|
N BLOCK SPENOPALATINE GANGL
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
9816450502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$235.62 |
| Max. Negotiated Rate |
$505.40 |
| Rate for Payer: Aetna of VT Commercial |
$505.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$476.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$476.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$320.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$430.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$239.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$422.94
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: Cigna Commercial |
$425.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$425.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$425.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$239.40
|
| Rate for Payer: Multiplan Commercial |
$494.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$452.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$239.40
|
| Rate for Payer: United Healthcare Commercial |
$505.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$239.40
|
| Rate for Payer: United Healthcare VA CCN |
$239.40
|
|
|
N BLOCK SPENOPALATINE GANGL
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
9816450502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$393.73 |
| Max. Negotiated Rate |
$505.40 |
| Rate for Payer: Aetna of VT Commercial |
$505.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$393.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$393.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$425.60
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: Cigna Commercial |
$425.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$425.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$425.60
|
| Rate for Payer: Multiplan Commercial |
$494.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$452.20
|
| Rate for Payer: United Healthcare Commercial |
$505.40
|
|
|
N BLOCK SPENOPALATINE GANGL
|
Facility
|
IP
|
$600.07
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
4506450501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$444.11 |
| Max. Negotiated Rate |
$570.07 |
| Rate for Payer: Aetna of VT Commercial |
$570.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$444.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$444.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$510.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$504.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$480.06
|
| Rate for Payer: Cash Price |
$300.04
|
| Rate for Payer: Cigna Commercial |
$480.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$480.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$480.06
|
| Rate for Payer: Multiplan Commercial |
$558.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$510.06
|
| Rate for Payer: United Healthcare Commercial |
$570.07
|
|
|
N BLOCK SPENOPALATINE GANGL
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
9826450501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$235.62 |
| Max. Negotiated Rate |
$505.40 |
| Rate for Payer: Aetna of VT Commercial |
$505.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$476.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$476.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$320.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$430.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$239.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$422.94
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: Cigna Commercial |
$425.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$425.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$425.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$239.40
|
| Rate for Payer: Multiplan Commercial |
$494.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$452.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$239.40
|
| Rate for Payer: United Healthcare Commercial |
$505.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$239.40
|
| Rate for Payer: United Healthcare VA CCN |
$239.40
|
|
|
N BLOCK SPENOPALATINE GANGL
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
9826450501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$97.42 |
| Max. Negotiated Rate |
$500.08 |
| Rate for Payer: Aetna of VT Commercial |
$500.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$476.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$100.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$476.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$136.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$203.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$203.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$112.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$203.62
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: Cigna Commercial |
$135.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$225.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$225.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$135.32
|
| Rate for Payer: Multiplan Commercial |
$494.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$138.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$97.42
|
| Rate for Payer: United Healthcare Commercial |
$149.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.42
|
| Rate for Payer: United Healthcare VA CCN |
$97.42
|
|
|
N BLOCK SPENOPALATINE GANGL
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
9816450501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
NB RESUSCITATION
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
9879946501
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$371.15 |
| Max. Negotiated Rate |
$796.10 |
| Rate for Payer: Aetna of VT Commercial |
$796.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$750.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$371.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$750.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$504.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$712.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$678.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$377.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$666.21
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$670.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$670.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$670.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$377.10
|
| Rate for Payer: Multiplan Commercial |
$779.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$712.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$377.10
|
| Rate for Payer: United Healthcare Commercial |
$796.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.10
|
| Rate for Payer: United Healthcare VA CCN |
$377.10
|
|
|
NB RESUSCITATION
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
9879946501
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$620.20 |
| Max. Negotiated Rate |
$796.10 |
| Rate for Payer: Aetna of VT Commercial |
$796.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$620.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$620.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$712.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$703.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$670.40
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$670.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$670.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$670.40
|
| Rate for Payer: Multiplan Commercial |
$779.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$712.30
|
| Rate for Payer: United Healthcare Commercial |
$796.10
|
|
|
NDL BREAST LOC 21G 5CM
|
Facility
|
OP
|
$190.00
|
|
| Hospital Charge Code |
2720017941
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Aetna of VT Commercial |
$180.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$170.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$170.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$114.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$161.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$153.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$151.05
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$152.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$152.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$152.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$85.50
|
| Rate for Payer: Multiplan Commercial |
