|
RMVL OF FOOT FOREIGN BODY SUBQ
|
Facility
|
IP
|
$613.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
9822819001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$453.68 |
| Max. Negotiated Rate |
$582.35 |
| Rate for Payer: Aetna of VT Commercial |
$582.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$453.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$453.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$521.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$514.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$490.40
|
| Rate for Payer: Cash Price |
$306.50
|
| Rate for Payer: Cigna Commercial |
$490.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$490.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$490.40
|
| Rate for Payer: Multiplan Commercial |
$570.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$521.05
|
| Rate for Payer: United Healthcare Commercial |
$582.35
|
|
|
RMVL OF FOOT FOREIGN BODY SUBQ
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
9812819001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$408.68 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$130.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$177.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$408.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$408.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$145.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$408.68
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$240.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$365.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$365.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$225.75
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$126.50
|
| Rate for Payer: United Healthcare Commercial |
$194.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.50
|
| Rate for Payer: United Healthcare VA CCN |
$126.50
|
|
|
RMVL SUBQ CAR RHYTHM MNTR
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
9823328601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$262.74 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Aetna of VT Commercial |
$337.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$262.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$262.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$301.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$298.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$284.00
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$284.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$284.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$284.00
|
| Rate for Payer: Multiplan Commercial |
$330.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$301.75
|
| Rate for Payer: United Healthcare Commercial |
$337.25
|
|
|
RMVL SUBQ CAR RHYTHM MNTR
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
9823328601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$76.38 |
| Max. Negotiated Rate |
$333.70 |
| Rate for Payer: Aetna of VT Commercial |
$333.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$318.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$78.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$318.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$106.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$187.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$87.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$187.99
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$138.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$118.14
|
| Rate for Payer: Multiplan Commercial |
$330.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$108.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.38
|
| Rate for Payer: United Healthcare Commercial |
$117.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.38
|
| Rate for Payer: United Healthcare VA CCN |
$76.38
|
|
|
RMVL SUBQ CAR RHYTHM MNTR
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
9823328601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$157.23 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Aetna of VT Commercial |
$337.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$318.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$157.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$318.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$213.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$301.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$287.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$159.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$282.23
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$284.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$284.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$284.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$159.75
|
| Rate for Payer: Multiplan Commercial |
$330.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$301.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$159.75
|
| Rate for Payer: United Healthcare Commercial |
$337.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.75
|
| Rate for Payer: United Healthcare VA CCN |
$159.75
|
|
|
RMVL W/RINSJ DRUG DLVR IMPLT
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
9601198302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$344.89 |
| Max. Negotiated Rate |
$442.70 |
| Rate for Payer: Aetna of VT Commercial |
$442.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$344.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$344.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$396.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$391.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$372.80
|
| Rate for Payer: Cash Price |
$233.00
|
| Rate for Payer: Cigna Commercial |
$372.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$372.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$372.80
|
| Rate for Payer: Multiplan Commercial |
$433.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$396.10
|
| Rate for Payer: United Healthcare Commercial |
$442.70
|
|
|
RMVL W/RINSJ DRUG DLVR IMPLT
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
5101198301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$182.80 |
| Max. Negotiated Rate |
$234.65 |
| Rate for Payer: Aetna of VT Commercial |
$234.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$182.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$182.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$207.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$197.60
|
| Rate for Payer: Cash Price |
$123.50
|
| Rate for Payer: Cigna Commercial |
$197.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$197.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$197.60
|
| Rate for Payer: Multiplan Commercial |
$229.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.95
|
| Rate for Payer: United Healthcare Commercial |
$234.65
|
|
|
RMVL W/RINSJ DRUG DLVR IMPLT
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
