|
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
|
|
|
INSJ NON-BIOD DRUG IMPLANT DEV
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
9601198102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$299.86 |
| Rate for Payer: Aetna of VT Commercial |
$299.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$285.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$59.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$285.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$80.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$196.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$66.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.72
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna Commercial |
$105.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.36
|
| Rate for Payer: Multiplan Commercial |
$296.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.74
|
| Rate for Payer: United Healthcare Commercial |
$88.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.74
|
| Rate for Payer: United Healthcare VA CCN |
$57.74
|
|
|
INSJ NON-BIOD DRUG IMPLANT DEV
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
9601198101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$353.03 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Aetna of VT Commercial |
$453.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$353.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$353.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$405.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$400.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$381.60
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$381.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$381.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$381.60
|
| Rate for Payer: Multiplan Commercial |
$443.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$405.45
|
| Rate for Payer: United Healthcare Commercial |
$453.15
|
|
|
INSJ NON-BIOD DRUG IMPLANT DEV
|
Professional
|
Both
|
$477.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
9601198101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$448.38 |
| Rate for Payer: Aetna of VT Commercial |
$448.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$427.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$59.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$427.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$80.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$196.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$66.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.72
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$105.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.36
|
| Rate for Payer: Multiplan Commercial |
$443.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.74
|
| Rate for Payer: United Healthcare Commercial |
$88.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.74
|
| Rate for Payer: United Healthcare VA CCN |
$57.74
|
|
|
INSJ NON-BIOD DRUG IMPLANT DEV
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
5101198101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.42 |
| Max. Negotiated Rate |
$151.05 |
| Rate for Payer: Aetna of VT Commercial |
$151.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$142.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$70.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$142.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$95.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$128.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$126.41
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$127.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$127.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$127.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$71.55
|
| Rate for Payer: Multiplan Commercial |
$147.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$71.55
|
| Rate for Payer: United Healthcare Commercial |
$151.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.55
|
| Rate for Payer: United Healthcare VA CCN |
$71.55
|
|
|
INSJ NON-BIOD DRUG IMPLANT DEV
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
5101198101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$196.72 |
| Rate for Payer: Aetna of VT Commercial |
$149.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$142.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$59.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$142.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$80.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$196.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$66.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.72
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$105.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.36
|
| Rate for Payer: Multiplan Commercial |
$147.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.74
|
| Rate for Payer: United Healthcare Commercial |
$88.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.74
|
| Rate for Payer: United Healthcare VA CCN |
$57.74
|
|
|
INSJ NON-BIOD DRUG IMPLANT DEV
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
9601198102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$141.29 |
| Max. Negotiated Rate |
$303.05 |
| Rate for Payer: Aetna of VT Commercial |
$303.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$285.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$141.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$285.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$192.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$271.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$258.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$143.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$253.60
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna Commercial |
$255.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$255.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$255.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$143.55
|
| Rate for Payer: Multiplan Commercial |
$296.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$271.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$143.55
|
| Rate for Payer: United Healthcare Commercial |
$303.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$143.55
|
| Rate for Payer: United Healthcare VA CCN |
$143.55
|
|
|
INSJ NON-BIOD DRUG IMPLANT DEV
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
9601198102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$236.09 |
| Max. Negotiated Rate |
$303.05 |
| Rate for Payer: Aetna of VT Commercial |
$303.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$236.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$236.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$271.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$267.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$255.20
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna Commercial |
$255.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$255.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$255.20
|
| Rate for Payer: Multiplan Commercial |
$296.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$271.15
|
| Rate for Payer: United Healthcare Commercial |
$303.05
|
|
|
INSJ NON-BIOD DRUG IMPLANT DEV
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
9601198101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$211.26 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Aetna of VT Commercial |
$453.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$427.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$211.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$427.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$287.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$405.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$386.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$214.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$379.21
