|
K FLOW/FUNCT IMAGE MULTIPLE
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
9727870901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$182.28 |
| Max. Negotiated Rate |
$1,185.08 |
| Rate for Payer: Aetna of VT Commercial |
$184.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,185.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$327.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,185.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$445.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$492.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$492.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$365.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$492.17
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cigna Commercial |
$491.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$511.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$511.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$318.05
|
| Rate for Payer: Multiplan Commercial |
$182.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$318.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$318.06
|
| Rate for Payer: United Healthcare Commercial |
$489.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$318.06
|
| Rate for Payer: United Healthcare VA CCN |
$318.06
|
|
|
K FLOW/FUNCT IMAGE MULTIPLE
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
9727870901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$86.81 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Aetna of VT Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$175.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$86.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$175.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$117.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$158.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.82
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cigna Commercial |
$156.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$156.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$156.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$88.20
|
| Rate for Payer: Multiplan Commercial |
$182.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$166.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$88.20
|
| Rate for Payer: United Healthcare Commercial |
$186.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.20
|
| Rate for Payer: United Healthcare VA CCN |
$88.20
|
|
|
K FLOW/FUNCT IMAGE MULTIPLE
|
Facility
|
OP
|
$2,566.39
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
3417870901
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,136.65 |
| Max. Negotiated Rate |
$2,438.07 |
| Rate for Payer: Aetna of VT Commercial |
$2,438.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,185.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,136.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,185.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,544.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,181.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,078.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,154.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,040.28
|
| Rate for Payer: Cash Price |
$1,283.19
|
| Rate for Payer: Cash Price |
$1,283.19
|
| Rate for Payer: Cigna Commercial |
$2,053.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,053.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,053.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,154.88
|
| Rate for Payer: Multiplan Commercial |
$2,386.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,181.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,154.88
|
| Rate for Payer: United Healthcare Commercial |
$2,438.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,154.88
|
| Rate for Payer: United Healthcare VA CCN |
$1,154.88
|
|
|
K FLOW/FUNCT IMAGE W/DRUG
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
9727870801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$152.36 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna of VT Commercial |
$326.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$152.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$207.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$292.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$154.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$273.48
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna Commercial |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$275.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$154.80
|
| Rate for Payer: Multiplan Commercial |
$319.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$292.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$154.80
|
| Rate for Payer: United Healthcare Commercial |
$326.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.80
|
| Rate for Payer: United Healthcare VA CCN |
$154.80
|
|
|
K FLOW/FUNCT IMAGE W/DRUG
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
9727870801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$168.16 |
| Max. Negotiated Rate |
$519.18 |
| Rate for Payer: Aetna of VT Commercial |
$323.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$519.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$173.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$519.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$235.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$278.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$193.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$278.16
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna Commercial |
$254.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$271.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$271.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$168.17
|
| Rate for Payer: Multiplan Commercial |
$319.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$168.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$168.16
|
| Rate for Payer: United Healthcare Commercial |
$258.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.16
|
| Rate for Payer: United Healthcare VA CCN |
$168.16
|
|
|
K FLOW/FUNCT IMAGE W/DRUG
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
9727870801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$254.59 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna of VT Commercial |
$326.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$254.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$254.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$292.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$288.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$275.20
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna Commercial |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$275.20
|
| Rate for Payer: Multiplan Commercial |
$319.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$292.40
|
| Rate for Payer: United Healthcare Commercial |
$326.80
|
|
|
K FLOW/FUNCT IMAGE W/DRUG
|
Facility
|
IP
|
$2,546.74
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
3417870801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,884.84 |
| Max. Negotiated Rate |
$2,419.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,419.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,884.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,884.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,164.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,139.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,037.39
|
| Rate for Payer: Cash Price |
$1,273.37
|
| Rate for Payer: Cigna Commercial |
