|
NEEDLE GUID ENDO
|
Facility
|
OP
|
$83.24
|
|
| Hospital Charge Code |
2720017241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.87 |
| Max. Negotiated Rate |
$79.08 |
| Rate for Payer: Aetna of VT Commercial |
$79.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.18
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cigna Commercial |
$66.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.59
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.46
|
| Rate for Payer: Multiplan Commercial |
$77.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.46
|
| Rate for Payer: United Healthcare Commercial |
$79.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.46
|
| Rate for Payer: United Healthcare VA CCN |
$37.46
|
|
|
NEEDLE GUID ENDO
|
Facility
|
IP
|
$83.24
|
|
| Hospital Charge Code |
2720017241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.61 |
| Max. Negotiated Rate |
$79.08 |
| Rate for Payer: Aetna of VT Commercial |
$79.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$69.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.59
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cigna Commercial |
$66.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.59
|
| Rate for Payer: Multiplan Commercial |
$77.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.75
|
| Rate for Payer: United Healthcare Commercial |
$79.08
|
|
|
NEEDLE INJ WILLIAMS CYSTOSCPC
|
Facility
|
IP
|
$130.28
|
|
| Hospital Charge Code |
2720018221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$123.77 |
| Rate for Payer: Aetna of VT Commercial |
$123.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$96.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$96.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$110.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.22
|
| Rate for Payer: Cash Price |
$65.14
|
| Rate for Payer: Cigna Commercial |
$104.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$104.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$104.22
|
| Rate for Payer: Multiplan Commercial |
$121.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.74
|
| Rate for Payer: United Healthcare Commercial |
$123.77
|
|
|
NEEDLE INJ WILLIAMS CYSTOSCPC
|
Facility
|
OP
|
$130.28
|
|
| Hospital Charge Code |
2720018221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.70 |
| Max. Negotiated Rate |
$123.77 |
| Rate for Payer: Aetna of VT Commercial |
$123.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$116.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$57.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$116.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$78.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$110.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$105.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$58.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$103.57
|
| Rate for Payer: Cash Price |
$65.14
|
| Rate for Payer: Cigna Commercial |
$104.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$104.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$104.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$58.63
|
| Rate for Payer: Multiplan Commercial |
$121.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$58.63
|
| Rate for Payer: United Healthcare Commercial |
$123.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.63
|
| Rate for Payer: United Healthcare VA CCN |
$58.63
|
|
|
NEEDLE INTRAOSSE 25MM ADULT
|
Facility
|
OP
|
$141.24
|
|
| Hospital Charge Code |
2720045331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.56 |
| Max. Negotiated Rate |
$134.18 |
| Rate for Payer: Aetna of VT Commercial |
$134.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$85.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.29
|
| Rate for Payer: Cash Price |
$70.62
|
| Rate for Payer: Cigna Commercial |
$112.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.56
|
| Rate for Payer: Multiplan Commercial |
$131.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.56
|
| Rate for Payer: United Healthcare Commercial |
$134.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.56
|
| Rate for Payer: United Healthcare VA CCN |
$63.56
|
|
|
NEEDLE INTRAOSSE 25MM ADULT
|
Facility
|
IP
|
$141.24
|
|
| Hospital Charge Code |
2720045331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.53 |
| Max. Negotiated Rate |
$134.18 |
| Rate for Payer: Aetna of VT Commercial |
$134.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.99
|
| Rate for Payer: Cash Price |
$70.62
|
| Rate for Payer: Cigna Commercial |
$112.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.99
|
| Rate for Payer: Multiplan Commercial |
$131.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.05
|
| Rate for Payer: United Healthcare Commercial |
$134.18
|
|
|
NEEDLE INTRAOSSE 45MM ADULT
|
Facility
|
IP
|
$141.24
|
|
| Hospital Charge Code |
2720048821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.53 |
| Max. Negotiated Rate |
$134.18 |
| Rate for Payer: Aetna of VT Commercial |
$134.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.99
|
| Rate for Payer: Cash Price |
$70.62
|
| Rate for Payer: Cigna Commercial |
$112.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.99
|
| Rate for Payer: Multiplan Commercial |
$131.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.05
|
| Rate for Payer: United Healthcare Commercial |
$134.18
|
|
|
NEEDLE INTRAOSSE 45MM ADULT
|
Facility
|
OP
|
$141.24
|
|
| Hospital Charge Code |
2720048821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.56 |
| Max. Negotiated Rate |
$134.18 |
| Rate for Payer: Aetna of VT Commercial |
$134.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$85.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.29
|
| Rate for Payer: Cash Price |
$70.62
|
| Rate for Payer: Cigna Commercial |
$112.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.56
|
| Rate for Payer: Multiplan Commercial |
$131.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.56
|
| Rate for Payer: United Healthcare Commercial |
$134.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.56
|
| Rate for Payer: United Healthcare VA CCN |
$63.56
|
|
|
NEEDLE INTRAOSSE PEDI
|
Facility
|
IP
|
$141.24
|
|
| Hospital Charge Code |
2720045341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.53 |
| Max. Negotiated Rate |
$134.18 |
| Rate for Payer: Aetna of VT Commercial |
$134.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.99
|
| Rate for Payer: Cash Price |
$70.62
|
| Rate for Payer: Cigna Commercial |
$112.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.99
|
| Rate for Payer: Multiplan Commercial |
$131.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.05
|
| Rate for Payer: United Healthcare Commercial |
$134.18
|
|
|
NEEDLE INTRAOSSE PEDI
|
Facility
|
OP
|
$141.24
|
|
| Hospital Charge Code |
2720045341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.56 |
| Max. Negotiated Rate |
$134.18 |
| Rate for Payer: Aetna of VT Commercial |
$134.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$85.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.29
|
| Rate for Payer: Cash Price |
$70.62
|
| Rate for Payer: Cigna Commercial |
$112.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.56
|
| Rate for Payer: Multiplan Commercial |
$131.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.56
|