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$381.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$381.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$381.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$214.65
|
| Rate for Payer: Multiplan Commercial |
$443.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$405.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$214.65
|
| Rate for Payer: United Healthcare Commercial |
$453.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$214.65
|
| Rate for Payer: United Healthcare VA CCN |
$214.65
|
|
|
INSJ NON-BIOD DRUG IMPLANT DEV
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
5101198101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$117.68 |
| Max. Negotiated Rate |
$151.05 |
| Rate for Payer: Aetna of VT Commercial |
$151.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$117.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$117.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$133.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$127.20
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$127.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$127.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$127.20
|
| Rate for Payer: Multiplan Commercial |
$147.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.15
|
| Rate for Payer: United Healthcare Commercial |
$151.05
|
|
|
INSJ NON-TUNNEL CV CATH < 5 Y
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
9813655501
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
INSJ NON-TUNNEL CV CATH < 5 Y
|
Facility
|
OP
|
$2,353.28
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
4503655501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,042.27 |
| Max. Negotiated Rate |
$2,235.62 |
| Rate for Payer: Aetna of VT Commercial |
$2,235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,108.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,042.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,108.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,416.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,000.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,906.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,058.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,870.86
|
| Rate for Payer: Cash Price |
$1,176.64
|
| Rate for Payer: Cigna Commercial |
$1,882.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,882.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,882.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,058.98
|
| Rate for Payer: Multiplan Commercial |
$2,188.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,000.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,058.98
|
| Rate for Payer: United Healthcare Commercial |
$2,235.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,058.98
|
| Rate for Payer: United Healthcare VA CCN |
$1,058.98
|
|
|
INSJ NON-TUNNEL CV CATH < 5 Y
|
Facility
|
IP
|
$2,353.28
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
4503655501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,741.66 |
| Max. Negotiated Rate |
$2,235.62 |
| Rate for Payer: Aetna of VT Commercial |
$2,235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,741.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,741.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,000.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,976.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,882.62
|
| Rate for Payer: Cash Price |
$1,176.64
|
| Rate for Payer: Cigna Commercial |
$1,882.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,882.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,882.62
|
| Rate for Payer: Multiplan Commercial |
$2,188.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,000.29
|
| Rate for Payer: United Healthcare Commercial |
$2,235.62
|
|
|
INSJ NON-TUNNEL CV CATH < 5 Y
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
9813655501
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
INSJ NON-TUNNEL CV CATH < 5 Y
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
9813655502
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
INSJ NON-TUNNEL CV CATH < 5 Y
|
Professional
|
Both
|
$621.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
9813655501
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
INSJ NON-TUNNEL CV CATH < 5 Y
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
9813655502
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
INSJ NON-TUNNEL CV CATH < 5 Y
|
Professional
|
Both
|
$621.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
9813655502
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
INSJ NON-TUNNEL CV CATH 5 YR/>
|
Professional
|
Both
|
$1,478.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
9813655601
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
INSJ NON-TUNNEL CV CATH 5 YR/>
|
Facility
|
OP
|
$1,478.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
9813655601
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
INSJ NON-TUNNEL CV CATH 5 YR/>
|
Facility
|
OP
|
$1,478.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
9813655602
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
INSJ NON-TUNNEL CV CATH 5 YR/>
|
Facility
|
IP
|
$1,478.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
9813655601
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
INSJ NON-TUNNEL CV CATH 5 YR/>
|
Facility
|
IP
|
$1,656.26
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
4503655601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,225.80 |
| Max. Negotiated Rate |
$1,573.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,573.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,225.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,225.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,407.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,391.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,325.01
|
| Rate for Payer: Cash Price |
$828.13
|
| Rate for Payer: Cigna Commercial |
$1,325.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,325.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,325.01
|
| Rate for Payer: Multiplan Commercial |
$1,540.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,407.82
|
| Rate for Payer: United Healthcare Commercial |
$1,573.45
|
|
|
INSJ NON-TUNNEL CV CATH 5 YR/>
|
Facility
|
OP
|
$1,656.26
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
4503655601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$733.56 |
| Max. Negotiated Rate |
$1,573.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,573.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,483.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$733.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,483.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$997.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,407.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,341.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$745.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,316.73
|
| Rate for Payer: Cash Price |
$828.13
|
| Rate for Payer: Cigna Commercial |
$1,325.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,325.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,325.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$745.32
|
| Rate for Payer: Multiplan Commercial |
$1,540.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,407.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$745.32
|
| Rate for Payer: United Healthcare Commercial |
$1,573.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$745.32
|
| Rate for Payer: United Healthcare VA CCN |
$745.32
|
|
|
INSJ NON-TUNNEL CV CATH 5 YR/>
|
Facility
|
IP
|
$1,478.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
9813655602
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