$2,037.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,037.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,037.39
|
| Rate for Payer: Multiplan Commercial |
$2,368.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,164.73
|
| Rate for Payer: United Healthcare Commercial |
$2,419.40
|
|
|
K FLOW/FUNCT IMAGE W/DRUG
|
Facility
|
OP
|
$2,546.74
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
3417870801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$519.18 |
| Max. Negotiated Rate |
$2,419.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,419.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$519.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,127.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$519.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,533.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,164.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,062.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,146.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,024.66
|
| Rate for Payer: Cash Price |
$1,273.37
|
| Rate for Payer: Cash Price |
$1,273.37
|
| Rate for Payer: Cigna Commercial |
$2,037.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,037.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,037.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,146.03
|
| Rate for Payer: Multiplan Commercial |
$2,368.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,164.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,146.03
|
| Rate for Payer: United Healthcare Commercial |
$2,419.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,146.03
|
| Rate for Payer: United Healthcare VA CCN |
$1,146.03
|
|
|
K FLOW/FUNCT IMAGE W/O DRUG
|
Facility
|
IP
|
$2,854.87
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
3417870701
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,112.89 |
| Max. Negotiated Rate |
$2,712.13 |
| Rate for Payer: Aetna of VT Commercial |
$2,712.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,112.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,112.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,426.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,398.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,283.90
|
| Rate for Payer: Cash Price |
$1,427.43
|
| Rate for Payer: Cigna Commercial |
$2,283.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,283.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,283.90
|
| Rate for Payer: Multiplan Commercial |
$2,655.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,426.64
|
| Rate for Payer: United Healthcare Commercial |
$2,712.13
|
|
|
K FLOW/FUNCT IMAGE W/O DRUG
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
9727870701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$100.65 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Aetna of VT Commercial |
$129.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$115.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.80
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$108.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.80
|
| Rate for Payer: Multiplan Commercial |
$126.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.60
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
|
|
K FLOW/FUNCT IMAGE W/O DRUG
|
Facility
|
OP
|
$2,854.87
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
3417870701
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$743.36 |
| Max. Negotiated Rate |
$2,712.13 |
| Rate for Payer: Aetna of VT Commercial |
$2,712.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$743.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,264.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$743.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,718.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,426.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,312.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,284.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,269.62
|
| Rate for Payer: Cash Price |
$1,427.43
|
| Rate for Payer: Cash Price |
$1,427.43
|
| Rate for Payer: Cigna Commercial |
$2,283.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,283.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,283.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,284.69
|
| Rate for Payer: Multiplan Commercial |
$2,655.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,426.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,284.69
|
| Rate for Payer: United Healthcare Commercial |
$2,712.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,284.69
|
| Rate for Payer: United Healthcare VA CCN |
$1,284.69
|
|
|
K FLOW/FUNCT IMAGE W/O DRUG
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
9727870701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$126.48 |
| Max. Negotiated Rate |
$743.36 |
| Rate for Payer: Aetna of VT Commercial |
$127.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$743.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$209.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$743.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$285.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$348.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$348.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$234.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$348.13
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$313.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$327.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$327.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$203.60
|
| Rate for Payer: Multiplan Commercial |
$126.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$203.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$203.59
|
| Rate for Payer: United Healthcare Commercial |
$313.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$203.59
|
| Rate for Payer: United Healthcare VA CCN |
$203.59
|
|
|
K FLOW/FUNCT IMAGE W/O DRUG
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
9727870701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$60.23 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Aetna of VT Commercial |
$129.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$121.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$60.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$121.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$81.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$115.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.12
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$108.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$126.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$61.20
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.20
|
| Rate for Payer: United Healthcare VA CCN |
$61.20
|
|
|
KIT ABG 23G 25G
|
Facility
|
OP
|
$1.43
|
|
| Hospital Charge Code |
2720034741
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Aetna of VT Commercial |
$1.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.14
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cigna Commercial |
$1.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.64
|
| Rate for Payer: United Healthcare Commercial |
$1.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.64
|
| Rate for Payer: United Healthcare VA CCN |
$0.64
|
|
|
KIT ABG 23G 25G
|
Facility
|
IP
|
$1.43
|
|
| Hospital Charge Code |
2720034741
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Aetna of VT Commercial |
$1.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.14
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cigna Commercial |
