|
INSERT PESSARY/OTHER DEVICE
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
5105716001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.61 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of VT Commercial |
$133.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$119.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$112.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$130.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$119.00
|
| Rate for Payer: United Healthcare Commercial |
$133.00
|
|
|
INSERT PESSARY/OTHER DEVICE
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
9605716002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$69.09 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna of VT Commercial |
$148.20
|
| 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 |
$69.09
|
| 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 |
$93.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$126.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.02
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.20
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare Commercial |
$148.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare VA CCN |
$70.20
|
|
|
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
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
5105716001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.01 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of VT Commercial |
$133.00
|
| 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 |
$62.01
|
| 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 |
$84.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$119.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$111.30
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$112.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$130.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$119.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.00
|
| Rate for Payer: United Healthcare Commercial |
$133.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.00
|
| Rate for Payer: United Healthcare VA CCN |
$63.00
|
|
|
INSERT PESSARY/OTHER DEVICE
|
Facility
|
OP
|
$139.59
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
4505716001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.82 |
| 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 |
$125.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$61.82
|
| 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 |
$84.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.97
|
| 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: Martins Point Health Care Commercial |
$62.82
|
| Rate for Payer: Multiplan Commercial |
$129.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$62.82
|
| Rate for Payer: United Healthcare Commercial |
$132.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.82
|
| Rate for Payer: United Healthcare VA CCN |
$62.82
|
|
|
INSERT PESSARY/OTHER DEVICE
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
9605716002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$115.46 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna of VT Commercial |
$148.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$131.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.60
|
| Rate for Payer: United Healthcare Commercial |
$148.20
|
|
|
INSERT PESSARY/OTHER DEVICE
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
9605716001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.22 |
| Max. Negotiated Rate |
$277.30 |
| Rate for Payer: Aetna of VT Commercial |
$277.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$264.29
|
| 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 |
$264.29
|
| 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 |
$147.50
|
| Rate for Payer: Cash Price |
$147.50
|
| 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 |
$274.35
|
| 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 PICVAD CATH
|
Professional
|
Both
|
$4,818.54
|
|
|
Service Code
|
CPT 36571
|
| Hospital Charge Code |
9823657101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$284.53 |
| Max. Negotiated Rate |
$4,529.43 |
| Rate for Payer: Aetna of VT Commercial |
$4,529.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,316.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$293.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,316.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$398.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,351.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,351.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$327.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,351.27
|
| Rate for Payer: Cash Price |
$2,409.27
|
| Rate for Payer: Cash Price |
$2,409.27
|
| Rate for Payer: Cigna Commercial |
$521.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,830.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,830.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,128.65
|
| Rate for Payer: Multiplan Commercial |
$4,481.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$404.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$284.53
|
| Rate for Payer: United Healthcare Commercial |
$437.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$284.53
|
| Rate for Payer: United Healthcare VA CCN |
$284.53
|
|
|
INSERT PICVAD CATH
|
Facility
|
OP
|
$4,818.54
|
|
|
Service Code
|
CPT 36571
|
| Hospital Charge Code |
9823657101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,134.13 |
| Max. Negotiated Rate |
$4,577.61 |
| Rate for Payer: Aetna of VT Commercial |
$4,577.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,316.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,134.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,316.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,900.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,095.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,903.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,168.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,830.74
|
| Rate for Payer: Cash Price |
$2,409.27
|
| Rate for Payer: Cigna Commercial |
$3,854.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,854.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,854.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,168.34
|
| Rate for Payer: Multiplan Commercial |
$4,481.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,095.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,168.34
|
| Rate for Payer: United Healthcare Commercial |
$4,577.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,168.34
|
| Rate for Payer: United Healthcare VA CCN |
$2,168.34
|
|
|
INSERT PICVAD CATH
|
Facility
|
IP
|
$4,818.54
|
|
|
Service Code
|
CPT 36571
|
| Hospital Charge Code |
9823657101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$3,566.20 |
| Max. Negotiated Rate |
$4,577.61 |
| Rate for Payer: Aetna of VT Commercial |
$4,577.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,566.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,566.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,095.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,047.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,854.83
|
| Rate for Payer: Cash Price |
$2,409.27
|
| Rate for Payer: Cigna Commercial |
$3,854.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,854.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,854.83
|
| Rate for Payer: Multiplan Commercial |
$4,481.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,095.76
|
| Rate for Payer: United Healthcare Commercial |
$4,577.61
|
|
|
INSERT PLEURAL CATH
|
Facility
|
IP
|
$729.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
9813255002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$539.53 |
| Max. Negotiated Rate |
$692.55 |
| Rate for Payer: Aetna of VT Commercial |
$692.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$539.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$539.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$619.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$612.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$583.20
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna Commercial |
