|
INSERT TEMP BLADDER CATH
|
Facility
|
IP
|
$205.77
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
7225170201
|
|
Hospital Revenue Code
|
722
|
| 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
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
9815170202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$159.12 |
| 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 |
$159.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$159.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$182.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$172.00
|
| 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: Multiplan Commercial |
$199.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$182.75
|
| Rate for Payer: United Healthcare Commercial |
$204.25
|
|
|
INSERT TEMP BLADDER CATH
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
9815170201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$159.12 |
| 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 |
$159.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$159.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$182.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$172.00
|
| 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: Multiplan Commercial |
$199.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$182.75
|
| Rate for Payer: United Healthcare Commercial |
$204.25
|
|
|
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
|
$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 SMPL
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
9605170201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$311.58 |
| Max. Negotiated Rate |
$399.95 |
| Rate for Payer: Aetna of VT Commercial |
$399.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$311.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$311.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$357.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$353.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$336.80
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cigna Commercial |
$336.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$336.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$336.80
|
| Rate for Payer: Multiplan Commercial |
$391.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$357.85
|
| Rate for Payer: United Healthcare Commercial |
$399.95
|
|
|
INSERT TEMP BLADDER CATH SMPL
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5105170201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.11 |
| Max. Negotiated Rate |
$193.64 |
| Rate for Payer: Aetna of VT Commercial |
$193.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$184.56
|
| 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 |
$184.56
|
| 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 |
$103.00
|
| Rate for Payer: Cash Price |
$103.00
|
| 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 |
$191.58
|
| 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 SMPL
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
9605170202
|
|
Hospital Revenue Code
|
960
|
| 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 SMPL
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
9605170201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$186.46 |
| Max. Negotiated Rate |
$399.95 |
| Rate for Payer: Aetna of VT Commercial |
$399.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$377.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$186.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$377.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$253.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$357.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$341.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$189.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$334.69
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cigna Commercial |
$336.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$336.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$336.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$189.45
|
| Rate for Payer: Multiplan Commercial |
$391.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$357.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$189.45
|
| Rate for Payer: United Healthcare Commercial |
$399.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$189.45
|
| Rate for Payer: United Healthcare VA CCN |
$189.45
|
|
|
INSERT TEMP BLADDER CATH SMPL
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5105170201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$152.46 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Aetna of VT Commercial |
$195.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$152.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$152.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$175.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$173.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$164.80
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$164.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$164.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$164.80
|
| Rate for Payer: Multiplan Commercial |
$191.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.10
|
| Rate for Payer: United Healthcare Commercial |
$195.70
|
|
|
INSERT TEMP BLADDER CATH SMPL
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
9605170202
|
|
Hospital Revenue Code
|
960
|
| 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 SMPL
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5105170201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$91.24 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Aetna of VT Commercial |
$195.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$184.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$91.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$184.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$124.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$175.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$166.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$163.77
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$164.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$164.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$164.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$92.70
|
| Rate for Payer: Multiplan Commercial |
$191.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$92.70
|
| Rate for Payer: United Healthcare Commercial |
$195.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.70
|
| Rate for Payer: United Healthcare VA CCN |
$92.70
|
|
|
INSERT TEMP BLADDER CATH SMPL
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
9605170202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$159.12 |
| 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 |
$159.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$159.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$182.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$172.00
|
| 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: Multiplan Commercial |
$199.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$182.75
|
| Rate for Payer: United Healthcare Commercial |
$204.25
|
|
|
INSERT TEMP BLADDER CATH SMPL
|
Professional
|
Both
|
$421.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
9605170201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$23.11 |
| Max. Negotiated Rate |
$395.74 |
| Rate for Payer: Aetna of VT Commercial |
$395.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$377.17
|
| 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 |
$377.17
|
| 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 |
$210.50
|
| Rate for Payer: Cash Price |
$210.50
|
| 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 |
$391.53
|
| 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 TUNNELED CV CATH
|
Facility
|
IP
|
$953.00
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
9823655801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$705.32 |
| Max. Negotiated Rate |
$905.35 |
| Rate for Payer: Aetna of VT Commercial |
$905.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$705.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$705.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$810.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$800.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$762.40
|
| Rate for Payer: Cash Price |
$476.50
|
| Rate for Payer: Cigna Commercial |
$762.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$762.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$762.40
|
| Rate for Payer: Multiplan Commercial |
$886.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$810.05
|
| Rate for Payer: United Healthcare Commercial |
$905.35
|
|
|
INSERT TUNNELED CV CATH
|
Facility
|
OP
|
$953.00
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
9823655801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$422.08 |
| Max. Negotiated Rate |
$905.35 |
| Rate for Payer: Aetna of VT Commercial |
$905.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$853.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$422.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$853.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$573.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$810.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$771.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$428.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$757.63
|
| Rate for Payer: Cash Price |
$476.50
|
| Rate for Payer: Cigna Commercial |
$762.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$762.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$762.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$428.85
|
| Rate for Payer: Multiplan Commercial |
$886.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$810.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$428.85
|
| Rate for Payer: United Healthcare Commercial |
$905.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$428.85
|
| Rate for Payer: United Healthcare VA CCN |
$428.85
|
|
|
INSERT TUNNELED CV CATH
|
Professional
|
Both
|
$1,578.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
9823656101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$303.24 |
| Max. Negotiated Rate |
$1,937.37 |
| Rate for Payer: Aetna of VT Commercial |
