|
ASPIRATE PLEURA W/O IMAGING
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
9813255401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$188.23 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna of VT Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$188.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$255.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$361.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$344.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.88
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$361.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$191.25
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.25
|
| Rate for Payer: United Healthcare VA CCN |
$191.25
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
9813255402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$314.54 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna of VT Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$314.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$314.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$361.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$340.00
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.00
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$361.25
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Facility
|
IP
|
$1,053.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
5103255401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$779.33 |
| Max. Negotiated Rate |
$1,000.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,000.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$779.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$779.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$895.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$884.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$842.40
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cigna Commercial |
$842.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$842.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$842.40
|
| Rate for Payer: Multiplan Commercial |
$979.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$895.05
|
| Rate for Payer: United Healthcare Commercial |
$1,000.35
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
9813255401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$81.02 |
| Max. Negotiated Rate |
$400.03 |
| Rate for Payer: Aetna of VT Commercial |
$399.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$83.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$113.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$400.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$400.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$400.03
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$147.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$353.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$353.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$217.85
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$81.02
|
| Rate for Payer: United Healthcare Commercial |
$124.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.02
|
| Rate for Payer: United Healthcare VA CCN |
$81.02
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Facility
|
OP
|
$1,052.61
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
7203255401
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$466.20 |
| Max. Negotiated Rate |
$999.98 |
| Rate for Payer: Aetna of VT Commercial |
$999.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$943.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$466.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$943.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$633.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$894.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$852.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$473.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$836.82
|
| Rate for Payer: Cash Price |
$526.30
|
| Rate for Payer: Cigna Commercial |
$842.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$842.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$842.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$473.67
|
| Rate for Payer: Multiplan Commercial |
$978.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$894.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$473.67
|
| Rate for Payer: United Healthcare Commercial |
$999.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$473.67
|
| Rate for Payer: United Healthcare VA CCN |
$473.67
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
9813255402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$81.02 |
| Max. Negotiated Rate |
$400.03 |
| Rate for Payer: Aetna of VT Commercial |
$399.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$83.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$113.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$400.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$400.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$400.03
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$147.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$353.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$353.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$217.85
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$81.02
|
| Rate for Payer: United Healthcare Commercial |
$124.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.02
|
| Rate for Payer: United Healthcare VA CCN |
$81.02
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Facility
|
IP
|
$1,052.61
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
7203255401
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$779.04 |
| Max. Negotiated Rate |
$999.98 |
| Rate for Payer: Aetna of VT Commercial |
$999.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$779.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$779.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$894.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$884.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$842.09
|
| Rate for Payer: Cash Price |
$526.30
|
| Rate for Payer: Cigna Commercial |
$842.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$842.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$842.09
|
| Rate for Payer: Multiplan Commercial |
$978.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$894.72
|
| Rate for Payer: United Healthcare Commercial |
$999.98
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Facility
|
OP
|
$1,053.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
5103255401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$466.37 |
| Max. Negotiated Rate |
$1,000.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,000.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$943.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$466.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$943.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$633.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$895.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$852.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$473.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$837.13
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cigna Commercial |
$842.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$842.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$842.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$473.85
|
| Rate for Payer: Multiplan Commercial |
$979.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$895.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$473.85
|
| Rate for Payer: United Healthcare Commercial |
$1,000.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$473.85
|
| Rate for Payer: United Healthcare VA CCN |
$473.85
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
9813255402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$188.23 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna of VT Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$188.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$255.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$361.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$344.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.88
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$361.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$191.25
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.25
|
| Rate for Payer: United Healthcare VA CCN |
$191.25
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
9823255401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$314.54 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna of VT Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$314.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$314.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$361.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$340.00
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.00
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$361.25
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Professional
|
Both
|
$1,053.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
5103255401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.02 |
| Max. Negotiated Rate |
$989.82 |
| Rate for Payer: Aetna of VT Commercial |
$989.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$943.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$83.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$943.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$113.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$400.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$400.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$400.03
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cigna Commercial |
$147.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$353.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$353.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$217.85
|
| Rate for Payer: Multiplan Commercial |
$979.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$81.02
|
| Rate for Payer: United Healthcare Commercial |
