|
SCR HEADLESS ST 5.5X44MM
|
Facility
|
IP
|
$663.03
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780074271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.71 |
| Max. Negotiated Rate |
$629.88 |
| Rate for Payer: Aetna of VT Commercial |
$629.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$490.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$490.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$563.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$556.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$530.42
|
| Rate for Payer: Cash Price |
$331.52
|
| Rate for Payer: Cigna Commercial |
$530.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$530.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$530.42
|
| Rate for Payer: Multiplan Commercial |
$616.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$563.58
|
| Rate for Payer: United Healthcare Commercial |
$629.88
|
|
|
SCR HEADLESS ST 5.5X44MM
|
Facility
|
OP
|
$663.03
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780074271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$293.66 |
| Max. Negotiated Rate |
$629.88 |
| Rate for Payer: Aetna of VT Commercial |
$629.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$594.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$293.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$594.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$399.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$563.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$537.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$298.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$527.11
|
| Rate for Payer: Cash Price |
$331.52
|
| Rate for Payer: Cigna Commercial |
$530.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$530.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$530.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$298.36
|
| Rate for Payer: Multiplan Commercial |
$616.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$563.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$298.36
|
| Rate for Payer: United Healthcare Commercial |
$629.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$298.36
|
| Rate for Payer: United Healthcare VA CCN |
$298.36
|
|
|
SCR LOCK BG, 2.5X14MM
|
Facility
|
OP
|
$271.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.34 |
| Max. Negotiated Rate |
$258.12 |
| Rate for Payer: Aetna of VT Commercial |
$258.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$243.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$120.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$243.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$163.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$230.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$122.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.00
|
| Rate for Payer: Cash Price |
$135.85
|
| Rate for Payer: Cigna Commercial |
$217.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$122.27
|
| Rate for Payer: Multiplan Commercial |
$252.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$230.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$122.27
|
| Rate for Payer: United Healthcare Commercial |
$258.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.27
|
| Rate for Payer: United Healthcare VA CCN |
$122.27
|
|
|
SCR LOCK BG, 2.5X14MM
|
Facility
|
IP
|
$271.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.09 |
| Max. Negotiated Rate |
$258.12 |
| Rate for Payer: Aetna of VT Commercial |
$258.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$201.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$201.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$230.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$228.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$217.36
|
| Rate for Payer: Cash Price |
$135.85
|
| Rate for Payer: Cigna Commercial |
$217.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.36
|
| Rate for Payer: Multiplan Commercial |
$252.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$230.94
|
| Rate for Payer: United Healthcare Commercial |
$258.12
|
|
|
SCR LOCK BG, 2.5X15MM
|
Facility
|
OP
|
$271.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.34 |
| Max. Negotiated Rate |
$258.12 |
| Rate for Payer: Aetna of VT Commercial |
$258.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$243.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$120.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$243.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$163.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$230.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$122.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.00
|
| Rate for Payer: Cash Price |
$135.85
|
| Rate for Payer: Cigna Commercial |
$217.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$122.27
|
| Rate for Payer: Multiplan Commercial |
$252.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$230.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$122.27
|
| Rate for Payer: United Healthcare Commercial |
$258.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.27
|
| Rate for Payer: United Healthcare VA CCN |
$122.27
|
|
|
SCR LOCK BG, 2.5X15MM
|
Facility
|
IP
|
$271.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.09 |
| Max. Negotiated Rate |
$258.12 |
| Rate for Payer: Aetna of VT Commercial |
$258.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$201.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$201.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$230.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$228.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$217.36
|
| Rate for Payer: Cash Price |
$135.85
|
| Rate for Payer: Cigna Commercial |
$217.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.36
|
| Rate for Payer: Multiplan Commercial |
$252.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$230.94
|
| Rate for Payer: United Healthcare Commercial |
$258.12
|
|
|
SCR LOCK BG, 2.5X16MM
|
Facility
|
IP
|
$271.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.09 |
| Max. Negotiated Rate |
$258.12 |
| Rate for Payer: Aetna of VT Commercial |
$258.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$201.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$201.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$230.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$228.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$217.36
|
| Rate for Payer: Cash Price |
$135.85
|
| Rate for Payer: Cigna Commercial |
$217.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.36
|
| Rate for Payer: Multiplan Commercial |
$252.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$230.94
|
| Rate for Payer: United Healthcare Commercial |
$258.12
|
|
|
SCR LOCK BG, 2.5X16MM
|
Facility
|
OP
|
$271.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.34 |
| Max. Negotiated Rate |
$258.12 |
| Rate for Payer: Aetna of VT Commercial |
