|
PENILE INJECTION
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
9605423502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$130.26 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Aetna of VT Commercial |
$167.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.80
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.80
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.60
|
| Rate for Payer: United Healthcare Commercial |
$167.20
|
|
|
PERICARDIOCENTESIS W/IMAGING
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
9813301602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$592.08 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna of VT Commercial |
$760.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$592.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$592.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$680.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$672.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$640.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$640.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$640.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$640.00
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$680.00
|
| Rate for Payer: United Healthcare Commercial |
$760.00
|
|
|
PERICARDIOCENTESIS W/IMAGING
|
Facility
|
OP
|
$2,498.26
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
4503301601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,106.48 |
| Max. Negotiated Rate |
$2,373.35 |
| Rate for Payer: Aetna of VT Commercial |
$2,373.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,238.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,106.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,238.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,503.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,123.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,023.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,124.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,986.12
|
| Rate for Payer: Cash Price |
$1,249.13
|
| Rate for Payer: Cigna Commercial |
$1,998.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,998.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,998.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,124.22
|
| Rate for Payer: Multiplan Commercial |
$2,323.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,123.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,124.22
|
| Rate for Payer: United Healthcare Commercial |
$2,373.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,124.22
|
| Rate for Payer: United Healthcare VA CCN |
$1,124.22
|
|
|
PERICARDIOCENTESIS W/IMAGING
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
9813301601
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$207.40 |
| Max. Negotiated Rate |
$752.00 |
| Rate for Payer: Aetna of VT Commercial |
$752.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$716.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$213.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$716.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$290.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$328.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$328.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$238.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$328.66
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$377.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$354.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$354.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$207.40
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$207.40
|
| Rate for Payer: United Healthcare Commercial |
$319.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$207.40
|
| Rate for Payer: United Healthcare VA CCN |
$207.40
|
|
|
PERICARDIOCENTESIS W/IMAGING
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
9823301601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$354.32 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna of VT Commercial |
$760.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$716.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$354.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$716.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$481.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$680.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$648.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$360.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$636.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$640.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$640.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$640.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$680.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$360.00
|
| Rate for Payer: United Healthcare Commercial |
$760.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.00
|
| Rate for Payer: United Healthcare VA CCN |
$360.00
|
|
|
PERICARDIOCENTESIS W/IMAGING
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
9823301601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$592.08 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna of VT Commercial |
$760.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$592.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$592.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$680.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$672.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$640.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$640.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$640.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$640.00
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$680.00
|
| Rate for Payer: United Healthcare Commercial |
$760.00
|
|
|
PERICARDIOCENTESIS W/IMAGING
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
9813301602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$354.32 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna of VT Commercial |
$760.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$716.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$354.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$716.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$481.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$680.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$648.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$360.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$636.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$640.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$640.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$640.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$680.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$360.00
|
| Rate for Payer: United Healthcare Commercial |
$760.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.00
|
| Rate for Payer: United Healthcare VA CCN |
$360.00
|
|
|
PERICARDIOCENTESIS W/IMAGING
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
9813301602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$207.40 |
| Max. Negotiated Rate |
$752.00 |
| Rate for Payer: Aetna of VT Commercial |
$752.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$716.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$213.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$716.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$290.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$328.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$328.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$238.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$328.66
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$377.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$354.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$354.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$207.40
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$207.40
|
| Rate for Payer: United Healthcare Commercial |
$319.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$207.40
|
| Rate for Payer: United Healthcare VA CCN |
$207.40
|
|
|
PERICARDIOCENTESIS W/IMAGING
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
9823301601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$207.40 |
| Max. Negotiated Rate |
$752.00 |
| Rate for Payer: Aetna of VT Commercial |