$124.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.02
|
| Rate for Payer: United Healthcare VA CCN |
$81.02
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
9813255401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$314.54 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna of VT Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$314.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$314.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$361.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$340.00
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.00
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$361.25
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Facility
|
IP
|
$1,052.61
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
4503255401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$779.04 |
| Max. Negotiated Rate |
$999.98 |
| Rate for Payer: Aetna of VT Commercial |
$999.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$779.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$779.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$894.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$884.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$842.09
|
| Rate for Payer: Cash Price |
$526.30
|
| Rate for Payer: Cigna Commercial |
$842.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$842.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$842.09
|
| Rate for Payer: Multiplan Commercial |
$978.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$894.72
|
| Rate for Payer: United Healthcare Commercial |
$999.98
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
9603255402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$188.23 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna of VT Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$188.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$255.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$361.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$344.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.88
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$361.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$191.25
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.25
|
| Rate for Payer: United Healthcare VA CCN |
$191.25
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
9603255402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$314.54 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna of VT Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$314.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$314.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$361.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$340.00
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.00
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$361.25
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
9823255401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$188.23 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna of VT Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$188.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$255.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$361.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$344.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.88
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$361.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$191.25
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.25
|
| Rate for Payer: United Healthcare VA CCN |
$191.25
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
9603255402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$81.02 |
| Max. Negotiated Rate |
$400.03 |
| Rate for Payer: Aetna of VT Commercial |
$399.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$83.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$113.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$400.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$400.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$400.03
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$147.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$353.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$353.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$217.85
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$81.02
|
| Rate for Payer: United Healthcare Commercial |
$124.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.02
|
| Rate for Payer: United Healthcare VA CCN |
$81.02
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Facility
|
OP
|
$1,052.61
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
4503255401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$466.20 |
| Max. Negotiated Rate |
$999.98 |
| Rate for Payer: Aetna of VT Commercial |
$999.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$943.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$466.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$943.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$633.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$894.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$852.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$473.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$836.82
|
| Rate for Payer: Cash Price |
$526.30
|
| Rate for Payer: Cigna Commercial |
$842.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$842.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$842.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$473.67
|
| Rate for Payer: Multiplan Commercial |
$978.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$894.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$473.67
|
| Rate for Payer: United Healthcare Commercial |
$999.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$473.67
|
| Rate for Payer: United Healthcare VA CCN |
$473.67
|
|
|
ASPIRIN 81 MG CHEWABLE TAB
|
Professional
|
Both
|
$0.03
|
|
| Hospital Charge Code |
2500000327
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
ASPIRIN 81 MG CHEWABLE TAB
|
Professional
|
Both
|
$0.03
|
|
|
Service Code
|
NDC 904679430
|
| Hospital Charge Code |
2500000327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
ASPR/INJ GANGLION CYST ANY LOC
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
5102061201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.73 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$57.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$57.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.40
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
|
|
ASPR/INJ GANGLION CYST ANY LOC
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
5102061201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.55 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.01
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.10
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare VA CCN |
$35.10
|
|
|
ASPR/INJ GANGLION CYST ANY LOC
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
9602061202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$38.45 |
| Max. Negotiated Rate |
$196.46 |
| Rate for Payer: Aetna of VT Commercial |
$196.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$187.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$187.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$84.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.94
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$72.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$101.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$101.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$61.90
|
| Rate for Payer: Multiplan Commercial |
$194.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.45
|
| Rate for Payer: United Healthcare Commercial |
$59.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.45
|
| Rate for Payer: United Healthcare VA CCN |
$38.45
|
|
|
ASPR/INJ GANGLION CYST ANY LOC
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
9602061201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$127.11 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Aetna of VT Commercial |
$272.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$257.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$127.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$257.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$172.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$243.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$232.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$228.16
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$229.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$229.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$229.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$129.15
|
| Rate for Payer: Multiplan Commercial |
$266.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$243.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$129.15
|
| Rate for Payer: United Healthcare Commercial |
$272.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.15
|
| Rate for Payer: United Healthcare VA CCN |
$129.15
|
|
|
ASPR/INJ GANGLION CYST ANY LOC
|
Professional
|
Both
|
$287.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
9602061201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$38.45 |
| Max. Negotiated Rate |
$269.78 |
| Rate for Payer: Aetna of VT Commercial |
$269.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$257.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$257.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$84.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.94
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$72.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$101.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$101.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$61.90
|
| Rate for Payer: Multiplan Commercial |
$266.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.45
|
| Rate for Payer: United Healthcare Commercial |
$59.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.45
|
| Rate for Payer: United Healthcare VA CCN |
$38.45
|
|
