|
INSJ PICC RS&I <5 YR
|
Facility
|
OP
|
$1,110.00
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
9813657202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$491.62 |
| 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 |
$994.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$491.62
|
| 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 |
$668.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$943.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$899.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$499.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$882.45
|
| 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: Martins Point Health Care Commercial |
$499.50
|
| Rate for Payer: Multiplan Commercial |
$1,032.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$943.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$499.50
|
| Rate for Payer: United Healthcare Commercial |
$1,054.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$499.50
|
| Rate for Payer: United Healthcare VA CCN |
$499.50
|
|
|
INSUFFLATION BULB SYSTEM
|
Facility
|
OP
|
$280.00
|
|
| Hospital Charge Code |
2700073021
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$124.01 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Aetna of VT Commercial |
$266.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$250.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$124.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$250.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$168.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$238.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$226.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$222.60
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$224.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$224.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$224.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$260.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$238.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$126.00
|
| Rate for Payer: United Healthcare Commercial |
$266.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.00
|
| Rate for Payer: United Healthcare VA CCN |
$126.00
|
|
|
INSUFFLATION BULB SYSTEM
|
Facility
|
IP
|
$280.00
|
|
| Hospital Charge Code |
2700073021
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$207.23 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Aetna of VT Commercial |
$266.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$207.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$207.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$238.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$224.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$224.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$224.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$224.00
|
| Rate for Payer: Multiplan Commercial |
$260.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$238.00
|
| Rate for Payer: United Healthcare Commercial |
$266.00
|
|
|
INSULIN ANTIBODIES
|
Facility
|
IP
|
$318.47
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
3008633701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$235.70 |
| Max. Negotiated Rate |
$302.55 |
| Rate for Payer: Aetna of VT Commercial |
$302.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$235.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$235.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$270.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$267.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$254.78
|
| Rate for Payer: Cash Price |
$159.24
|
| Rate for Payer: Cigna Commercial |
$254.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$254.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$254.78
|
| Rate for Payer: Multiplan Commercial |
$296.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$270.70
|
| Rate for Payer: United Healthcare Commercial |
$302.55
|
|
|
INSULIN ANTIBODIES
|
Professional
|
Both
|
$318.47
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
3008633701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.11 |
| Max. Negotiated Rate |
$299.36 |
| Rate for Payer: Aetna of VT Commercial |
$299.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$36.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$36.59
|
| Rate for Payer: Cash Price |
$159.24
|
| Rate for Payer: Cash Price |
$159.24
|
| Rate for Payer: Cigna Commercial |
$25.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$21.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$21.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$21.11
|
| Rate for Payer: Multiplan Commercial |
$296.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.41
|
| Rate for Payer: United Healthcare Commercial |
$32.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.41
|
| Rate for Payer: United Healthcare VA CCN |
$21.41
|
|
|
INSULIN ANTIBODIES
|
Facility
|
OP
|
$318.47
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
3008633701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$302.55 |
| Rate for Payer: Aetna of VT Commercial |
$302.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$141.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$191.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$270.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$257.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$143.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$253.18
|
| Rate for Payer: Cash Price |
$159.24
|
| Rate for Payer: Cash Price |
$159.24
|
| Rate for Payer: Cigna Commercial |
$254.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$254.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$254.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$143.31
|
| Rate for Payer: Multiplan Commercial |
$296.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$270.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$143.31
|
| Rate for Payer: United Healthcare Commercial |
$302.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.41
|
| Rate for Payer: United Healthcare VA CCN |
$143.31
|
|
|
INSULIN NPH 10 ML VIAL NOVOLOG
|
Facility
|
OP
|
$0.01
|
|
| Hospital Charge Code |
2500000558
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
INSULIN NPH 10 ML VIAL NOVOLOG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 169183411
|
| Hospital Charge Code |
2500000558
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
INSULIN NPH 10 ML VIAL NOVOLOG
|
Facility
|
IP
|
$0.01
|
|
| Hospital Charge Code |
2500000558
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
INSULIN NPH 10 ML VIAL NOVOLOG
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 169183411
|
| Hospital Charge Code |
2500000558
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
INTERROGATE SUBQ DEFIB
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
9609326101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$66.52 |
| Max. Negotiated Rate |
$334.64 |
| Rate for Payer: Aetna of VT Commercial |
$334.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$318.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$318.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.74