$752.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$716.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$213.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$716.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$290.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$328.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$328.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$238.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$328.66
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$377.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$354.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$354.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$207.40
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$207.40
|
| Rate for Payer: United Healthcare Commercial |
$319.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$207.40
|
| Rate for Payer: United Healthcare VA CCN |
$207.40
|
|
|
PERICARDIOCENTESIS W/IMAGING
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
9813301601
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$592.08 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna of VT Commercial |
$760.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$592.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$592.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$680.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$672.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$640.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$640.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$640.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$640.00
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$680.00
|
| Rate for Payer: United Healthcare Commercial |
$760.00
|
|
|
PERICARDIOCENTESIS W/IMAGING
|
Facility
|
IP
|
$2,498.26
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
4503301601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,848.96 |
| Max. Negotiated Rate |
$2,373.35 |
| Rate for Payer: Aetna of VT Commercial |
$2,373.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,848.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,848.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,123.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,098.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,998.61
|
| Rate for Payer: Cash Price |
$1,249.13
|
| Rate for Payer: Cigna Commercial |
$1,998.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,998.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,998.61
|
| Rate for Payer: Multiplan Commercial |
$2,323.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,123.52
|
| Rate for Payer: United Healthcare Commercial |
$2,373.35
|
|
|
PERICARDIOCENTESIS W/IMAGING
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
9813301601
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$354.32 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna of VT Commercial |
$760.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$716.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$354.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$716.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$481.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$680.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$648.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$360.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$636.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$640.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$640.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$640.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$680.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$360.00
|
| Rate for Payer: United Healthcare Commercial |
$760.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.00
|
| Rate for Payer: United Healthcare VA CCN |
$360.00
|
|
|
PERITONEAL LAVAGE
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 49084
|
| Hospital Charge Code |
9814908401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$255.33 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Aetna of VT Commercial |
$327.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$255.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$255.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$293.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$289.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$276.00
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$276.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$276.00
|
| Rate for Payer: Multiplan Commercial |
$320.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$293.25
|
| Rate for Payer: United Healthcare Commercial |
$327.75
|
|
|
PERITONEAL LAVAGE
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
CPT 49084
|
| Hospital Charge Code |
9814908402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$96.50 |
| Max. Negotiated Rate |
$324.30 |
| Rate for Payer: Aetna of VT Commercial |
$324.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$309.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$99.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$309.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$135.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$110.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.04
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$175.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$165.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$165.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$96.51
|
| Rate for Payer: Multiplan Commercial |
$320.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$137.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$96.50
|
| Rate for Payer: United Healthcare Commercial |
$148.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.50
|
| Rate for Payer: United Healthcare VA CCN |
$96.50
|
|
|
PERITONEAL LAVAGE
|
Facility
|
IP
|
$104.95
|
|
|
Service Code
|
CPT 49084
|
| Hospital Charge Code |
4504908401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$77.67 |
| Max. Negotiated Rate |
$99.70 |
| Rate for Payer: Aetna of VT Commercial |
$99.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$77.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$77.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$88.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.96
|
| Rate for Payer: Cash Price |
$52.48
|
| Rate for Payer: Cigna Commercial |
$83.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$83.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$83.96
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.21
|
| Rate for Payer: United Healthcare Commercial |
$99.70
|
|
|
PERITONEAL LAVAGE
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 49084
|
| Hospital Charge Code |
9814908402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$255.33 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Aetna of VT Commercial |
$327.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$255.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$255.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$293.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$289.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$276.00
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$276.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$276.00
|
| Rate for Payer: Multiplan Commercial |
$320.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$293.25
|
| Rate for Payer: United Healthcare Commercial |
$327.75
|
|
|
PERITONEAL LAVAGE
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 49084
|
| Hospital Charge Code |
9814908401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Aetna of VT Commercial |
$327.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$309.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$152.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$309.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$207.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$293.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$279.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$155.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$274.27
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$276.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$276.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$155.25
|
| Rate for Payer: Multiplan Commercial |
$320.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$293.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$155.25
|
| Rate for Payer: United Healthcare Commercial |
$327.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.25