$258.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$243.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$120.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$243.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$163.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$230.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$122.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.00
|
| Rate for Payer: Cash Price |
$135.85
|
| Rate for Payer: Cigna Commercial |
$217.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$122.27
|
| Rate for Payer: Multiplan Commercial |
$252.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$230.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$122.27
|
| Rate for Payer: United Healthcare Commercial |
$258.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.27
|
| Rate for Payer: United Healthcare VA CCN |
$122.27
|
|
|
SCR NONLOCK BG, 2.5X15MM
|
Facility
|
OP
|
$278.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.30 |
| Max. Negotiated Rate |
$264.48 |
| Rate for Payer: Aetna of VT Commercial |
$264.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$249.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$123.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$249.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$167.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$225.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$125.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$221.33
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$222.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$222.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$222.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$125.28
|
| Rate for Payer: Multiplan Commercial |
$258.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$125.28
|
| Rate for Payer: United Healthcare Commercial |
$264.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.28
|
| Rate for Payer: United Healthcare VA CCN |
$125.28
|
|
|
SCR NONLOCK BG, 2.5X15MM
|
Facility
|
IP
|
$278.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.04 |
| Max. Negotiated Rate |
$264.48 |
| Rate for Payer: Aetna of VT Commercial |
$264.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$206.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$206.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$233.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$222.72
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$222.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$222.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$222.72
|
| Rate for Payer: Multiplan Commercial |
$258.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.64
|
| Rate for Payer: United Healthcare Commercial |
$264.48
|
|
|
SCR NONLOCK BG, 2.5X18MM
|
Facility
|
IP
|
$278.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.04 |
| Max. Negotiated Rate |
$264.48 |
| Rate for Payer: Aetna of VT Commercial |
$264.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$206.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$206.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$233.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$222.72
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$222.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$222.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$222.72
|
| Rate for Payer: Multiplan Commercial |
$258.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.64
|
| Rate for Payer: United Healthcare Commercial |
$264.48
|
|
|
SCR NONLOCK BG, 2.5X18MM
|
Facility
|
OP
|
$278.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.30 |
| Max. Negotiated Rate |
$264.48 |
| Rate for Payer: Aetna of VT Commercial |
$264.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$249.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$123.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$249.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$167.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$225.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$125.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$221.33
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$222.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$222.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$222.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$125.28
|
| Rate for Payer: Multiplan Commercial |
$258.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$125.28
|
| Rate for Payer: United Healthcare Commercial |
$264.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.28
|
| Rate for Payer: United Healthcare VA CCN |
$125.28
|
|
|
SELF CARE MNGMENT TRAINING
|
Facility
|
OP
|
$110.64
|
|
|
Service Code
|
CPT 97535 GO
|
| Hospital Charge Code |
4309753501
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna of VT Commercial |
$105.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$66.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.96
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cigna Commercial |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.79
|
| Rate for Payer: Multiplan Commercial |
$102.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.79
|
| Rate for Payer: United Healthcare Commercial |
$105.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.79
|
| Rate for Payer: United Healthcare VA CCN |
$49.79
|
|
|
SELF CARE MNGMENT TRAINING
|
Facility
|
OP
|
$110.64
|
|
|
Service Code
|
CPT 97535 GP
|
| Hospital Charge Code |
4209753501
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna of VT Commercial |
$105.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$66.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.96
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cigna Commercial |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.79
|
| Rate for Payer: Multiplan Commercial |
$102.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.79
|
| Rate for Payer: United Healthcare Commercial |
$105.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.79
|
| Rate for Payer: United Healthcare VA CCN |
$49.79
|
|
|
SELF CARE MNGMENT TRAINING
|
Facility
|
IP
|
$110.64
|
|
|
Service Code
|
CPT 97535 GO
|
| Hospital Charge Code |
4309753501
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$81.88 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna of VT Commercial |
$105.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.51
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cigna Commercial |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.51
|
| Rate for Payer: Multiplan Commercial |
$102.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.04
|
| Rate for Payer: United Healthcare Commercial |
$105.11
|
|
|
SELF CARE MNGMENT TRAINING
|
Facility
|
IP
|
$110.64
|
|
|
Service Code
|
CPT 97535 GP
|
| Hospital Charge Code |
4209753501
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$81.88 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna of VT Commercial |
$105.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.51
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cigna Commercial |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.51
|