5101198301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.40 |
| Max. Negotiated Rate |
$234.65 |
| Rate for Payer: Aetna of VT Commercial |
$234.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$221.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$109.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$221.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$148.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$200.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$111.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.37
|
| Rate for Payer: Cash Price |
$123.50
|
| Rate for Payer: Cigna Commercial |
$197.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$197.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$197.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$111.15
|
| Rate for Payer: Multiplan Commercial |
$229.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$111.15
|
| Rate for Payer: United Healthcare Commercial |
$234.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.15
|
| Rate for Payer: United Healthcare VA CCN |
$111.15
|
|
|
RMVL W/RINSJ DRUG DLVR IMPLT
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
5101198301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.78 |
| Max. Negotiated Rate |
$332.66 |
| Rate for Payer: Aetna of VT Commercial |
$232.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$221.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$97.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$221.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$132.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$332.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$332.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$109.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$332.66
|
| Rate for Payer: Cash Price |
$123.50
|
| Rate for Payer: Cash Price |
$123.50
|
| Rate for Payer: Cigna Commercial |
$173.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$218.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$218.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$131.72
|
| Rate for Payer: Multiplan Commercial |
$229.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$134.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$94.78
|
| Rate for Payer: United Healthcare Commercial |
$145.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.78
|
| Rate for Payer: United Healthcare VA CCN |
$94.78
|
|
|
RMVL W/RINSJ DRUG DLVR IMPLT
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
9601198302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$206.39 |
| Max. Negotiated Rate |
$442.70 |
| Rate for Payer: Aetna of VT Commercial |
$442.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$417.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$206.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$417.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$280.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$396.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$377.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$209.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$370.47
|
| Rate for Payer: Cash Price |
$233.00
|
| Rate for Payer: Cigna Commercial |
$372.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$372.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$372.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$209.70
|
| Rate for Payer: Multiplan Commercial |
$433.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$396.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$209.70
|
| Rate for Payer: United Healthcare Commercial |
$442.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$209.70
|
| Rate for Payer: United Healthcare VA CCN |
$209.70
|
|
|
RMVL W/RINSJ DRUG DLVR IMPLT
|
Facility
|
IP
|
$712.00
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
9601198301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$526.95 |
| Max. Negotiated Rate |
$676.40 |
| Rate for Payer: Aetna of VT Commercial |
$676.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$526.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$526.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$605.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$598.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$569.60
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cigna Commercial |
$569.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$569.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$569.60
|
| Rate for Payer: Multiplan Commercial |
$662.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$605.20
|
| Rate for Payer: United Healthcare Commercial |
$676.40
|
|
|
RMVL W/RINSJ DRUG DLVR IMPLT
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
9601198302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$94.78 |
| Max. Negotiated Rate |
$438.04 |
| Rate for Payer: Aetna of VT Commercial |
$438.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$417.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$97.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$417.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$132.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$332.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$332.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$109.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$332.66
|
| Rate for Payer: Cash Price |
$233.00
|
| Rate for Payer: Cash Price |
$233.00
|
| Rate for Payer: Cigna Commercial |
$173.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$218.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$218.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$131.72
|
| Rate for Payer: Multiplan Commercial |
$433.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$134.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$94.78
|
| Rate for Payer: United Healthcare Commercial |
$145.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.78
|
| Rate for Payer: United Healthcare VA CCN |
$94.78
|
|
|
RMVL W/RINSJ DRUG DLVR IMPLT
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
9601198301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$315.34 |
| Max. Negotiated Rate |
$676.40 |
| Rate for Payer: Aetna of VT Commercial |
$676.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$637.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$315.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$637.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$428.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$605.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$576.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$320.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$566.04
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cigna Commercial |
$569.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$569.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$569.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$320.40
|
| Rate for Payer: Multiplan Commercial |
