|
TEMPORAL ARTERY PROCEDURE
|
Facility
|
OP
|
$706.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
9603760902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$312.69 |
| Max. Negotiated Rate |
$670.70 |
| Rate for Payer: Aetna of VT Commercial |
$670.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$632.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$312.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$632.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$425.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$600.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$571.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$317.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$561.27
|
| Rate for Payer: Cash Price |
$353.00
|
| Rate for Payer: Cigna Commercial |
$564.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$564.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$564.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$317.70
|
| Rate for Payer: Multiplan Commercial |
$656.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$317.70
|
| Rate for Payer: United Healthcare Commercial |
$670.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$317.70
|
| Rate for Payer: United Healthcare VA CCN |
$317.70
|
|
|
TEMPORAL ARTERY PROCEDURE
|
Facility
|
IP
|
$5,347.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
9603760901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,957.31 |
| Max. Negotiated Rate |
$5,079.65 |
| Rate for Payer: Aetna of VT Commercial |
$5,079.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,957.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,957.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,544.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,491.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,277.60
|
| Rate for Payer: Cash Price |
$2,673.50
|
| Rate for Payer: Cigna Commercial |
$4,277.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,277.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,277.60
|
| Rate for Payer: Multiplan Commercial |
$4,972.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,544.95
|
| Rate for Payer: United Healthcare Commercial |
$5,079.65
|
|
|
TEMPORAL ARTERY PROCEDURE
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
9823760901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$381.78 |
| Max. Negotiated Rate |
$818.90 |
| Rate for Payer: Aetna of VT Commercial |
$818.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$772.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$381.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$772.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$518.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$732.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$698.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$387.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$685.29
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cigna Commercial |
$689.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$689.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$689.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$387.90
|
| Rate for Payer: Multiplan Commercial |
$801.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$732.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$387.90
|
| Rate for Payer: United Healthcare Commercial |
$818.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.90
|
| Rate for Payer: United Healthcare VA CCN |
$387.90
|
|
|
TEMPORAL ARTERY PROCEDURE
|
Professional
|
Both
|
$4,641.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
5103760901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$186.79 |
| Max. Negotiated Rate |
$4,362.54 |
| Rate for Payer: Aetna of VT Commercial |
$4,362.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,157.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$192.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,157.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$261.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$490.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$490.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$214.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$490.90
|
| Rate for Payer: Cash Price |
$2,320.50
|
| Rate for Payer: Cash Price |
$2,320.50
|
| Rate for Payer: Cigna Commercial |
$344.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$471.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$471.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$285.40
|
| Rate for Payer: Multiplan Commercial |
$4,316.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$265.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$186.79
|
| Rate for Payer: United Healthcare Commercial |
$287.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.79
|
| Rate for Payer: United Healthcare VA CCN |
$186.79
|
|
|
TEMPORAL ARTERY PROCEDURE
|
Facility
|
IP
|
$706.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
9603760902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$522.51 |
| Max. Negotiated Rate |
$670.70 |
| Rate for Payer: Aetna of VT Commercial |
$670.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$522.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$522.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$600.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$593.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$564.80
|
| Rate for Payer: Cash Price |
$353.00
|
| Rate for Payer: Cigna Commercial |
$564.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$564.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$564.80
|
| Rate for Payer: Multiplan Commercial |
$656.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.10
|
| Rate for Payer: United Healthcare Commercial |
$670.70
|
|
|
TEMPORAL ARTERY PROCEDURE
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
9823760901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$637.97 |
| Max. Negotiated Rate |
$818.90 |
| Rate for Payer: Aetna of VT Commercial |
$818.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$637.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$637.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$732.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$724.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$689.60
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cigna Commercial |
$689.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$689.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$689.60
|
| Rate for Payer: Multiplan Commercial |
$801.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$732.70
|
| Rate for Payer: United Healthcare Commercial |
$818.90
|
|
|
TEMPORAL ARTERY PROCEDURE
|
Professional
|
Both
|
$5,347.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
9603760901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$186.79 |
| Max. Negotiated Rate |
$5,026.18 |
| Rate for Payer: Aetna of VT Commercial |
$5,026.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,790.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$192.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,790.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$261.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$490.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$490.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$214.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$490.90
|
| Rate for Payer: Cash Price |
$2,673.50
|
| Rate for Payer: Cash Price |
$2,673.50
|
| Rate for Payer: Cigna Commercial |
$344.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$471.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$471.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$285.40
|
| Rate for Payer: Multiplan Commercial |
$4,972.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$265.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$186.79
|
| Rate for Payer: United Healthcare Commercial |
$287.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.79
|
| Rate for Payer: United Healthcare VA CCN |
$186.79
|
|
|
TEMPORAL ARTERY PROCEDURE
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
9823760901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$186.79 |
| Max. Negotiated Rate |
$810.28 |
| Rate for Payer: Aetna of VT Commercial |
$810.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$772.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$192.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$772.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$261.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$490.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$490.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$214.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$490.90