$176.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$161.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$180.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.50
|
| Rate for Payer: United Healthcare VA CCN |
$85.50
|
|
|
NDL BREAST LOC 21G 5CM
|
Facility
|
IP
|
$190.00
|
|
| Hospital Charge Code |
2720017941
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Aetna of VT Commercial |
$180.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$140.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$140.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$161.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$152.00
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$152.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$152.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$152.00
|
| Rate for Payer: Multiplan Commercial |
$176.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$161.50
|
| Rate for Payer: United Healthcare Commercial |
$180.50
|
|
|
NDL INSJ W/O NJX 1 OR 2 MUSC
|
Professional
|
Both
|
$51.29
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
4202056001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.22 |
| Max. Negotiated Rate |
$48.21 |
| Rate for Payer: Aetna of VT Commercial |
$48.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$45.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$45.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$32.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$32.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$32.83
|
| Rate for Payer: Cash Price |
$25.64
|
| Rate for Payer: Cash Price |
$25.64
|
| Rate for Payer: Cigna Commercial |
$26.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$39.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$39.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$24.17
|
| Rate for Payer: Multiplan Commercial |
$47.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.22
|
| Rate for Payer: United Healthcare Commercial |
$21.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.22
|
| Rate for Payer: United Healthcare VA CCN |
$14.22
|
|
|
NDL INSJ W/O NJX 1 OR 2 MUSC
|
Facility
|
OP
|
$51.29
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
4202056001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.72 |
| Max. Negotiated Rate |
$48.73 |
| Rate for Payer: Aetna of VT Commercial |
$48.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$45.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$45.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$30.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$43.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$41.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$40.78
|
| Rate for Payer: Cash Price |
$25.64
|
| Rate for Payer: Cigna Commercial |
$41.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$41.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$41.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$23.08
|
| Rate for Payer: Multiplan Commercial |
$47.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.08
|
| Rate for Payer: United Healthcare Commercial |
$48.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.08
|
| Rate for Payer: United Healthcare VA CCN |
$23.08
|
|
|
NDL INSJ W/O NJX 1 OR 2 MUSC
|
Facility
|
IP
|
$51.29
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
4202056001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$48.73 |
| Rate for Payer: Aetna of VT Commercial |
$48.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$37.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$37.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$43.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$43.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$41.03
|
| Rate for Payer: Cash Price |
$25.64
|
| Rate for Payer: Cigna Commercial |
$41.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$41.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$41.03
|
| Rate for Payer: Multiplan Commercial |
$47.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$43.60
|
| Rate for Payer: United Healthcare Commercial |
$48.73
|
|
|
NDL INSJ W/O NJX 3+ MUSC
|
Professional
|
Both
|
$57.16
|
|
|
Service Code
|
CPT 20561
|
| Hospital Charge Code |
4202056101
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.49 |
| Max. Negotiated Rate |
$57.08 |
| Rate for Payer: Aetna of VT Commercial |
$53.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$30.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$48.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$48.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$48.69
|
| Rate for Payer: Cash Price |
$28.58
|
| Rate for Payer: Cash Price |
$28.58
|
| Rate for Payer: Cigna Commercial |
$40.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$57.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$57.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.30
|
| Rate for Payer: Multiplan Commercial |
$53.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.49
|
| Rate for Payer: United Healthcare Commercial |
$33.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.49
|
| Rate for Payer: United Healthcare VA CCN |
$21.49
|
|
|
NDL INSJ W/O NJX 3+ MUSC
|
Facility
|
OP
|
$57.16
|
|
|
Service Code
|
CPT 20561
|
| Hospital Charge Code |
4202056101
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.32 |
| Max. Negotiated Rate |
$54.30 |
| Rate for Payer: Aetna of VT Commercial |
$54.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$25.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$34.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$48.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$46.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$25.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$45.44
|
| Rate for Payer: Cash Price |
$28.58
|
| Rate for Payer: Cigna Commercial |
$45.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$45.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$45.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$25.72
|
| Rate for Payer: Multiplan Commercial |
$53.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.72
|
| Rate for Payer: United Healthcare Commercial |
$54.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.72
|
| Rate for Payer: United Healthcare VA CCN |
$25.72
|
|
|
NDL INSJ W/O NJX 3+ MUSC
|
Facility
|
IP
|
$57.16
|
|
|
Service Code
|
CPT 20561
|
| Hospital Charge Code |
4202056101
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$54.30 |
| Rate for Payer: Aetna of VT Commercial |
$54.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$42.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$42.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$48.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$48.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$45.73
|
| Rate for Payer: Cash Price |
$28.58
|
| Rate for Payer: Cigna Commercial |
$45.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$45.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$45.73
|
| Rate for Payer: Multiplan Commercial |
$53.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.59
|
| Rate for Payer: United Healthcare Commercial |
$54.30
|
|
|
NEEDLE ACHIEVE BIOPSY 14GX11CM
|
Facility
|
IP
|
$682.45
|
|
| Hospital Charge Code |
2720016961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.08 |
| Max. Negotiated Rate |
$648.33 |
| Rate for Payer: Aetna of VT Commercial |
$648.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$505.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$505.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$580.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$573.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$545.96
|
| Rate for Payer: Cash Price |
$341.22
|
| Rate for Payer: Cigna Commercial |
$545.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$545.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$545.96
|
| Rate for Payer: Multiplan Commercial |
$634.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$580.08
|
| Rate for Payer: United Healthcare Commercial |
$648.33
|
|
|
NEEDLE ACHIEVE BIOPSY 14GX11CM
|
Facility
|
OP
|
$682.45
|
|
| Hospital Charge Code |
2720016961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$302.26 |
| Max. Negotiated Rate |
$648.33 |
| Rate for Payer: Aetna of VT Commercial |