$662.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$605.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$320.40
|
| Rate for Payer: United Healthcare Commercial |
$676.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$320.40
|
| Rate for Payer: United Healthcare VA CCN |
$320.40
|
|
|
RMVL W/RINSJ DRUG DLVR IMPLT
|
Professional
|
Both
|
$712.00
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
9601198301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$94.78 |
| Max. Negotiated Rate |
$669.28 |
| Rate for Payer: Aetna of VT Commercial |
$669.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$637.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$97.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$637.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$132.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$332.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$332.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$109.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$332.66
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cigna Commercial |
$173.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$218.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$218.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$131.72
|
| Rate for Payer: Multiplan Commercial |
$662.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$134.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$94.78
|
| Rate for Payer: United Healthcare Commercial |
$145.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.78
|
| Rate for Payer: United Healthcare VA CCN |
$94.78
|
|
|
ROOM RATE - PRIVATE
|
Facility
|
IP
|
$1,845.69
|
|
| Hospital Charge Code |
1100000001
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$1,366.00 |
| Max. Negotiated Rate |
$5,520.51 |
| Rate for Payer: Aetna of VT Commercial |
$1,753.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,366.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4,061.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,366.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5,520.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,568.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,550.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,781.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,476.55
|
| Rate for Payer: Cash Price |
$922.84
|
| Rate for Payer: Cash Price |
$922.84
|
| Rate for Payer: Cigna Commercial |
$1,476.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,476.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,476.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,781.22
|
| Rate for Payer: Multiplan Commercial |
$1,716.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,568.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,781.22
|
| Rate for Payer: United Healthcare Commercial |
$1,753.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,781.22
|
| Rate for Payer: United Healthcare VA CCN |
$3,781.22
|
|
|
ROOM RATE - SEMI-PRIVATE
|
Facility
|
IP
|
$1,700.93
|
|
| Hospital Charge Code |
1200000001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$1,258.86 |
| Max. Negotiated Rate |
$5,520.51 |
| Rate for Payer: Aetna of VT Commercial |
$1,615.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,258.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4,061.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,258.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5,520.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,445.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,428.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,781.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,360.74
|
| Rate for Payer: Cash Price |
$850.46
|
| Rate for Payer: Cash Price |
$850.46
|
| Rate for Payer: Cigna Commercial |
$1,360.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,360.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,360.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,781.22
|
| Rate for Payer: Multiplan Commercial |
$1,581.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,445.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,781.22
|
| Rate for Payer: United Healthcare Commercial |
$1,615.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,781.22
|
| Rate for Payer: United Healthcare VA CCN |
$3,781.22
|
|
|
ROOM RATE SEMI-PRIVATE NURSERY
|
Facility
|
IP
|
$1,292.50
|
|
| Hospital Charge Code |
1710000001
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$956.58 |
| Max. Negotiated Rate |
$5,520.51 |
| Rate for Payer: Aetna of VT Commercial |
$1,227.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$956.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4,061.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$956.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5,520.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,098.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,085.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,781.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,034.00
|
| Rate for Payer: Cash Price |
$646.25
|
| Rate for Payer: Cash Price |
$646.25
|
| Rate for Payer: Cigna Commercial |
$1,034.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,034.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,034.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,781.22
|
| Rate for Payer: Multiplan Commercial |
$1,202.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,098.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,781.22
|
| Rate for Payer: United Healthcare Commercial |
$1,227.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,781.22
|
| Rate for Payer: United Healthcare VA CCN |
$3,781.22
|
|
|
ROOM RATE - SEMI-PRIVATE OB
|
Facility
|
IP
|
$1,700.93
|
|
| Hospital Charge Code |
1220000001
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$1,258.86 |
| Max. Negotiated Rate |
$5,520.51 |
| Rate for Payer: Aetna of VT Commercial |
$1,615.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,258.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4,061.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,258.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5,520.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,445.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,428.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,781.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,360.74
|
| Rate for Payer: Cash Price |
$850.46
|
| Rate for Payer: Cash Price |
$850.46
|
| Rate for Payer: Cigna Commercial |
$1,360.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,360.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,360.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,781.22
|
| Rate for Payer: Multiplan Commercial |
$1,581.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,445.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,781.22
|
| Rate for Payer: United Healthcare Commercial |
$1,615.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,781.22