$583.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$583.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$583.20
|
| Rate for Payer: Multiplan Commercial |
$677.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$619.65
|
| Rate for Payer: United Healthcare Commercial |
$692.55
|
|
|
INSERT PLEURAL CATH
|
Facility
|
OP
|
$5,496.10
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
4503255001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,434.22 |
| Max. Negotiated Rate |
$5,221.30 |
| Rate for Payer: Aetna of VT Commercial |
$5,221.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,923.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,434.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,923.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,308.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,671.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,451.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,473.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,369.40
|
| Rate for Payer: Cash Price |
$2,748.05
|
| Rate for Payer: Cigna Commercial |
$4,396.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,396.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,396.88
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,473.24
|
| Rate for Payer: Multiplan Commercial |
$5,111.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,671.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,473.24
|
| Rate for Payer: United Healthcare Commercial |
$5,221.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,473.24
|
| Rate for Payer: United Healthcare VA CCN |
$2,473.24
|
|
|
INSERT PLEURAL CATH
|
Professional
|
Both
|
$729.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
9813255002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$186.26 |
| Max. Negotiated Rate |
$1,142.79 |
| Rate for Payer: Aetna of VT Commercial |
$685.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$653.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$191.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$653.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$260.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,044.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,044.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,044.69
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna Commercial |
$337.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,142.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,142.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$706.61
|
| Rate for Payer: Multiplan Commercial |
$677.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$186.26
|
| Rate for Payer: United Healthcare Commercial |
$286.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.26
|
| Rate for Payer: United Healthcare VA CCN |
$186.26
|
|
|
INSERT PLEURAL CATH
|
Facility
|
IP
|
$5,496.10
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
4503255001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,067.66 |
| Max. Negotiated Rate |
$5,221.30 |
| Rate for Payer: Aetna of VT Commercial |
$5,221.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,067.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,067.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,671.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,616.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,396.88
|
| Rate for Payer: Cash Price |
$2,748.05
|
| Rate for Payer: Cigna Commercial |
$4,396.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,396.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,396.88
|
| Rate for Payer: Multiplan Commercial |
$5,111.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,671.69
|
| Rate for Payer: United Healthcare Commercial |
$5,221.30
|
|
|
INSERT PLEURAL CATH
|
Professional
|
Both
|
$729.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
9813255001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$186.26 |
| Max. Negotiated Rate |
$1,142.79 |
| Rate for Payer: Aetna of VT Commercial |
$685.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$653.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$191.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$653.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$260.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,044.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,044.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,044.69
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna Commercial |
$337.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,142.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,142.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$706.61
|
| Rate for Payer: Multiplan Commercial |
$677.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$186.26
|
| Rate for Payer: United Healthcare Commercial |
$286.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.26
|
| Rate for Payer: United Healthcare VA CCN |
$186.26
|
|
|
INSERT PLEURAL CATH
|
Facility
|
OP
|
$729.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
9813255001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$322.87 |
| Max. Negotiated Rate |
$692.55 |
| Rate for Payer: Aetna of VT Commercial |
$692.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$653.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$322.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$653.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$438.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$619.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$590.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$328.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$579.55
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna Commercial |
$583.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$583.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$583.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$328.05
|
| Rate for Payer: Multiplan Commercial |
$677.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$619.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$328.05
|
| Rate for Payer: United Healthcare Commercial |
$692.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$328.05
|
| Rate for Payer: United Healthcare VA CCN |
$328.05
|
|
|
INSERT PLEURAL CATH
|
Facility
|
OP
|
$729.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
9813255002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$322.87 |
| Max. Negotiated Rate |
$692.55 |
| Rate for Payer: Aetna of VT Commercial |
$692.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$653.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$322.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$653.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$438.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$619.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$590.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$328.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$579.55
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna Commercial |
$583.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$583.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$583.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$328.05
|
| Rate for Payer: Multiplan Commercial |
$677.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$619.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$328.05
|
| Rate for Payer: United Healthcare Commercial |
$692.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$328.05
|
| Rate for Payer: United Healthcare VA CCN |
$328.05
|
|
|
INSERT PLEURAL CATH
|
Facility
|
IP
|
$729.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
9813255001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$539.53 |
| Max. Negotiated Rate |
$692.55 |
| Rate for Payer: Aetna of VT Commercial |
$692.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$539.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$539.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$619.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$612.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$583.20
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna Commercial |
