|
VBAC DELIVERY ONLY
|
Facility
|
IP
|
$947.14
|
|
|
Service Code
|
CPT 59612
|
| Hospital Charge Code |
7225961201
|
|
Hospital Revenue Code
|
722
|
| Min. Negotiated Rate |
$700.98 |
| Max. Negotiated Rate |
$899.78 |
| Rate for Payer: Aetna of VT Commercial |
$899.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$700.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$700.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$805.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$795.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$757.71
|
| Rate for Payer: Cash Price |
$473.57
|
| Rate for Payer: Cigna Commercial |
$757.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$757.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$757.71
|
| Rate for Payer: Multiplan Commercial |
$880.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$805.07
|
| Rate for Payer: United Healthcare Commercial |
$899.78
|
|
|
VBAC DELIVERY ONLY
|
Facility
|
IP
|
$2,316.00
|
|
|
Service Code
|
CPT 59612
|
| Hospital Charge Code |
9695961201
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$1,714.07 |
| Max. Negotiated Rate |
$2,200.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,200.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,714.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,714.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,968.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,945.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,852.80
|
| Rate for Payer: Cash Price |
$1,158.00
|
| Rate for Payer: Cigna Commercial |
$1,852.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,852.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,852.80
|
| Rate for Payer: Multiplan Commercial |
$2,153.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,968.60
|
| Rate for Payer: United Healthcare Commercial |
$2,200.20
|
|
|
VBAC DELIVERY ONLY
|
Professional
|
Both
|
$2,316.00
|
|
|
Service Code
|
CPT 59612
|
| Hospital Charge Code |
9695961201
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$801.86 |
| Max. Negotiated Rate |
$2,177.04 |
| Rate for Payer: Aetna of VT Commercial |
$2,177.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,074.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$825.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,074.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,122.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,441.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,441.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$922.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,441.50
|
| Rate for Payer: Cash Price |
$1,158.00
|
| Rate for Payer: Cash Price |
$1,158.00
|
| Rate for Payer: Cigna Commercial |
$879.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,398.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,398.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$951.90
|
| Rate for Payer: Multiplan Commercial |
$2,153.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,138.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$801.86
|
| Rate for Payer: United Healthcare Commercial |
$1,233.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$801.86
|
| Rate for Payer: United Healthcare VA CCN |
$801.86
|
|
|
VENAFLOW BARIATRIC CALF CUFF
|
Facility
|
OP
|
$20.58
|
|
| Hospital Charge Code |
2720021761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: Aetna of VT Commercial |
$19.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$18.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$18.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$17.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$16.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.36
|
| Rate for Payer: Cash Price |
$10.29
|
| Rate for Payer: Cigna Commercial |
$16.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.26
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.26
|
| Rate for Payer: United Healthcare Commercial |
$19.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.26
|
| Rate for Payer: United Healthcare VA CCN |
$9.26
|
|
|
VENAFLOW BARIATRIC CALF CUFF
|
Facility
|
IP
|
$20.58
|
|
| Hospital Charge Code |
2720021761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.23 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: Aetna of VT Commercial |
$19.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$15.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$15.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$17.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$17.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.46
|
| Rate for Payer: Cash Price |
$10.29
|
| Rate for Payer: Cigna Commercial |
$16.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.46
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.49
|
| Rate for Payer: United Healthcare Commercial |
$19.55
|
|
|
VENAFLOW THIGH CUFF
|
Facility
|
IP
|
$30.37
|
|
| Hospital Charge Code |
2720021771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.48 |
| Max. Negotiated Rate |
$28.85 |
| Rate for Payer: Aetna of VT Commercial |
$28.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$22.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$22.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$25.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$25.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.30
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: Cigna Commercial |
$24.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$24.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$24.30
|
| Rate for Payer: Multiplan Commercial |
$28.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.81
|
| Rate for Payer: United Healthcare Commercial |
$28.85
|
|
|
VENAFLOW THIGH CUFF
|
Facility
|
OP
|
$30.37
|
|
| Hospital Charge Code |
2720021771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.45 |
| Max. Negotiated Rate |
$28.85 |
| Rate for Payer: Aetna of VT Commercial |
$28.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$27.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$27.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$25.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$24.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.14
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: Cigna Commercial |
$24.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$24.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$24.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.67
|
| Rate for Payer: Multiplan Commercial |
$28.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.67
|
| Rate for Payer: United Healthcare Commercial |
$28.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.67
|
| Rate for Payer: United Healthcare VA CCN |
$13.67
|
|
|
VENIPUNCTURE 3/>, MD SKILL
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
9813641001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of VT Commercial |
$34.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$21.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$29.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.62
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$28.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$33.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.20
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.20
|
| Rate for Payer: United Healthcare VA CCN |
$16.20
|
|
|
VENIPUNCTURE 3/>, MD SKILL
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
9813641001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$26.64 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of VT Commercial |
$34.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$26.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$26.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$28.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$33.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.60
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
|
|
VENIPUNCTURE 3/>, MD SKILL
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
9813641002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$33.84 |
| Rate for Payer: Aetna of VT Commercial |
$33.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$30.79
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$15.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$27.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$27.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.08
|
| Rate for Payer: Multiplan Commercial |
$33.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.41
|
| Rate for Payer: United Healthcare Commercial |
$12.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.41
|
| Rate for Payer: United Healthcare VA CCN |
$8.41
|
|
|
VENIPUNCTURE 3/>, MD SKILL
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
9813641002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$26.64 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of VT Commercial |
$34.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$26.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$26.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$28.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$33.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.60
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
|
|
VENIPUNCTURE 3/>, MD SKILL
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
9813641001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$33.84 |
| Rate for Payer: Aetna of VT Commercial |
$33.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$30.79