| Rate for Payer: United Healthcare Commercial |
$134.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.56
|
| Rate for Payer: United Healthcare VA CCN |
$63.56
|
|
|
NEEDLE LOCALIZATION BY XRAY
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
9607700202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$137.74 |
| Max. Negotiated Rate |
$295.45 |
| Rate for Payer: Aetna of VT Commercial |
$295.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$278.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$137.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$278.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$187.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$264.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$251.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$139.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$247.25
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cigna Commercial |
$248.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$248.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$248.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$139.95
|
| Rate for Payer: Multiplan Commercial |
$289.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$139.95
|
| Rate for Payer: United Healthcare Commercial |
$295.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$139.95
|
| Rate for Payer: United Healthcare VA CCN |
$139.95
|
|
|
NEEDLE LOCALIZATION BY XRAY
|
Professional
|
Both
|
$543.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
5107700201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.04 |
| Max. Negotiated Rate |
$510.42 |
| Rate for Payer: Aetna of VT Commercial |
$510.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$388.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$112.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$388.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$152.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.36
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$169.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$175.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$175.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$109.04
|
| Rate for Payer: Multiplan Commercial |
$504.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$154.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$109.04
|
| Rate for Payer: United Healthcare Commercial |
$167.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$109.04
|
| Rate for Payer: United Healthcare VA CCN |
$109.04
|
|
|
NEEDLE LOCALIZATION BY XRAY
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
5107700201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$240.49 |
| Max. Negotiated Rate |
$515.85 |
| Rate for Payer: Aetna of VT Commercial |
$515.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$486.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$240.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$486.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$326.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$461.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$439.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$244.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$431.69
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$434.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$434.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$434.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$244.35
|
| Rate for Payer: Multiplan Commercial |
$504.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$461.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$244.35
|
| Rate for Payer: United Healthcare Commercial |
$515.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.35
|
| Rate for Payer: United Healthcare VA CCN |
$244.35
|
|
|
NEEDLE LOCALIZATION BY XRAY
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
5107700201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$401.87 |
| Max. Negotiated Rate |
$515.85 |
| Rate for Payer: Aetna of VT Commercial |
$515.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$401.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$401.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$461.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$456.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$434.40
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$434.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$434.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$434.40
|
| Rate for Payer: Multiplan Commercial |
$504.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$461.55
|
| Rate for Payer: United Healthcare Commercial |
$515.85
|
|
|
NEEDLE LOCALIZATION BY XRAY
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
9607700201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$631.31 |
| Max. Negotiated Rate |
$810.35 |
| Rate for Payer: Aetna of VT Commercial |
$810.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$631.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$631.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$725.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$716.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$682.40
|
| Rate for Payer: Cash Price |
$426.50
|
| Rate for Payer: Cigna Commercial |
$682.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$682.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$682.40
|
| Rate for Payer: Multiplan Commercial |
$793.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$725.05
|
| Rate for Payer: United Healthcare Commercial |
$810.35
|
|
|
NEEDLE LOCALIZATION BY XRAY
|
Professional
|
Both
|
$853.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
9607700201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$109.04 |
| Max. Negotiated Rate |
$801.82 |
| Rate for Payer: Aetna of VT Commercial |
$801.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$388.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$112.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$388.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$152.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.36
|
| Rate for Payer: Cash Price |
$426.50
|
| Rate for Payer: Cash Price |
$426.50
|
| Rate for Payer: Cigna Commercial |
$169.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$175.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$175.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$109.04
|
| Rate for Payer: Multiplan Commercial |
$793.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$154.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$109.04
|
| Rate for Payer: United Healthcare Commercial |
$167.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$109.04
|
| Rate for Payer: United Healthcare VA CCN |
$109.04
|
|
|
NEEDLE LOCALIZATION BY XRAY
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
9607700202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$109.04 |
| Max. Negotiated Rate |
$388.47 |
| Rate for Payer: Aetna of VT Commercial |
$292.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$388.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$112.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$388.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$152.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.36
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cigna Commercial |