|
| Rate for Payer: United Healthcare VA CCN |
$155.25
|
|
|
PERITONEAL LAVAGE
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
CPT 49084
|
| Hospital Charge Code |
9814908401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$96.50 |
| Max. Negotiated Rate |
$324.30 |
| Rate for Payer: Aetna of VT Commercial |
$324.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$309.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$99.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$309.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$135.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$110.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.04
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$175.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$165.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$165.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$96.51
|
| Rate for Payer: Multiplan Commercial |
$320.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$137.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$96.50
|
| Rate for Payer: United Healthcare Commercial |
$148.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.50
|
| Rate for Payer: United Healthcare VA CCN |
$96.50
|
|
|
PERITONEAL LAVAGE
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 49084
|
| Hospital Charge Code |
9814908402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Aetna of VT Commercial |
$327.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$309.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$152.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$309.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$207.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$293.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$279.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$155.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$274.27
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$276.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$276.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$155.25
|
| Rate for Payer: Multiplan Commercial |
$320.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$293.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$155.25
|
| Rate for Payer: United Healthcare Commercial |
$327.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.25
|
| Rate for Payer: United Healthcare VA CCN |
$155.25
|
|
|
PERITONEAL LAVAGE
|
Facility
|
OP
|
$104.95
|
|
|
Service Code
|
CPT 49084
|
| Hospital Charge Code |
4504908401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.48 |
| Max. Negotiated Rate |
$99.70 |
| Rate for Payer: Aetna of VT Commercial |
$99.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$94.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$46.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$94.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$63.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$47.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.44
|
| Rate for Payer: Cash Price |
$52.48
|
| Rate for Payer: Cigna Commercial |
$83.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$83.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$83.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.23
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.23
|
| Rate for Payer: United Healthcare Commercial |
$99.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.23
|
| Rate for Payer: United Healthcare VA CCN |
$47.23
|
|
|
PERITONEAL LAVAGE W/WO IMAGING
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 49084
|
| Hospital Charge Code |
9824908401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$255.33 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Aetna of VT Commercial |
$327.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$255.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$255.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$293.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$289.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$276.00
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$276.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$276.00
|
| Rate for Payer: Multiplan Commercial |
$320.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$293.25
|
| Rate for Payer: United Healthcare Commercial |
$327.75
|
|
|
PERITONEAL LAVAGE W/WO IMAGING
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 49084
|
| Hospital Charge Code |
9824908401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Aetna of VT Commercial |
$327.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$309.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$152.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$309.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$207.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$293.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$279.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$155.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$274.27
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$276.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$276.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$155.25
|
| Rate for Payer: Multiplan Commercial |
$320.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$293.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$155.25
|
| Rate for Payer: United Healthcare Commercial |
$327.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.25
|
| Rate for Payer: United Healthcare VA CCN |
$155.25
|
|
|
PERITONEAL LAVAGE W/WO IMAGING
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
CPT 49084
|
| Hospital Charge Code |
9824908401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$96.50 |
| Max. Negotiated Rate |
$324.30 |
| Rate for Payer: Aetna of VT Commercial |
$324.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$309.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$99.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$309.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$135.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$110.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.04
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$175.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$165.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$165.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$96.51
|
| Rate for Payer: Multiplan Commercial |
$320.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$137.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$96.50
|
| Rate for Payer: United Healthcare Commercial |
$148.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.50
|
| Rate for Payer: United Healthcare VA CCN |
$96.50
|
|
|
PER PM REEVAL EST PAT 65+ YR
|
Professional
|
Both
|
$304.00
|
|
|
Service Code
|
CPT 99397
|
| Hospital Charge Code |
9609939702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$285.76 |
| Rate for Payer: Aetna of VT Commercial |
$285.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$272.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$272.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$215.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$215.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$215.55
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$100.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$127.90
|
| Rate for Payer: Multiplan Commercial |
$282.72
|
| Rate for Payer: United Healthcare Commercial |
$258.40
|
| Rate for Payer: United Healthcare VA CCN |
$96.46
|
|
|
PER PM REEVAL EST PAT 65+ YR
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 99397
|
| Hospital Charge Code |
5109939701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.20 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Aetna of VT Commercial |
$149.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$116.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$116.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$133.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$131.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$125.60
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cigna Commercial |
$125.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$125.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$125.60
|
| Rate for Payer: Multiplan Commercial |
$146.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$133.45
|
| Rate for Payer: United Healthcare Commercial |
$149.15
|
|