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$15.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$27.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$27.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.08
|
| Rate for Payer: Multiplan Commercial |
$33.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.41
|
| Rate for Payer: United Healthcare Commercial |
$12.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.41
|
| Rate for Payer: United Healthcare VA CCN |
$8.41
|
|
|
VENIPUNCTURE 3/>, MD SKILL
|
Facility
|
IP
|
$42.39
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
4503641001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.37 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna of VT Commercial |
$40.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.91
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Cigna Commercial |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.91
|
| Rate for Payer: Multiplan Commercial |
$39.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.03
|
| Rate for Payer: United Healthcare Commercial |
$40.27
|
|
|
VENIPUNCTURE 3/>, MD SKILL
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
9813641002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of VT Commercial |
$34.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$21.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$29.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.62
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$28.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$33.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.20
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.20
|
| Rate for Payer: United Healthcare VA CCN |
$16.20
|
|
|
VENIPUNCTURE 3/>, MD SKILL
|
Facility
|
OP
|
$42.39
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
4503641001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna of VT Commercial |
$40.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$37.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$37.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.70
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Cigna Commercial |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.08
|
| Rate for Payer: Multiplan Commercial |
$39.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.08
|
| Rate for Payer: United Healthcare Commercial |
$40.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.08
|
| Rate for Payer: United Healthcare VA CCN |
$19.08
|
|
|
VENT MASK INFANT SIZE 0
|
Facility
|
OP
|
$11.00
|
|
| Hospital Charge Code |
2700006676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Aetna of VT Commercial |
$10.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$9.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$9.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$6.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.74
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna Commercial |
$8.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$10.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.95
|
| Rate for Payer: United Healthcare Commercial |
$10.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.95
|
| Rate for Payer: United Healthcare VA CCN |
$4.95
|
|
|
VENT MASK INFANT SIZE 0
|
Facility
|
IP
|
$11.00
|
|
| Hospital Charge Code |
2700006676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Aetna of VT Commercial |
$10.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.80
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna Commercial |
$8.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$10.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.35
|
| Rate for Payer: United Healthcare Commercial |
$10.45
|
|
|
VENT MASK INFANT SIZE 0
|
Facility
|
OP
|
$11.00
|
|
| Hospital Charge Code |
2700066761
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Aetna of VT Commercial |
$10.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$9.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$9.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$6.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.74
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna Commercial |
$8.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$10.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.95
|
| Rate for Payer: United Healthcare Commercial |
$10.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.95
|
| Rate for Payer: United Healthcare VA CCN |
$4.95
|
|
|
VENT MASK INFANT SIZE 0
|
Facility
|
IP
|
$11.00
|
|
| Hospital Charge Code |
2700066761
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Aetna of VT Commercial |
$10.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.80
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna Commercial |
$8.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$10.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.35
|
| Rate for Payer: United Healthcare Commercial |
$10.45
|
|
|
VENT MASK INFANT SIZE 1
|
Facility
|
IP
|
$7.00
|
|
| Hospital Charge Code |
2700066771
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Aetna of VT Commercial |
$6.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5.60
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cigna Commercial |
$5.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.60
|
| Rate for Payer: Multiplan Commercial |
$6.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.95
|
| Rate for Payer: United Healthcare Commercial |
$6.65
|
|
|
VENT MASK INFANT SIZE 1
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
2700066771
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Aetna of VT Commercial |
$6.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5.57
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cigna Commercial |
$5.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$6.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3.15
|
| Rate for Payer: United Healthcare Commercial |
$6.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.15
|
| Rate for Payer: United Healthcare VA CCN |
$3.15
|
|
|
VENT MASK INFANT SIZE 2
|
Facility
|
OP
|
$11.00
|
|
| Hospital Charge Code |
2700066751
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Aetna of VT Commercial |
$10.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$9.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$9.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$6.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.74
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna Commercial |
$8.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$10.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.95
|
| Rate for Payer: United Healthcare Commercial |
$10.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.95
|
| Rate for Payer: United Healthcare VA CCN |
$4.95
|
|
|
VENT MASK INFANT SIZE 2
|
Facility
|
IP
|
$11.00
|
|
| Hospital Charge Code |
2700066751
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Aetna of VT Commercial |
$10.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.80
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna Commercial |
$8.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$10.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.35
|
| Rate for Payer: United Healthcare Commercial |
$10.45
|
|
|
VENT MGMT INPAT INIT DAY
|
Facility
|
IP
|
$886.12
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
4109400201
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$655.82 |
| Max. Negotiated Rate |
$841.81 |
| Rate for Payer: Aetna of VT Commercial |
$841.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$655.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$655.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$753.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$744.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$708.90
|
| Rate for Payer: Cash Price |
$443.06
|
| Rate for Payer: Cigna Commercial |
$708.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$708.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$708.90
|
| Rate for Payer: Multiplan Commercial |
$824.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$753.20
|
| Rate for Payer: United Healthcare Commercial |
$841.81
|
|
|
VENT MGMT INPAT INIT DAY
|
Facility
|
OP
|
$886.12
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
4109400201
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$392.46 |
| Max. Negotiated Rate |
$841.81 |
| Rate for Payer: Aetna of VT Commercial |
$841.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$793.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$392.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$793.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$533.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$753.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$717.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$398.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$704.47
|
| Rate for Payer: Cash Price |
$443.06
|
| Rate for Payer: Cigna Commercial |
$708.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$708.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$708.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$398.75
|
| Rate for Payer: Multiplan Commercial |
$824.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$753.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$398.75
|
| Rate for Payer: United Healthcare Commercial |
$841.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$398.75
|
| Rate for Payer: United Healthcare VA CCN |
$398.75
|
|