| Rate for Payer: Multiplan Commercial |
$102.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.04
|
| Rate for Payer: United Healthcare Commercial |
$105.11
|
|
|
SELF-MGMT EDUC & TRAIN 1 PT
|
Facility
|
OP
|
$130.28
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
9429896001
|
|
Hospital Revenue Code
|
942
|
| 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
|
|
|
SELF-MGMT EDUC & TRAIN 1 PT
|
Facility
|
IP
|
$130.28
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
9429896001
|
|
Hospital Revenue Code
|
942
|
| 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
|
|
|
SEMEN ANAL VOL/COUNT/MOT
|
Facility
|
IP
|
$177.85
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
3008932001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$131.63 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna of VT Commercial |
$168.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$151.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$142.28
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Cigna Commercial |
$142.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$142.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$142.28
|
| Rate for Payer: Multiplan Commercial |
$165.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.17
|
| Rate for Payer: United Healthcare Commercial |
$168.96
|
|
|
SEMEN ANAL VOL/COUNT/MOT
|
Facility
|
OP
|
$177.85
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
3008932001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna of VT Commercial |
$168.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$60.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$78.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$60.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$151.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$141.39
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Cigna Commercial |
$142.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$142.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$142.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.03
|
| Rate for Payer: Multiplan Commercial |
$165.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.03
|
| Rate for Payer: United Healthcare Commercial |
$168.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.31
|
| Rate for Payer: United Healthcare VA CCN |
$80.03
|
|
|
SEMEN ANAL VOL/COUNT/MOT
|
Professional
|
Both
|
$177.85
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
3008932001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.14 |
| Max. Negotiated Rate |
$167.18 |
| Rate for Payer: Aetna of VT Commercial |
$167.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$60.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$60.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$17.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$21.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$21.05
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Cigna Commercial |
$15.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.31
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.31
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.14
|
| Rate for Payer: Multiplan Commercial |
$165.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.31
|
| Rate for Payer: United Healthcare Commercial |
$18.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.31
|
| Rate for Payer: United Healthcare VA CCN |
$12.31
|
|
|
SEMEN ANALYSIS W/COUNT
|
Facility
|
OP
|
$112.71
|
|
|
Service Code
|
CPT 89310
|
| Hospital Charge Code |
3008931001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$107.07 |
| Rate for Payer: Aetna of VT Commercial |
$107.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$42.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$42.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$67.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$95.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$91.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$50.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.60
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cigna Commercial |
$90.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$90.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$90.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$50.72
|
| Rate for Payer: Multiplan Commercial |
$104.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$50.72
|
| Rate for Payer: United Healthcare Commercial |
$107.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.61
|
| Rate for Payer: United Healthcare VA CCN |
$50.72
|
|
|
SEMEN ANALYSIS W/COUNT
|
Facility
|
IP
|
$112.71
|
|
|
Service Code
|
CPT 89310
|
| Hospital Charge Code |
3008931001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.42 |
| Max. Negotiated Rate |
$107.07 |
| Rate for Payer: Aetna of VT Commercial |
$107.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$95.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$90.17
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cigna Commercial |
$90.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$90.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$90.17
|
| Rate for Payer: Multiplan Commercial |
$104.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.80
|
| Rate for Payer: United Healthcare Commercial |
$107.07
|
|
|
SEMEN ANALYSIS W/COUNT
|
Professional
|
Both
|
$112.71
|
|
|
Service Code
|
CPT 89310
|
| Hospital Charge Code |
3008931001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.49 |
| Max. Negotiated Rate |
$105.95 |
| Rate for Payer: Aetna of VT Commercial |
$105.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$42.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$42.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.70
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cigna Commercial |
$10.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.49
|
| Rate for Payer: Multiplan Commercial |
$104.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.61
|
| Rate for Payer: United Healthcare Commercial |
$13.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.61
|
| Rate for Payer: United Healthcare VA CCN |
$8.61
|
|
|
SESAMOIDECTOMY FIRST TOE SPX
|
Facility
|
IP
|
$1,008.00
|
|
|
Service Code
|
CPT 28315
|
| Hospital Charge Code |
9822831501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$746.02 |
| Max. Negotiated Rate |
$957.60 |
| Rate for Payer: Aetna of VT Commercial |
$957.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$746.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$746.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$856.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$846.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$806.40
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna Commercial |
$806.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$806.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$806.40
|
| Rate for Payer: Multiplan Commercial |
$937.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$856.80
|
| Rate for Payer: United Healthcare Commercial |
$957.60
|
|
