|
INSJ NON-TUNNEL CV CATH 5 YR/>
|
Professional
|
Both
|
$1,478.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
9813655602
|
|
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 PICC 5 YR+ W/O IMAGING
|
Professional
|
Both
|
$2,154.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
5103656901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$86.23 |
| Max. Negotiated Rate |
$2,024.76 |
| Rate for Payer: Aetna of VT Commercial |
$2,024.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,929.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$88.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,929.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$120.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$135.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.65
|
| Rate for Payer: Cash Price |
$1,077.00
|
| Rate for Payer: Cash Price |
$1,077.00
|
| Rate for Payer: Cigna Commercial |
$157.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.23
|
| Rate for Payer: Multiplan Commercial |
$2,003.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$86.23
|
| Rate for Payer: United Healthcare Commercial |
$132.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.23
|
| Rate for Payer: United Healthcare VA CCN |
$86.23
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
9603656902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$86.23 |
| Max. Negotiated Rate |
$358.14 |
| Rate for Payer: Aetna of VT Commercial |
$358.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$88.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$120.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$135.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.65
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$157.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.23
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$86.23
|
| Rate for Payer: United Healthcare Commercial |
$132.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.23
|
| Rate for Payer: United Healthcare VA CCN |
$86.23
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
OP
|
$2,535.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
9603656901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,122.75 |
| Max. Negotiated Rate |
$2,408.25 |
| Rate for Payer: Aetna of VT Commercial |
$2,408.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,271.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,122.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,271.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,526.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,154.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,053.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,140.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,015.33
|
| Rate for Payer: Cash Price |
$1,267.50
|
| Rate for Payer: Cigna Commercial |
$2,028.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,028.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,028.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,140.75
|
| Rate for Payer: Multiplan Commercial |
$2,357.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,154.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,140.75
|
| Rate for Payer: United Healthcare Commercial |
$2,408.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,140.75
|
| Rate for Payer: United Healthcare VA CCN |
$1,140.75
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
OP
|
$2,154.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
5103656901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$954.01 |
| Max. Negotiated Rate |
$2,046.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,046.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,929.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$954.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,929.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,296.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,830.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,744.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$969.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,712.43
|
| Rate for Payer: Cash Price |
$1,077.00
|
| Rate for Payer: Cigna Commercial |
$1,723.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,723.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,723.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$969.30
|
| Rate for Payer: Multiplan Commercial |
$2,003.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,830.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$969.30
|
| Rate for Payer: United Healthcare Commercial |
$2,046.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$969.30
|
| Rate for Payer: United Healthcare VA CCN |
$969.30
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
OP
|
$2,153.75
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
4503656901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$953.90 |
| Max. Negotiated Rate |
$2,046.06 |
| Rate for Payer: Aetna of VT Commercial |
$2,046.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,929.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$953.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,929.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,296.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,830.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,744.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$969.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,712.23
|
| Rate for Payer: Cash Price |
$1,076.88
|
| Rate for Payer: Cigna Commercial |
$1,723.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,723.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,723.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$969.19
|
| Rate for Payer: Multiplan Commercial |
$2,002.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,830.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$969.19
|
| Rate for Payer: United Healthcare Commercial |
$2,046.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$969.19
|
| Rate for Payer: United Healthcare VA CCN |
$969.19
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
9813656902
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$86.23 |
| Max. Negotiated Rate |
$358.14 |
| Rate for Payer: Aetna of VT Commercial |
$358.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$88.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$120.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$135.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.65
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$157.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.23
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$86.23
|
| Rate for Payer: United Healthcare Commercial |
$132.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.23
|
| Rate for Payer: United Healthcare VA CCN |
$86.23
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
9813656902
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$168.74 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Aetna of VT Commercial |
$361.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$168.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$229.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$308.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$171.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$302.89
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$304.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$171.45
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$323.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$171.45
|
| Rate for Payer: United Healthcare Commercial |
$361.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.45
|
| Rate for Payer: United Healthcare VA CCN |
$171.45
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
IP
|
$2,535.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
9603656901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,876.15 |
| Max. Negotiated Rate |
$2,408.25 |
| Rate for Payer: Aetna of VT Commercial |
$2,408.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,876.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,876.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,154.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,129.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,267.50
|
| Rate for Payer: Cigna Commercial |
$2,028.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,028.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,028.00
|
| Rate for Payer: Multiplan Commercial |
$2,357.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,154.75
|
| Rate for Payer: United Healthcare Commercial |
$2,408.25
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
9823656901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$281.98 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Aetna of VT Commercial |
$361.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$281.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$281.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$320.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$304.80
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$304.80
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$323.85
|
| Rate for Payer: United Healthcare Commercial |
$361.95
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
9813656902
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$281.98 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Aetna of VT Commercial |
$361.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$281.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$281.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$320.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$304.80
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$304.80
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$323.85
|
| Rate for Payer: United Healthcare Commercial |
$361.95
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
9823656901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$168.74 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Aetna of VT Commercial |
$361.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$168.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$229.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$308.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$171.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$302.89
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$304.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$171.45
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$323.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$171.45
|
| Rate for Payer: United Healthcare Commercial |
$361.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.45
|
| Rate for Payer: United Healthcare VA CCN |
$171.45
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
IP
|
$2,154.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
5103656901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,594.18 |
| Max. Negotiated Rate |
$2,046.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,046.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,594.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,594.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,830.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,809.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,723.20
