer: Multiplan Commercial |
$1,541.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,408.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$745.65
|
| Rate for Payer: United Healthcare Commercial |
$1,574.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$745.65
|
| Rate for Payer: United Healthcare VA CCN |
$745.65
|
|
|
INSERT NON-TUNNEL CV CATH
|
Facility
|
IP
|
$1,657.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
5103655601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,226.35 |
| Max. Negotiated Rate |
$1,574.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,574.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,226.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,226.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,408.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,391.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,325.60
|
| Rate for Payer: Cash Price |
$828.50
|
| Rate for Payer: Cigna Commercial |
$1,325.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,325.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,325.60
|
| Rate for Payer: Multiplan Commercial |
$1,541.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,408.45
|
| Rate for Payer: United Healthcare Commercial |
$1,574.15
|
|
|
INSERT NON-TUNNEL CV CATH
|
Professional
|
Both
|
$621.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
9823655501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$77.96 |
| Max. Negotiated Rate |
$583.74 |
| Rate for Payer: Aetna of VT Commercial |
$583.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$556.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$80.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$556.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$109.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$337.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$337.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$89.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.95
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cigna Commercial |
$142.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$283.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$283.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$174.96
|
| Rate for Payer: Multiplan Commercial |
$577.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$77.96
|
| Rate for Payer: United Healthcare Commercial |
$119.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.96
|
| Rate for Payer: United Healthcare VA CCN |
$77.96
|
|
|
INSERT NON-TUNNEL CV CATH
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
9823655501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$275.04 |
| Max. Negotiated Rate |
$589.95 |
| Rate for Payer: Aetna of VT Commercial |
$589.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$556.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$275.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$556.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$373.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$527.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$503.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$279.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$493.69
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$496.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$496.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$279.45
|
| Rate for Payer: Multiplan Commercial |
$577.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$527.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$279.45
|
| Rate for Payer: United Healthcare Commercial |
$589.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$279.45
|
| Rate for Payer: United Healthcare VA CCN |
$279.45
|
|
|
INSERT NON-TUNNEL CV CATH
|
Professional
|
Both
|
$3,134.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
9603655601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$2,945.96 |
| Rate for Payer: Aetna of VT Commercial |
$2,945.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,807.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,807.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$383.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$383.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$383.19
|
| Rate for Payer: Cash Price |
$1,567.00
|
| Rate for Payer: Cash Price |
$1,567.00
|
| Rate for Payer: Cigna Commercial |
$141.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$319.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$319.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.81
|
| Rate for Payer: Multiplan Commercial |
$2,914.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$109.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$118.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.00
|
| Rate for Payer: United Healthcare VA CCN |
$77.00
|
|
|
INSERT NON-TUNNEL CV CATH
|
Facility
|
OP
|
$3,134.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
9603655601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,388.05 |
| Max. Negotiated Rate |
$2,977.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,977.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,807.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,388.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,807.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,886.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,663.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,538.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,410.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,491.53
|
| Rate for Payer: Cash Price |
$1,567.00
|
| Rate for Payer: Cigna Commercial |
$2,507.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,507.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,507.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,410.30
|
| Rate for Payer: Multiplan Commercial |
$2,914.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,663.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,410.30
|
| Rate for Payer: United Healthcare Commercial |
$2,977.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,410.30
|
| Rate for Payer: United Healthcare VA CCN |
$1,410.30
|
|
|
INSERT PESSARY/OTHER DEVICE
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
5105716001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.22 |
| Max. Negotiated Rate |
$131.60 |
| Rate for Payer: Aetna of VT Commercial |
$131.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$43.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$59.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$48.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.15
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$74.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$114.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$114.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.52
|
| Rate for Payer: Multiplan Commercial |
$130.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$42.22
|
| Rate for Payer: United Healthcare Commercial |
$64.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.22
|
| Rate for Payer: United Healthcare VA CCN |
$42.22
|
|
|
INSERT PESSARY/OTHER DEVICE
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
9605716002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.22 |
| Max. Negotiated Rate |
$146.64 |
| Rate for Payer: Aetna of VT Commercial |
$146.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$43.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$59.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$48.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.15
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$74.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$114.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$114.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.52
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$42.22
|
| Rate for Payer: United Healthcare Commercial |
$64.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.22
|
| Rate for Payer: United Healthcare VA CCN |
$42.22
|
|
|
INSERT PESSARY/OTHER DEVICE
|
Professional
|
Both
|
$139.59
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
4505716001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.22 |
| Max. Negotiated Rate |
$131.21 |
| Rate for Payer: Aetna of VT Commercial |
$131.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$43.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$59.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$48.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.15
|
| Rate for Payer: Cash Price |
$69.80
|
| Rate for Payer: Cash Price |
$69.80
|
| Rate for Payer: Cigna Commercial |
$74.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$114.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$114.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.52
|
| Rate for Payer: Multiplan Commercial |
$129.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$42.22
|
| Rate for Payer: United Healthcare Commercial |
$64.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.22
|
| Rate for Payer: United Healthcare VA CCN |
$42.22
|
|
|
INSERT PESSARY/OTHER DEVICE
|
Facility
|
IP
|
$139.59
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
4505716001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.31 |
| Max. Negotiated Rate |
$132.61 |
| Rate for Payer: Aetna of VT Commercial |
$132.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$117.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$111.67
|
| Rate for Payer: Cash Price |
$69.80
|
| Rate for Payer: Cigna Commercial |
$111.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$111.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$111.67
|
| Rate for Payer: Multiplan Commercial |
$129.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.65
|
| Rate for Payer: United Healthcare Commercial |
$132.61
|
|
|
INSERT PESSARY/OTHER DEVICE
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
9605716001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$218.33 |
| Max. Negotiated Rate |
$280.25 |
| Rate for Payer: Aetna of VT Commercial |
$280.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$218.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$218.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$250.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$247.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$236.00
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$236.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.00
|
| Rate for Payer: Multiplan Commercial |
$274.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.75
|
| Rate for Payer: United Healthcare Commercial |
$280.25
|
|