$1.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.22
|
| Rate for Payer: United Healthcare Commercial |
$1.36
|
|
|
KIT DRAINAGE PLEURX 500ML
|
Facility
|
IP
|
$70.96
|
|
| Hospital Charge Code |
2720016901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.52 |
| Max. Negotiated Rate |
$67.41 |
| Rate for Payer: Aetna of VT Commercial |
$67.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$52.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$52.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$60.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.77
|
| Rate for Payer: Cash Price |
$35.48
|
| Rate for Payer: Cigna Commercial |
$56.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.77
|
| Rate for Payer: Multiplan Commercial |
$65.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.32
|
| Rate for Payer: United Healthcare Commercial |
$67.41
|
|
|
KIT DRAINAGE PLEURX 500ML
|
Facility
|
OP
|
$70.96
|
|
| Hospital Charge Code |
2720016901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.43 |
| Max. Negotiated Rate |
$67.41 |
| Rate for Payer: Aetna of VT Commercial |
$67.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$42.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$60.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.41
|
| Rate for Payer: Cash Price |
$35.48
|
| Rate for Payer: Cigna Commercial |
$56.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.77
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.93
|
| Rate for Payer: Multiplan Commercial |
$65.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.93
|
| Rate for Payer: United Healthcare Commercial |
$67.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.93
|
| Rate for Payer: United Healthcare VA CCN |
$31.93
|
|
|
KIT, GUIDE PIN, PFXL
|
Facility
|
OP
|
$129.00
|
|
| Hospital Charge Code |
2720074981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.13 |
| Max. Negotiated Rate |
$122.55 |
| Rate for Payer: Aetna of VT Commercial |
$122.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$115.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$57.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$115.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$77.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$109.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$104.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$58.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$102.56
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$103.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$103.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$103.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$58.05
|
| Rate for Payer: Multiplan Commercial |
$119.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$109.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$58.05
|
| Rate for Payer: United Healthcare Commercial |
$122.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.05
|
| Rate for Payer: United Healthcare VA CCN |
$58.05
|
|
|
KIT, GUIDE PIN, PFXL
|
Facility
|
IP
|
$129.00
|
|
| Hospital Charge Code |
2720074981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.47 |
| Max. Negotiated Rate |
$122.55 |
| Rate for Payer: Aetna of VT Commercial |
$122.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$95.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$95.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$109.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$108.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$103.20
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$103.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$103.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$103.20
|
| Rate for Payer: Multiplan Commercial |
$119.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$109.65
|
| Rate for Payer: United Healthcare Commercial |
$122.55
|
|
|
KIT IV TRANS MONITOR 60
|
Facility
|
IP
|
$13.92
|
|
| Hospital Charge Code |
2720023501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$13.22 |
| Rate for Payer: Aetna of VT Commercial |
$13.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$10.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$10.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.14
|
| Rate for Payer: Cash Price |
$6.96
|
| Rate for Payer: Cigna Commercial |
$11.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.14
|
| Rate for Payer: Multiplan Commercial |
$12.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.83
|
| Rate for Payer: United Healthcare Commercial |
$13.22
|
|
|
KIT IV TRANS MONITOR 60
|
Facility
|
OP
|
$13.92
|
|
| Hospital Charge Code |
2720023501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$13.22 |
| Rate for Payer: Aetna of VT Commercial |
$13.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$12.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$6.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$12.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$8.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.07
|
| Rate for Payer: Cash Price |
$6.96
|
| Rate for Payer: Cigna Commercial |
$11.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.26
|
| Rate for Payer: Multiplan Commercial |
$12.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.26
|
| Rate for Payer: United Healthcare Commercial |
$13.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.26
|
| Rate for Payer: United Healthcare VA CCN |
$6.26
|
|
|
KIT LAVAGE GASTRIC 34FR/36 L
|
Facility
|
OP
|
$8.13
|
|
| Hospital Charge Code |
2720058471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: Aetna of VT Commercial |
$7.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6.46
|
| Rate for Payer: Cash Price |
$4.07
|
| Rate for Payer: Cigna Commercial |
$6.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$3.66
|
| Rate for Payer: Multiplan Commercial |
$7.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3.66
|
| Rate for Payer: United Healthcare Commercial |
$7.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.66
|
| Rate for Payer: United Healthcare VA CCN |
$3.66
|
|
|
KIT LAVAGE GASTRIC 34FR/36 L
|
Facility
|
IP
|
$8.13
|
|
| Hospital Charge Code |
2720058471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: Aetna of VT Commercial |
$7.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6.50
|
| Rate for Payer: Cash Price |
$4.07
|
| Rate for Payer: Cigna Commercial |
$6.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.50
|
| Rate for Payer: Multiplan Commercial |
$7.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.91
|
| Rate for Payer: United Healthcare Commercial |
$7.72
|
|
|
KIT STAPLE REMV
|
Facility
|
OP
|
$1.15
|
|
| Hospital Charge Code |
2720029691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Aetna of VT Commercial |
$1.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.91
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Cigna Commercial |
$0.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.52
|
| Rate for Payer: United Healthcare Commercial |
$1.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.52
|
| Rate for Payer: United Healthcare VA CCN |
$0.52
|
|
|
KIT STAPLE REMV
|
Facility
|
IP
|
$1.15
|
|
| Hospital Charge Code |
2720029691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Aetna of VT Commercial |
$1.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.92
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Cigna Commercial |
$0.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$1.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.98
|
| Rate for Payer: United Healthcare Commercial |
$1.09
|
|