$648.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$611.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$302.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$611.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$410.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$580.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$552.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$307.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$542.55
|
| Rate for Payer: Cash Price |
$341.22
|
| Rate for Payer: Cigna Commercial |
$545.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$545.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$545.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$307.10
|
| Rate for Payer: Multiplan Commercial |
$634.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$580.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$307.10
|
| Rate for Payer: United Healthcare Commercial |
$648.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$307.10
|
| Rate for Payer: United Healthcare VA CCN |
$307.10
|
|
|
NEEDLE BIOPSY 18GX20CM MARQUEE
|
Facility
|
IP
|
$133.72
|
|
| Hospital Charge Code |
2720075251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.97 |
| Max. Negotiated Rate |
$127.03 |
| Rate for Payer: Aetna of VT Commercial |
$127.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$98.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$98.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$112.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$106.98
|
| Rate for Payer: Cash Price |
$66.86
|
| Rate for Payer: Cigna Commercial |
$106.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.98
|
| Rate for Payer: Multiplan Commercial |
$124.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$113.66
|
| Rate for Payer: United Healthcare Commercial |
$127.03
|
|
|
NEEDLE BIOPSY 18GX20CM MARQUEE
|
Facility
|
OP
|
$133.72
|
|
| Hospital Charge Code |
2720075251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.22 |
| Max. Negotiated Rate |
$127.03 |
| Rate for Payer: Aetna of VT Commercial |
$127.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$119.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$59.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$119.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$108.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$106.31
|
| Rate for Payer: Cash Price |
$66.86
|
| Rate for Payer: Cigna Commercial |
$106.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$60.17
|
| Rate for Payer: Multiplan Commercial |
$124.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$113.66
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$60.17
|
| Rate for Payer: United Healthcare Commercial |
$127.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.17
|
| Rate for Payer: United Healthcare VA CCN |
$60.17
|
|
|
NEEDLE BIOPSY LYMPH NODES
|
Facility
|
OP
|
$2,042.15
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
3203850501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$904.47 |
| Max. Negotiated Rate |
$1,940.04 |
| Rate for Payer: Aetna of VT Commercial |
$1,940.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,829.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$904.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,829.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,229.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,735.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,654.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$918.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,623.51
|
| Rate for Payer: Cash Price |
$1,021.08
|
| Rate for Payer: Cigna Commercial |
$1,633.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,633.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,633.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$918.97
|
| Rate for Payer: Multiplan Commercial |
$1,899.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,735.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$918.97
|
| Rate for Payer: United Healthcare Commercial |
$1,940.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$918.97
|
| Rate for Payer: United Healthcare VA CCN |
$918.97
|
|
|
NEEDLE BIOPSY LYMPH NODES
|
Professional
|
Both
|
$343.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
9723850501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$79.81 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Aetna of VT Commercial |
$322.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$307.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$82.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$307.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$111.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$91.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$220.00
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cigna Commercial |
$145.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$264.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$264.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$163.32
|
| Rate for Payer: Multiplan Commercial |
$318.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$113.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.81
|
| Rate for Payer: United Healthcare Commercial |
$122.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.81
|
| Rate for Payer: United Healthcare VA CCN |
$79.81
|
|
|
NEEDLE BIOPSY LYMPH NODES
|
Facility
|
IP
|
$343.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
9723850501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$253.85 |
| Max. Negotiated Rate |
$325.85 |
| Rate for Payer: Aetna of VT Commercial |
$325.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$253.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$253.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$291.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$288.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$274.40
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cigna Commercial |
$274.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$274.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$274.40
|
| Rate for Payer: Multiplan Commercial |
$318.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$291.55
|
| Rate for Payer: United Healthcare Commercial |
$325.85
|
|
|
NEEDLE BIOPSY LYMPH NODES
|
Facility
|
IP
|
$2,042.15
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
3203850501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,511.40 |
| Max. Negotiated Rate |
$1,940.04 |
| Rate for Payer: Aetna of VT Commercial |
$1,940.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,511.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,511.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,735.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,715.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,633.72
|
| Rate for Payer: Cash Price |
$1,021.08
|
| Rate for Payer: Cigna Commercial |
$1,633.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,633.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,633.72
|
| Rate for Payer: Multiplan Commercial |
$1,899.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,735.83
|
| Rate for Payer: United Healthcare Commercial |
$1,940.04
|
|
|
NEEDLE BIOPSY LYMPH NODES
|
Facility
|
OP
|
$343.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
9723850501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$151.91 |
| Max. Negotiated Rate |
$325.85 |
| Rate for Payer: Aetna of VT Commercial |
$325.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$307.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$151.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$307.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$206.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$291.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$277.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$154.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$272.69
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cigna Commercial |
$274.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$274.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$274.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$154.35
|
| Rate for Payer: Multiplan Commercial |
$318.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$291.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$154.35
|
| Rate for Payer: United Healthcare Commercial |
$325.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.35
|
| Rate for Payer: United Healthcare VA CCN |
$154.35
|
|