|
| Rate for Payer: Cash Price |
$178.00
|
| Rate for Payer: Cash Price |
$178.00
|
| Rate for Payer: Cigna Commercial |
$153.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$66.52
|
| Rate for Payer: Multiplan Commercial |
$331.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.52
|
| Rate for Payer: United Healthcare Commercial |
$102.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.52
|
| Rate for Payer: United Healthcare VA CCN |
$66.52
|
|
|
INTERROGATE SUBQ DEFIB
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
5109326101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.52 |
| Max. Negotiated Rate |
$153.88 |
| Rate for Payer: Aetna of VT Commercial |
$106.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$101.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$101.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.74
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$153.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$66.52
|
| Rate for Payer: Multiplan Commercial |
$105.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.52
|
| Rate for Payer: United Healthcare Commercial |
$102.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.52
|
| Rate for Payer: United Healthcare VA CCN |
$66.52
|
|
|
INTERROGATE SUBQ DEFIB
|
Facility
|
IP
|
$356.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
9609326101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$263.48 |
| Max. Negotiated Rate |
$338.20 |
| Rate for Payer: Aetna of VT Commercial |
$338.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$263.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$263.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$302.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$299.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$284.80
|
| Rate for Payer: Cash Price |
$178.00
|
| Rate for Payer: Cigna Commercial |
$284.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$284.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$284.80
|
| Rate for Payer: Multiplan Commercial |
$331.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$302.60
|
| Rate for Payer: United Healthcare Commercial |
$338.20
|
|
|
INTERROGATE SUBQ DEFIB
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
9609326102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$179.84 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna of VT Commercial |
$230.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$179.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$179.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$206.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$204.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$194.40
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$194.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$194.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$194.40
|
| Rate for Payer: Multiplan Commercial |
$225.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$206.55
|
| Rate for Payer: United Healthcare Commercial |
$230.85
|
|
|
INTERROGATE SUBQ DEFIB
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
5109326101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Aetna of VT Commercial |
$107.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$101.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$101.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$68.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$91.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$50.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.83
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$90.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$90.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$90.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$50.85
|
| Rate for Payer: Multiplan Commercial |
$105.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$50.85
|
| Rate for Payer: United Healthcare Commercial |
$107.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.85
|
| Rate for Payer: United Healthcare VA CCN |
$50.85
|
|
|
INTERROGATE SUBQ DEFIB
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
9609326101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$157.67 |
| Max. Negotiated Rate |
$338.20 |
| Rate for Payer: Aetna of VT Commercial |
$338.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$318.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$157.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$318.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$214.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$302.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$288.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$160.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$283.02
|
| Rate for Payer: Cash Price |
$178.00
|
| Rate for Payer: Cigna Commercial |
$284.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$284.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$284.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$160.20
|
| Rate for Payer: Multiplan Commercial |
$331.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$302.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$160.20
|
| Rate for Payer: United Healthcare Commercial |
$338.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$160.20
|
| Rate for Payer: United Healthcare VA CCN |
$160.20
|
|
|
INTERROGATE SUBQ DEFIB
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
9609326102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$107.62 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna of VT Commercial |
$230.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$217.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$107.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$217.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$146.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$206.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$109.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$193.19
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$194.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$194.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$194.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$109.35
|
| Rate for Payer: Multiplan Commercial |
$225.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$206.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$109.35
|
| Rate for Payer: United Healthcare Commercial |
$230.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$109.35
|
| Rate for Payer: United Healthcare VA CCN |
$109.35
|
|
|
INTERROGATE SUBQ DEFIB
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
5109326101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.63 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Aetna of VT Commercial |
$107.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$90.40
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$90.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$90.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$90.40
|
| Rate for Payer: Multiplan Commercial |
$105.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.05
|