|
| Rate for Payer: United Healthcare VA CCN |
$3,781.22
|
|
|
ROOM RATE SEMI-PRIVT SWING BED
|
Facility
|
IP
|
$1,700.93
|
|
| Hospital Charge Code |
1200000002
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$5,520.51 |
| Rate for Payer: Aetna of VT Commercial |
$1,615.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,258.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4,061.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,258.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5,520.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,445.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,428.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,044.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,360.74
|
| Rate for Payer: Cash Price |
$850.46
|
| Rate for Payer: Cash Price |
$850.46
|
| Rate for Payer: Cigna Commercial |
$1,360.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,360.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,360.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,044.50
|
| Rate for Payer: Multiplan Commercial |
$1,581.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$455.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,044.50
|
| Rate for Payer: United Healthcare Commercial |
$1,615.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,044.50
|
| Rate for Payer: United Healthcare VA CCN |
$3,044.50
|
|
|
ROUTINE VENIPUNCTURE
|
Facility
|
IP
|
$28.44
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
3003641501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$27.02 |
| Rate for Payer: Aetna of VT Commercial |
$27.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$24.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$23.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.75
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cigna Commercial |
$22.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.75
|
| Rate for Payer: Multiplan Commercial |
$26.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.17
|
| Rate for Payer: United Healthcare Commercial |
$27.02
|
|
|
ROUTINE VENIPUNCTURE
|
Facility
|
OP
|
$28.44
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
3003641501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$43.51 |
| Rate for Payer: Aetna of VT Commercial |
$27.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$43.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$43.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$17.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$24.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$23.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.61
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cigna Commercial |
$22.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.80
|
| Rate for Payer: Multiplan Commercial |
$26.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.80
|
| Rate for Payer: United Healthcare Commercial |
$27.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.09
|
| Rate for Payer: United Healthcare VA CCN |
$12.80
|
|
|
ROUTINE VENIPUNCTURE
|
Professional
|
Both
|
$28.44
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
3003641501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$43.51 |
| Rate for Payer: Aetna of VT Commercial |
$26.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$43.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$43.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$12.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$10.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9.09
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cigna Commercial |
$6.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.09
|
| Rate for Payer: Multiplan Commercial |
$26.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.09
|
| Rate for Payer: United Healthcare Commercial |
$13.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.09
|
| Rate for Payer: United Healthcare VA CCN |
$9.09
|
|
|
RPLC GTUBE NO REVJ TRC
|
Facility
|
IP
|
$439.45
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
4504376201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$325.24 |
| Max. Negotiated Rate |
$417.48 |
| Rate for Payer: Aetna of VT Commercial |
$417.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$325.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$325.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$373.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$369.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$351.56
|
| Rate for Payer: Cash Price |
$219.72
|
| Rate for Payer: Cigna Commercial |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$351.56
|
| Rate for Payer: Multiplan Commercial |
$408.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.53
|
| Rate for Payer: United Healthcare Commercial |
$417.48
|
|
|
RPLC GTUBE NO REVJ TRC
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
9824376201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$33.84 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna of VT Commercial |
$389.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$370.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$370.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$323.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$38.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$323.58
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$61.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$337.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$337.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$208.90
|
| Rate for Payer: Multiplan Commercial |
$385.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.84
|
| Rate for Payer: United Healthcare Commercial |
$52.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.84
|
| Rate for Payer: United Healthcare VA CCN |
$33.84
|
|
|
RPLC GTUBE NO REVJ TRC
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
9814376201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$183.36 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna of VT Commercial |
$393.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$370.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$183.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$370.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$249.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$335.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$329.13
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$331.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$331.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$331.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$186.30
|
| Rate for Payer: Multiplan Commercial |
$385.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$351.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$186.30
|
| Rate for Payer: United Healthcare Commercial |
$393.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.30
|
| Rate for Payer: United Healthcare VA CCN |
$186.30
|
|