$583.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$583.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$583.20
|
| Rate for Payer: Multiplan Commercial |
$677.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$619.65
|
| Rate for Payer: United Healthcare Commercial |
$692.55
|
|
|
INSERT TEMP BLADDER CATH
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
9815170201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$95.22 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Aetna of VT Commercial |
$204.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$192.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$95.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$192.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$129.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$182.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$174.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$96.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$170.93
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$172.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$172.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$172.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$96.75
|
| Rate for Payer: Multiplan Commercial |
$199.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$182.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$96.75
|
| Rate for Payer: United Healthcare Commercial |
$204.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.75
|
| Rate for Payer: United Healthcare VA CCN |
$96.75
|
|
|
INSERT TEMP BLADDER CATH
|
Facility
|
IP
|
$205.77
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
4505170201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.29 |
| Max. Negotiated Rate |
$195.48 |
| Rate for Payer: Aetna of VT Commercial |
$195.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$152.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$152.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$174.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$172.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$164.62
|
| Rate for Payer: Cash Price |
$102.89
|
| Rate for Payer: Cigna Commercial |
$164.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$164.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$164.62
|
| Rate for Payer: Multiplan Commercial |
$191.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$174.90
|
| Rate for Payer: United Healthcare Commercial |
$195.48
|
|
|
INSERT TEMP BLADDER CATH
|
Facility
|
OP
|
$205.77
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
7225170201
|
|
Hospital Revenue Code
|
722
|
| Min. Negotiated Rate |
$91.14 |
| Max. Negotiated Rate |
$195.48 |
| Rate for Payer: Aetna of VT Commercial |
$195.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$184.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$91.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$184.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$123.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$174.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$166.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$163.59
|
| Rate for Payer: Cash Price |
$102.89
|
| Rate for Payer: Cigna Commercial |
$164.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$164.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$164.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$92.60
|
| Rate for Payer: Multiplan Commercial |
$191.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$174.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$92.60
|
| Rate for Payer: United Healthcare Commercial |
$195.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.60
|
| Rate for Payer: United Healthcare VA CCN |
$92.60
|
|
|
INSERT TEMP BLADDER CATH
|
Facility
|
OP
|
$205.77
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
4505170201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.14 |
| Max. Negotiated Rate |
$195.48 |
| Rate for Payer: Aetna of VT Commercial |
$195.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$184.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$91.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$184.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$123.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$174.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$166.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$163.59
|
| Rate for Payer: Cash Price |
$102.89
|
| Rate for Payer: Cigna Commercial |
$164.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$164.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$164.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$92.60
|
| Rate for Payer: Multiplan Commercial |
$191.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$174.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$92.60
|
| Rate for Payer: United Healthcare Commercial |
$195.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.60
|
| Rate for Payer: United Healthcare VA CCN |
$92.60
|
|
|
INSERT TEMP BLADDER CATH
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
9815170201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$23.11 |
| Max. Negotiated Rate |
$202.10 |
| Rate for Payer: Aetna of VT Commercial |
$202.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$192.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$192.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$109.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$109.75
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$40.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$95.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$95.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$58.77
|
| Rate for Payer: Multiplan Commercial |
$199.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.11
|
| Rate for Payer: United Healthcare Commercial |
$35.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.11
|
| Rate for Payer: United Healthcare VA CCN |
$23.11
|
|
|
INSERT TEMP BLADDER CATH
|
Facility
|
OP
|
$205.77
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
4905170201
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$91.14 |
| Max. Negotiated Rate |
$195.48 |
| Rate for Payer: Aetna of VT Commercial |
$195.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$184.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$91.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$184.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$123.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$174.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$166.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$163.59
|
| Rate for Payer: Cash Price |
$102.89
|
| Rate for Payer: Cigna Commercial |
$164.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$164.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$164.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$92.60
|
| Rate for Payer: Multiplan Commercial |
$191.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$174.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$92.60
|
| Rate for Payer: United Healthcare Commercial |
$195.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.60
|
| Rate for Payer: United Healthcare VA CCN |
$92.60
|
|
|
INSERT TEMP BLADDER CATH
|
Facility
|
IP
|
$205.77
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
4905170201
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$152.29 |
| Max. Negotiated Rate |
$195.48 |
| Rate for Payer: Aetna of VT Commercial |
$195.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$152.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$152.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$174.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$172.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$164.62
|
| Rate for Payer: Cash Price |
$102.89
|
| Rate for Payer: Cigna Commercial |
$164.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$164.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$164.62
|
| Rate for Payer: Multiplan Commercial |
$191.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$174.90
|
| Rate for Payer: United Healthcare Commercial |
$195.48
|
|