|
| Rate for Payer: Cash Price |
$1,077.00
|
| Rate for Payer: Cigna Commercial |
$1,723.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,723.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,723.20
|
| Rate for Payer: Multiplan Commercial |
$2,003.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,830.90
|
| Rate for Payer: United Healthcare Commercial |
$2,046.30
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
9823656901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$86.23 |
| Max. Negotiated Rate |
$358.14 |
| Rate for Payer: Aetna of VT Commercial |
$358.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$88.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$120.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$135.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.65
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$157.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.23
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$86.23
|
| Rate for Payer: United Healthcare Commercial |
$132.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.23
|
| Rate for Payer: United Healthcare VA CCN |
$86.23
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
IP
|
$2,153.75
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
4503656901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,593.99 |
| Max. Negotiated Rate |
$2,046.06 |
| Rate for Payer: Aetna of VT Commercial |
$2,046.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,593.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,593.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,830.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,809.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,723.00
|
| Rate for Payer: Cash Price |
$1,076.88
|
| Rate for Payer: Cigna Commercial |
$1,723.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,723.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,723.00
|
| Rate for Payer: Multiplan Commercial |
$2,002.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,830.69
|
| Rate for Payer: United Healthcare Commercial |
$2,046.06
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
9813656901
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$86.23 |
| Max. Negotiated Rate |
$358.14 |
| Rate for Payer: Aetna of VT Commercial |
$358.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$88.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$120.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$135.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.65
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$157.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.23
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$86.23
|
| Rate for Payer: United Healthcare Commercial |
$132.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.23
|
| Rate for Payer: United Healthcare VA CCN |
$86.23
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Professional
|
Both
|
$2,535.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
9603656901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$86.23 |
| Max. Negotiated Rate |
$2,382.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,382.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,271.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$88.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,271.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$120.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$135.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.65
|
| Rate for Payer: Cash Price |
$1,267.50
|
| Rate for Payer: Cash Price |
$1,267.50
|
| Rate for Payer: Cigna Commercial |
$157.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.23
|
| Rate for Payer: Multiplan Commercial |
$2,357.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$86.23
|
| Rate for Payer: United Healthcare Commercial |
$132.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.23
|
| Rate for Payer: United Healthcare VA CCN |
$86.23
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
9603656902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$281.98 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Aetna of VT Commercial |
$361.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$281.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$281.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$320.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$304.80
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$304.80
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$323.85
|
| Rate for Payer: United Healthcare Commercial |
$361.95
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
9813656901
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$281.98 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Aetna of VT Commercial |
$361.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$281.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$281.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$320.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$304.80
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$304.80
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$323.85
|
| Rate for Payer: United Healthcare Commercial |
$361.95
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
9603656902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$168.74 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Aetna of VT Commercial |
$361.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$168.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$229.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$308.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$171.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$302.89
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$304.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$171.45
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$323.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$171.45
|
| Rate for Payer: United Healthcare Commercial |
$361.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.45
|
| Rate for Payer: United Healthcare VA CCN |
$171.45
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
9813656901
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$168.74 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Aetna of VT Commercial |
$361.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$168.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$229.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$308.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$171.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$302.89
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$304.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$171.45
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$323.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$171.45
|
| Rate for Payer: United Healthcare Commercial |
$361.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.45
|
| Rate for Payer: United Healthcare VA CCN |
$171.45
|
|
|
INSJ PICC RS&I <5 YR
|
Facility
|
IP
|
$3,389.47
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
4503657201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,508.55 |
| Max. Negotiated Rate |
$3,220.00 |
| Rate for Payer: Aetna of VT Commercial |
$3,220.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,508.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,508.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,881.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,847.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,711.58
|
| Rate for Payer: Cash Price |
$1,694.73
|
| Rate for Payer: Cigna Commercial |
$2,711.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,711.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,711.58
|
| Rate for Payer: Multiplan Commercial |
$3,152.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,881.05
|
| Rate for Payer: United Healthcare Commercial |
$3,220.00
|
|
|
INSJ PICC RS&I <5 YR
|
Facility
|
IP
|
$1,110.00
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
9813657202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$821.51 |
| Max. Negotiated Rate |
$1,054.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,054.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$821.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$821.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$943.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$932.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$888.00
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cigna Commercial |
$888.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$888.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$888.00
|
| Rate for Payer: Multiplan Commercial |
$1,032.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$943.50
|
| Rate for Payer: United Healthcare Commercial |
$1,054.50
|
|
|
INSJ PICC RS&I <5 YR
|
Facility
|
OP
|
$3,389.47
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
4503657201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,501.20 |
| Max. Negotiated Rate |
$3,220.00 |
| Rate for Payer: Aetna of VT Commercial |
$3,220.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,036.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,501.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,036.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,040.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,881.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,745.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,525.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,694.63
|
| Rate for Payer: Cash Price |
$1,694.73
|
| Rate for Payer: Cigna Commercial |
$2,711.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,711.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,711.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,525.26
|
| Rate for Payer: Multiplan Commercial |
$3,152.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,881.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,525.26
|
| Rate for Payer: United Healthcare Commercial |
$3,220.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,525.26
|
| Rate for Payer: United Healthcare VA CCN |
$1,525.26
|
|
|
INSJ PICC RS&I <5 YR
|
Professional
|
Both
|
$1,110.00
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
9813657202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$74.12 |
| Max. Negotiated Rate |
$1,043.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,043.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$994.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$994.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$103.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$610.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$610.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$610.93
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cigna Commercial |
$134.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$562.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$562.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$348.42
|
| Rate for Payer: Multiplan Commercial |
$1,032.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.12
|
| Rate for Payer: United Healthcare Commercial |
$114.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.12
|
| Rate for Payer: United Healthcare VA CCN |
$74.12
|
|