| Rate for Payer: United Healthcare Commercial |
$107.35
|
|
|
INTERROGATE SUBQ DEFIB
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
9609326102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$66.52 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna of VT Commercial |
$228.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$217.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$217.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.74
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$153.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$66.52
|
| Rate for Payer: Multiplan Commercial |
$225.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.52
|
| Rate for Payer: United Healthcare Commercial |
$102.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.52
|
| Rate for Payer: United Healthcare VA CCN |
$66.52
|
|
|
INTERROG DEVICE EVAL HEART
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
CPT 93289
|
| Hospital Charge Code |
9609328902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$67.65 |
| Max. Negotiated Rate |
$182.36 |
| Rate for Payer: Aetna of VT Commercial |
$182.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$173.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$173.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$94.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$95.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$95.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$95.51
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$158.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$109.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$109.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$67.65
|
| Rate for Payer: Multiplan Commercial |
$180.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.65
|
| Rate for Payer: United Healthcare Commercial |
$104.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.65
|
| Rate for Payer: United Healthcare VA CCN |
$67.65
|
|
|
INTERROG DEVICE EVAL HEART
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
CPT 93289
|
| Hospital Charge Code |
5109328901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.65 |
| Max. Negotiated Rate |
$158.73 |
| Rate for Payer: Aetna of VT Commercial |
$100.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$95.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$95.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$94.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$95.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$95.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$95.51
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$158.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$109.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$109.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$67.65
|
| Rate for Payer: Multiplan Commercial |
$99.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.65
|
| Rate for Payer: United Healthcare Commercial |
$104.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.65
|
| Rate for Payer: United Healthcare VA CCN |
$67.65
|
|
|
INTERROG DEVICE EVAL HEART
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 93289
|
| Hospital Charge Code |
5109328901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$101.65 |
| Rate for Payer: Aetna of VT Commercial |
$101.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$95.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$47.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$95.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$64.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$90.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$86.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$48.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$85.06
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$85.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$85.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$85.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$48.15
|
| Rate for Payer: Multiplan Commercial |
$99.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$90.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$48.15
|
| Rate for Payer: United Healthcare Commercial |
$101.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.15
|
| Rate for Payer: United Healthcare VA CCN |
$48.15
|
|
|
INTERROG DEVICE EVAL HEART
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 93289
|
| Hospital Charge Code |
5109328901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.19 |
| Max. Negotiated Rate |
$101.65 |
| Rate for Payer: Aetna of VT Commercial |
$101.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$79.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$79.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$90.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$85.60
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$85.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$85.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$85.60
|
| Rate for Payer: Multiplan Commercial |
$99.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$90.95
|
| Rate for Payer: United Healthcare Commercial |
$101.65
|
|
|
INTERROG DEVICE EVAL HEART
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 93289
|
| Hospital Charge Code |
9609328901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$222.03 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of VT Commercial |
$285.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$222.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$222.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$252.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$240.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$240.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$240.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$240.00
|
| Rate for Payer: Multiplan Commercial |
$279.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$255.00
|
| Rate for Payer: United Healthcare Commercial |
$285.00
|
|
|
INTERROG DEVICE EVAL HEART
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 93289
|
| Hospital Charge Code |
9609328902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$85.92 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Aetna of VT Commercial |
$184.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$173.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$85.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$173.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$116.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$164.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$157.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$87.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$154.23
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$155.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$87.30
|
| Rate for Payer: Multiplan Commercial |
$180.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$87.30
|
| Rate for Payer: United Healthcare Commercial |
$184.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.30
|
| Rate for Payer: United Healthcare VA CCN |
$87.30
|
|