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cigna Commercial |
$344.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$471.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$471.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$285.40
|
| Rate for Payer: Multiplan Commercial |
$801.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$265.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$186.79
|
| Rate for Payer: United Healthcare Commercial |
$287.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.79
|
| Rate for Payer: United Healthcare VA CCN |
$186.79
|
|
|
TEMPORAL ARTERY PROCEDURE
|
Facility
|
OP
|
$5,347.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
9603760901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,368.19 |
| Max. Negotiated Rate |
$5,079.65 |
| Rate for Payer: Aetna of VT Commercial |
$5,079.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,790.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,368.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,790.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,218.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,544.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,331.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,406.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,250.86
|
| Rate for Payer: Cash Price |
$2,673.50
|
| Rate for Payer: Cigna Commercial |
$4,277.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,277.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,277.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,406.15
|
| Rate for Payer: Multiplan Commercial |
$4,972.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,544.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,406.15
|
| Rate for Payer: United Healthcare Commercial |
$5,079.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,406.15
|
| Rate for Payer: United Healthcare VA CCN |
$2,406.15
|
|
|
TEMPORAL ARTERY PROCEDURE
|
Facility
|
OP
|
$4,641.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
5103760901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,055.50 |
| Max. Negotiated Rate |
$4,408.95 |
| Rate for Payer: Aetna of VT Commercial |
$4,408.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,157.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,055.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,157.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,793.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,944.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,759.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,088.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,689.59
|
| Rate for Payer: Cash Price |
$2,320.50
|
| Rate for Payer: Cigna Commercial |
$3,712.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,712.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,712.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,088.45
|
| Rate for Payer: Multiplan Commercial |
$4,316.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,944.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,088.45
|
| Rate for Payer: United Healthcare Commercial |
$4,408.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,088.45
|
| Rate for Payer: United Healthcare VA CCN |
$2,088.45
|
|
|
TEMPORARY EXTERNAL PACING
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
9819295302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$48.85 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Aetna of VT Commercial |
$62.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$56.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$55.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.80
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$52.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$52.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$52.80
|
| Rate for Payer: Multiplan Commercial |
$61.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.10
|
| Rate for Payer: United Healthcare Commercial |
$62.70
|
|
|
TEMPORARY EXTERNAL PACING
|
Facility
|
OP
|
$1,243.90
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
4809295301
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$550.92 |
| Max. Negotiated Rate |
$1,181.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,181.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,114.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$550.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,114.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$748.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,057.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,007.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$559.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$988.90
|
| Rate for Payer: Cash Price |
$621.95
|
| Rate for Payer: Cigna Commercial |
$995.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$995.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$995.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$559.75
|
| Rate for Payer: Multiplan Commercial |
$1,156.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,057.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$559.75
|
| Rate for Payer: United Healthcare Commercial |
$1,181.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$559.75
|
| Rate for Payer: United Healthcare VA CCN |
$559.75
|
|
|
TEMPORARY EXTERNAL PACING
|
Facility
|
IP
|
$1,243.90
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
4809295301
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$920.61 |
| Max. Negotiated Rate |
$1,181.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,181.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$920.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$920.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,057.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,044.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$995.12
|
| Rate for Payer: Cash Price |
$621.95
|
| Rate for Payer: Cigna Commercial |
$995.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$995.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$995.12
|
| Rate for Payer: Multiplan Commercial |
$1,156.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,057.32
|
| Rate for Payer: United Healthcare Commercial |
$1,181.70
|
|
|
TEMPORARY EXTERNAL PACING
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
9819295302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$62.04 |
| Rate for Payer: Aetna of VT Commercial |
$62.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.65
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$1.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$61.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.81
|
| Rate for Payer: United Healthcare VA CCN |
$0.81
|
|
|
TEMPORARY EXTERNAL PACING
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
9819295301
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.88 |
| 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 |
$0.83
|
| 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 |
$1.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.65
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$1.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.81
|
| Rate for Payer: United Healthcare VA CCN |
$0.81
|
|
|
TEMPORARY EXTERNAL PACING
|
Facility
|
IP
|
$1,184.03
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
4509295301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$876.30 |
| Max. Negotiated Rate |
$1,124.83 |
| Rate for Payer: Aetna of VT Commercial |
$1,124.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$876.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$876.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,006.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$994.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$947.22
|
| Rate for Payer: Cash Price |
$592.02
|
| Rate for Payer: Cigna Commercial |
$947.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$947.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$947.22
|
| Rate for Payer: Multiplan Commercial |
$1,101.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,006.43
|
| Rate for Payer: United Healthcare Commercial |
$1,124.83
|
|
|
TEMPORARY EXTERNAL PACING
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
9819295301
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
TEMPORARY EXTERNAL PACING
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
9819295301
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| 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 |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
TEMPORARY EXTERNAL PACING
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