$1,483.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,413.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$312.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,413.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$424.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,937.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,937.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$348.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,937.37
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$555.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,430.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,430.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$880.76
|
| Rate for Payer: Multiplan Commercial |
$1,467.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$430.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$303.24
|
| Rate for Payer: United Healthcare Commercial |
$466.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$303.24
|
| Rate for Payer: United Healthcare VA CCN |
$303.24
|
|
|
INSERT TUNNELED CV CATH
|
Facility
|
IP
|
$1,578.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
9823656101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,167.88 |
| Max. Negotiated Rate |
$1,499.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,499.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,167.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,167.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,341.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,325.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,262.40
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$1,262.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,262.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,262.40
|
| Rate for Payer: Multiplan Commercial |
$1,467.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,341.30
|
| Rate for Payer: United Healthcare Commercial |
$1,499.10
|
|
|
INSERT TUNNELED CV CATH
|
Professional
|
Both
|
$953.00
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
9823655801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$238.04 |
| Max. Negotiated Rate |
$1,226.68 |
| Rate for Payer: Aetna of VT Commercial |
$895.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$853.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$245.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$853.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$333.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,226.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,226.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$273.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,226.68
|
| Rate for Payer: Cash Price |
$476.50
|
| Rate for Payer: Cash Price |
$476.50
|
| Rate for Payer: Cigna Commercial |
$435.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,212.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,212.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$748.75
|
| Rate for Payer: Multiplan Commercial |
$886.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$338.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$238.04
|
| Rate for Payer: United Healthcare Commercial |
$366.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$238.04
|
| Rate for Payer: United Healthcare VA CCN |
$238.04
|
|
|
INSERT TUNNELED CV CATH
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
9823656101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$698.90 |
| Max. Negotiated Rate |
$1,499.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,499.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,413.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$698.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,413.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$949.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,341.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,278.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$710.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,254.51
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$1,262.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,262.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,262.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$710.10
|
| Rate for Payer: Multiplan Commercial |
$1,467.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,341.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$710.10
|
| Rate for Payer: United Healthcare Commercial |
$1,499.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$710.10
|
| Rate for Payer: United Healthcare VA CCN |
$710.10
|
|
|
INSITU HYBRIDIZATION (FISH)
|
Facility
|
OP
|
$219.29
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
3008836501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$97.12 |
| Max. Negotiated Rate |
$658.31 |
| Rate for Payer: Aetna of VT Commercial |
$208.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$658.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$97.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$658.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$132.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$186.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$177.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$98.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$174.34
|
| Rate for Payer: Cash Price |
$109.64
|
| Rate for Payer: Cash Price |
$109.64
|
| Rate for Payer: Cigna Commercial |
$175.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$175.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$175.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$98.68
|
| Rate for Payer: Multiplan Commercial |
$203.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$98.68
|
| Rate for Payer: United Healthcare Commercial |
$208.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$167.41
|
| Rate for Payer: United Healthcare VA CCN |
$98.68
|
|
|
INSITU HYBRIDIZATION (FISH)
|
Facility
|
IP
|
$219.29
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
3008836501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$162.30 |
| Max. Negotiated Rate |
$208.33 |
| Rate for Payer: Aetna of VT Commercial |
$208.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$162.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$162.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$186.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$184.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$175.43
|
| Rate for Payer: Cash Price |
$109.64
|
| Rate for Payer: Cigna Commercial |
$175.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$175.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$175.43
|
| Rate for Payer: Multiplan Commercial |
$203.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.40
|
| Rate for Payer: United Healthcare Commercial |
$208.33
|
|
|
INSITU HYBRIDIZATION (FISH)
|
Professional
|
Both
|
$219.29
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
3008836501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$167.41 |
| Max. Negotiated Rate |
$658.31 |
| Rate for Payer: Aetna of VT Commercial |
$206.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$658.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$172.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$658.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$234.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$230.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$230.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$192.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$230.37
|
| Rate for Payer: Cash Price |
$109.64
|
| Rate for Payer: Cash Price |
$109.64
|
| Rate for Payer: Cigna Commercial |
$228.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$268.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$268.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$167.41
|
| Rate for Payer: Multiplan Commercial |
$203.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$167.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$167.41
|
| Rate for Payer: United Healthcare Commercial |
$257.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$167.41
|
| Rate for Payer: United Healthcare VA CCN |
$167.41
|
|
|
INSJ BIOMECHANICAL DEVICE
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
CPT 22853
|
| Hospital Charge Code |
9822285301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$254.22 |
| Max. Negotiated Rate |
$545.30 |
| Rate for Payer: Aetna of VT Commercial |
$545.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$514.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$254.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$514.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$345.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$487.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$464.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$258.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$456.33
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: Cigna Commercial |
$459.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$459.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$459.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$258.30
|
| Rate for Payer: Multiplan Commercial |
$533.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$487.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$258.30
|
| Rate for Payer: United Healthcare Commercial |
$545.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$258.30
|
| Rate for Payer: United Healthcare VA CCN |
$258.30
|
|
|
INSJ BIOMECHANICAL DEVICE
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
CPT 22853
|
| Hospital Charge Code |
9822285301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$424.82 |
| Max. Negotiated Rate |
$545.30 |
| Rate for Payer: Aetna of VT Commercial |
$545.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$424.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$424.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$487.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$482.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$459.20
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: Cigna Commercial |
$459.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$459.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$459.20
|
| Rate for Payer: Multiplan Commercial |
$533.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$487.90
|
| Rate for Payer: United Healthcare Commercial |
$545.30
|
|