$169.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$175.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$175.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$109.04
|
| Rate for Payer: Multiplan Commercial |
$289.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$154.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$109.04
|
| Rate for Payer: United Healthcare Commercial |
$167.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$109.04
|
| Rate for Payer: United Healthcare VA CCN |
$109.04
|
|
|
NEEDLE LOCALIZATION BY XRAY
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
9607700201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$377.79 |
| Max. Negotiated Rate |
$810.35 |
| Rate for Payer: Aetna of VT Commercial |
$810.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$764.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$377.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$764.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$513.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$725.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$690.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$383.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$678.13
|
| Rate for Payer: Cash Price |
$426.50
|
| Rate for Payer: Cigna Commercial |
$682.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$682.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$682.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$383.85
|
| Rate for Payer: Multiplan Commercial |
$793.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$725.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$383.85
|
| Rate for Payer: United Healthcare Commercial |
$810.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$383.85
|
| Rate for Payer: United Healthcare VA CCN |
$383.85
|
|
|
NEEDLE LOCALIZATION BY XRAY
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
9607700202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$230.17 |
| Max. Negotiated Rate |
$295.45 |
| Rate for Payer: Aetna of VT Commercial |
$295.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$230.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$230.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$264.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$261.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$248.80
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cigna Commercial |
$248.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$248.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$248.80
|
| Rate for Payer: Multiplan Commercial |
$289.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.35
|
| Rate for Payer: United Healthcare Commercial |
$295.45
|
|
|
NEG PRESS WND TX <=50 SQ CM
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
9609760701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$347.11 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Aetna of VT Commercial |
$445.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$347.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$347.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$398.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$393.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$375.20
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$375.20
|
| Rate for Payer: Multiplan Commercial |
$436.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$398.65
|
| Rate for Payer: United Healthcare Commercial |
$445.55
|
|
|
NEG PRESS WND TX <=50 SQ CM
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
5109760701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.43 |
| Max. Negotiated Rate |
$284.05 |
| Rate for Payer: Aetna of VT Commercial |
$284.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$267.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$132.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$267.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$254.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$242.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$134.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$237.71
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$239.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$239.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$134.55
|
| Rate for Payer: Multiplan Commercial |
$278.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$254.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$134.55
|
| Rate for Payer: United Healthcare Commercial |
$284.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$134.55
|
| Rate for Payer: United Healthcare VA CCN |
$134.55
|
|
|
NEG PRESS WND TX <=50 SQ CM
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
9609760702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$75.29 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Aetna of VT Commercial |
$161.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$75.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$102.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$137.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.15
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.50
|
| Rate for Payer: Multiplan Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$144.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.50
|
| Rate for Payer: United Healthcare Commercial |
$161.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.50
|
| Rate for Payer: United Healthcare VA CCN |
$76.50
|
|
|
NEG PRESS WND TX <=50 SQ CM
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
9609760702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$125.82 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Aetna of VT Commercial |
$161.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$136.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.00
|
| Rate for Payer: Multiplan Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$144.50
|
| Rate for Payer: United Healthcare Commercial |
$161.50
|
|
|
NEG PRESS WND TX <=50 SQ CM
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
9609760702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$19.56 |
| Max. Negotiated Rate |
$513.79 |
| Rate for Payer: Aetna of VT Commercial |
$159.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$27.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$22.49
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$23.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$513.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$513.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$320.20
|
| Rate for Payer: Multiplan Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.56
|
| Rate for Payer: United Healthcare Commercial |
$30.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.56
|
| Rate for Payer: United Healthcare VA CCN |
$19.56
|
|
|
NEG PRESS WND TX <=50 SQ CM
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
9829760701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$125.82 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Aetna of VT Commercial |
$161.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$136.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.00
|
| Rate for Payer: Multiplan Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$144.50
|
| Rate for Payer: United Healthcare Commercial |
$161.50
|
|