9819295302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$29.23 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Aetna of VT Commercial |
$62.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$29.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$39.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$56.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$53.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.47
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$52.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$52.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$52.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.70
|
| Rate for Payer: Multiplan Commercial |
$61.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$29.70
|
| Rate for Payer: United Healthcare Commercial |
$62.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.70
|
| Rate for Payer: United Healthcare VA CCN |
$29.70
|
|
|
TEMPORARY EXTERNAL PACING
|
Facility
|
OP
|
$1,184.03
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
4509295301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$524.41 |
| Max. Negotiated Rate |
$1,124.83 |
| Rate for Payer: Aetna of VT Commercial |
$1,124.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,060.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$524.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,060.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$712.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,006.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$959.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$532.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$941.30
|
| Rate for Payer: Cash Price |
$592.02
|
| Rate for Payer: Cigna Commercial |
$947.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$947.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$947.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$532.81
|
| Rate for Payer: Multiplan Commercial |
$1,101.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,006.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$532.81
|
| Rate for Payer: United Healthcare Commercial |
$1,124.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$532.81
|
| Rate for Payer: United Healthcare VA CCN |
$532.81
|
|
|
TENDON GRAFT FROM A DISTANCE
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
CPT 20924
|
| Hospital Charge Code |
9822092401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,163.44 |
| Max. Negotiated Rate |
$1,493.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,493.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,163.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,163.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,336.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,320.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,257.60
|
| Rate for Payer: Cash Price |
$786.00
|
| Rate for Payer: Cigna Commercial |
$1,257.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,257.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,257.60
|
| Rate for Payer: Multiplan Commercial |
$1,461.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,336.20
|
| Rate for Payer: United Healthcare Commercial |
$1,493.40
|
|
|
TENDON GRAFT FROM A DISTANCE
|
Professional
|
Both
|
$1,572.00
|
|
|
Service Code
|
CPT 20924
|
| Hospital Charge Code |
9822092401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$479.83 |
| Max. Negotiated Rate |
$1,477.68 |
| Rate for Payer: Aetna of VT Commercial |
$1,477.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,408.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$494.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,408.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$671.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$763.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$763.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$551.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$763.33
|
| Rate for Payer: Cash Price |
$786.00
|
| Rate for Payer: Cash Price |
$786.00
|
| Rate for Payer: Cigna Commercial |
$906.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$796.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$796.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$479.83
|
| Rate for Payer: Multiplan Commercial |
$1,461.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$681.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$479.83
|
| Rate for Payer: United Healthcare Commercial |
$738.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$479.83
|
| Rate for Payer: United Healthcare VA CCN |
$479.83
|
|
|
TENDON GRAFT FROM A DISTANCE
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
CPT 20924
|
| Hospital Charge Code |
9822092401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$696.24 |
| Max. Negotiated Rate |
$1,493.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,493.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,408.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$696.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,408.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$946.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,336.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,273.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$707.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,249.74
|
| Rate for Payer: Cash Price |
$786.00
|
| Rate for Payer: Cigna Commercial |
$1,257.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,257.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,257.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$707.40
|
| Rate for Payer: Multiplan Commercial |
$1,461.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,336.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$707.40
|
| Rate for Payer: United Healthcare Commercial |
$1,493.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$707.40
|
| Rate for Payer: United Healthcare VA CCN |
$707.40
|
|
|
TENDON SHEATH INCISION
|
Facility
|
OP
|
$1,533.00
|
|
|
Service Code
|
CPT 26055
|
| Hospital Charge Code |
9602605502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$678.97 |
| Max. Negotiated Rate |
$1,456.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,456.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,373.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$678.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,373.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$922.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,303.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,241.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$689.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,218.73
|
| Rate for Payer: Cash Price |
$766.50
|
| Rate for Payer: Cigna Commercial |
$1,226.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,226.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,226.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$689.85
|
| Rate for Payer: Multiplan Commercial |
$1,425.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,303.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$689.85
|
| Rate for Payer: United Healthcare Commercial |
$1,456.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$689.85
|
| Rate for Payer: United Healthcare VA CCN |
$689.85
|
|
|
TENDON SHEATH INCISION
|
Professional
|
Both
|
$1,533.00
|
|
|
Service Code
|
CPT 26055
|
| Hospital Charge Code |
9602605502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$283.78 |
| Max. Negotiated Rate |
$1,441.02 |
| Rate for Payer: Aetna of VT Commercial |
$1,441.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,373.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$292.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,373.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$397.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$986.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$986.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$326.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$986.14
|
| Rate for Payer: Cash Price |
$766.50
|
| Rate for Payer: Cash Price |
$766.50
|
| Rate for Payer: Cigna Commercial |
$535.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$905.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$905.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$557.12
|
| Rate for Payer: Multiplan Commercial |
$1,425.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$402.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$283.78
|
| Rate for Payer: United Healthcare Commercial |
$436.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.78
|
| Rate for Payer: United Healthcare VA CCN |
$283.78
|
|
