|
IP/OBS CONSLTJ NEW/EST HI 80
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
CPT 99255
|
| Hospital Charge Code |
9879925501
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$439.62 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Aetna of VT Commercial |
$564.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$439.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$439.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$504.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$498.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$475.20
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna Commercial |
$475.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$475.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$475.20
|
| Rate for Payer: Multiplan Commercial |
$552.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$504.90
|
| Rate for Payer: United Healthcare Commercial |
$564.30
|
|
|
IP/OBS CONSLTJ NEW/EST SF 35
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
CPT 99252
|
| Hospital Charge Code |
9879925201
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$125.78 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Aetna of VT Commercial |
$269.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$254.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$125.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$254.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$170.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$241.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$230.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$127.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$225.78
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cigna Commercial |
$227.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$227.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$227.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$127.80
|
| Rate for Payer: Multiplan Commercial |
$264.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$241.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$127.80
|
| Rate for Payer: United Healthcare Commercial |
$269.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.80
|
| Rate for Payer: United Healthcare VA CCN |
$127.80
|
|
|
IP/OBS CONSLTJ NEW/EST SF 35
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT 99252
|
| Hospital Charge Code |
9879925201
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$210.19 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Aetna of VT Commercial |
$269.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$210.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$210.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$241.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$238.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$227.20
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cigna Commercial |
$227.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$227.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$227.20
|
| Rate for Payer: Multiplan Commercial |
$264.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$241.40
|
| Rate for Payer: United Healthcare Commercial |
$269.80
|
|
|
IP/OBS CONSLTJ NEW/EST SF 35
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
CPT 99252
|
| Hospital Charge Code |
9879925201
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$66.56 |
| Max. Negotiated Rate |
$266.96 |
| Rate for Payer: Aetna of VT Commercial |
$266.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$254.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$254.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$128.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$128.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$128.45
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$66.56
|
| Rate for Payer: Multiplan Commercial |
$264.12
|
| Rate for Payer: United Healthcare Commercial |
$241.40
|
| Rate for Payer: United Healthcare VA CCN |
$69.72
|
|
|
IPRATROPIUM 0.5 MG/2.5 ML NEBS
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
636J764401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.39
|
| Rate for Payer: United Healthcare Commercial |
$0.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.39
|
| Rate for Payer: United Healthcare VA CCN |
$0.39
|
|
|
IPRATROPIUM 0.5 MG/2.5 ML NEBS
|
Facility
|
OP
|
$0.99
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
636J764401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.99
|
|
|
IPRATROPIUM/ALBUTEROL NEB
|
Professional
|
Both
|
$8.23
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
636J762001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$7.74 |
| Rate for Payer: Aetna of VT Commercial |
$7.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.23
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.20
|
| Rate for Payer: United Healthcare Commercial |
$0.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.20
|
| Rate for Payer: United Healthcare VA CCN |
$0.20
|
|
|
IRON BINDING CAPACITY
|
Facility
|
OP
|
$91.92
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
3008355001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$87.32 |
| Rate for Payer: Aetna of VT Commercial |
$87.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$43.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$40.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$43.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$55.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$78.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$74.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$41.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$73.08
|
| Rate for Payer: Cash Price |
$45.96
|
| Rate for Payer: Cash Price |
$45.96
|
| Rate for Payer: Cigna Commercial |
$73.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$73.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$73.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$41.36
|
| Rate for Payer: Multiplan Commercial |
$85.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$41.36
|
| Rate for Payer: United Healthcare Commercial |
$87.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.74
|
| Rate for Payer: United Healthcare VA CCN |
$41.36
|
|
|
IRON BINDING CAPACITY
|
Facility
|
IP
|
$91.92
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
3008355001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.03 |
| Max. Negotiated Rate |
$87.32 |
| Rate for Payer: Aetna of VT Commercial |
$87.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$68.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$68.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$78.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$77.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$73.54
|
| Rate for Payer: Cash Price |
$45.96
|
| Rate for Payer: Cigna Commercial |
$73.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$73.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$73.54
|
| Rate for Payer: Multiplan Commercial |
$85.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.13
|
| Rate for Payer: United Healthcare Commercial |
$87.32
|
|
|
IRRIGATION OF BLADDER
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
9825170001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$96.11 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Aetna of VT Commercial |
$206.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$194.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$96.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$194.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$130.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$175.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$172.51
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$173.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$173.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$173.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$97.65
|
| Rate for Payer: Multiplan Commercial |
$201.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$184.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$97.65
|
| Rate for Payer: United Healthcare Commercial |
$206.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.65
|
| Rate for Payer: United Healthcare VA CCN |
$97.65
|
|
|
IRRIGATION OF BLADDER
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
9825170001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$160.60 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Aetna of VT Commercial |
$206.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$182.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$173.60
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$173.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$173.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$173.60
|
| Rate for Payer: Multiplan Commercial |
$201.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$184.45
|
| Rate for Payer: United Healthcare Commercial |
$206.15
|
|
|
IRRIGATION OF BLADDER
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
9815170002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$27.65 |
| Max. Negotiated Rate |
$203.98 |
| Rate for Payer: Aetna of VT Commercial |
$203.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$194.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$194.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$38.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$166.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$166.05
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$48.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$71.98
|
| Rate for Payer: Multiplan Commercial |
$201.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$27.65
|
| Rate for Payer: United Healthcare Commercial |
$42.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.65
|
| Rate for Payer: United Healthcare VA CCN |
$27.65
|
|
|
IRRIGATION OF BLADDER
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
9825170001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$27.65 |
| Max. Negotiated Rate |
$203.98 |
| Rate for Payer: Aetna of VT Commercial |
$203.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$194.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$194.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$38.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$166.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$166.05
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$48.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$71.98
|
| Rate for Payer: Multiplan Commercial |
$201.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$27.65
|
| Rate for Payer: United Healthcare Commercial |
$42.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.65
|
| Rate for Payer: United Healthcare VA CCN |
$27.65
|
|
|
IRRIGATION OF BLADDER
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
9815170002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$96.11 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Aetna of VT Commercial |
$206.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$194.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$96.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$194.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$130.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$175.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$172.51
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$173.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$173.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$173.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$97.65
|
| Rate for Payer: Multiplan Commercial |
$201.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$184.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$97.65
|
| Rate for Payer: United Healthcare Commercial |
$206.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.65
|
| Rate for Payer: United Healthcare VA CCN |
$97.65
|
|
|
IRRIGATION OF BLADDER
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
9815170001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$96.11 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Aetna of VT Commercial |
$206.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$194.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$96.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$194.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$130.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$175.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$172.51
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$173.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$173.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$173.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$97.65
|
| Rate for Payer: Multiplan Commercial |
$201.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$184.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$97.65
|
| Rate for Payer: United Healthcare Commercial |
$206.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.65
|
| Rate for Payer: United Healthcare VA CCN |
$97.65
|
|
|
IRRIGATION OF BLADDER
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
9815170002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$160.60 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Aetna of VT Commercial |
$206.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$182.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$173.60
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$173.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$173.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$173.60
|
| Rate for Payer: Multiplan Commercial |
$201.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$184.45
|
| Rate for Payer: United Healthcare Commercial |
$206.15
|
|
|
IRRIGATION OF BLADDER
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
9815170001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$27.65 |
| Max. Negotiated Rate |
$203.98 |
| Rate for Payer: Aetna of VT Commercial |
$203.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$194.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$194.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$38.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$166.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$166.05
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$48.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$71.98
|
| Rate for Payer: Multiplan Commercial |
$201.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$27.65
|
| Rate for Payer: United Healthcare Commercial |
$42.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.65
|
| Rate for Payer: United Healthcare VA CCN |
$27.65
|
|
|
IRRIGATION OF BLADDER
|
Facility
|
IP
|
$318.47
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
4505170001
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
IRRIGATION OF BLADDER
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
9815170001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$160.60 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Aetna of VT Commercial |
$206.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$182.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$173.60
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$173.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$173.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$173.60
|
| Rate for Payer: Multiplan Commercial |
$201.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$184.45
|
| Rate for Payer: United Healthcare Commercial |
$206.15
|
|
|
IRRIGATION OF BLADDER
|
Facility
|
OP
|
$318.47
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
4505170001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.05 |
| 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 |
$285.32
|
| 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 |
$285.32
|
| 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: 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 |
$143.31
|
| Rate for Payer: United Healthcare VA CCN |
$143.31
|
|
|
IRRIG NACL 250ML
|
Facility
|
IP
|
$1.73
|
|
| Hospital Charge Code |
2720066821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$1.64 |
| Rate for Payer: Aetna of VT Commercial |
$1.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.38
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna Commercial |
$1.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$1.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.47
|
| Rate for Payer: United Healthcare Commercial |
$1.64
|
|
|
IRRIG NACL 250ML
|
Facility
|
OP
|
$1.73
|
|
| Hospital Charge Code |
2720066821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.64 |
| Rate for Payer: Aetna of VT Commercial |
$1.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.38
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna Commercial |
$1.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$1.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.78
|
| Rate for Payer: United Healthcare Commercial |
$1.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.78
|
| Rate for Payer: United Healthcare VA CCN |
$0.78
|
|
|
IRRIG VA DRUG DELIVERY DEVICE
|
Professional
|
Both
|
$316.40
|
|
| Hospital Charge Code |
2609652301
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$126.56 |
| Max. Negotiated Rate |
$297.42 |
| Rate for Payer: Aetna of VT Commercial |
$297.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$283.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$283.46
|
| Rate for Payer: Cash Price |
$158.20
|
| Rate for Payer: Multiplan Commercial |
$294.25
|
| Rate for Payer: United Healthcare Commercial |
$268.94
|
| Rate for Payer: United Healthcare VA CCN |
$126.56
|
|
|
IRRIG VA DRUG DELIVERY DEVICE
|
Facility
|
OP
|
$188.19
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
2609652301
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$83.35 |
| Max. Negotiated Rate |
$178.78 |
| Rate for Payer: Aetna of VT Commercial |
$178.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$168.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$83.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$168.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$113.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$159.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$152.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$84.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$149.61
|
| Rate for Payer: Cash Price |
$94.10
|
| Rate for Payer: Cigna Commercial |
$150.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$150.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$150.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$84.69
|
| Rate for Payer: Multiplan Commercial |
$175.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$159.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$84.69
|
| Rate for Payer: United Healthcare Commercial |
$178.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.69
|
| Rate for Payer: United Healthcare VA CCN |
$84.69
|
|
|
IRRIG VA DRUG DELIVERY DEVICE
|
Facility
|
IP
|
$188.19
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
2609652301
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$139.28 |
| Max. Negotiated Rate |
$178.78 |
| Rate for Payer: Aetna of VT Commercial |
$178.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$159.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$158.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$150.55
|
| Rate for Payer: Cash Price |
$94.10
|
| Rate for Payer: Cigna Commercial |
$150.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$150.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$150.55
|
| Rate for Payer: Multiplan Commercial |
$175.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$159.96
|
| Rate for Payer: United Healthcare Commercial |
$178.78
|
|
