|
WHIRLPOOL THERAPY
|
Facility
|
IP
|
$295.72
|
|
|
Service Code
|
CPT 97022 GO
|
| Hospital Charge Code |
4309702201
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$218.86 |
| Max. Negotiated Rate |
$280.93 |
| Rate for Payer: Aetna of VT Commercial |
$280.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$218.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$218.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$251.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$248.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$236.58
|
| Rate for Payer: Cash Price |
$147.86
|
| Rate for Payer: Cigna Commercial |
$236.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.58
|
| Rate for Payer: Multiplan Commercial |
$275.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$251.36
|
| Rate for Payer: United Healthcare Commercial |
$280.93
|
|
|
WITHDRAWAL OF ARTERIAL BLOOD
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
9813660002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$13.90 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna of VT Commercial |
$164.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$156.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$156.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$44.13
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$25.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.10
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.90
|
| Rate for Payer: United Healthcare Commercial |
$21.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.90
|
| Rate for Payer: United Healthcare VA CCN |
$13.90
|
|
|
WITHDRAWAL OF ARTERIAL BLOOD
|
Facility
|
OP
|
$182.37
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
3003660001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.90 |
| Max. Negotiated Rate |
$173.25 |
| Rate for Payer: Aetna of VT Commercial |
$173.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$80.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$109.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$82.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.98
|
| Rate for Payer: Cash Price |
$91.18
|
| Rate for Payer: Cash Price |
$91.18
|
| Rate for Payer: Cigna Commercial |
$145.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$145.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$145.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$82.07
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$82.07
|
| Rate for Payer: United Healthcare Commercial |
$173.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.90
|
| Rate for Payer: United Healthcare VA CCN |
$82.07
|
|
|
WITHDRAWAL OF ARTERIAL BLOOD
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
9813660002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$129.52 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Aetna of VT Commercial |
$166.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$129.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$129.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$148.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$140.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$148.75
|
| Rate for Payer: United Healthcare Commercial |
$166.25
|
|
|
WITHDRAWAL OF ARTERIAL BLOOD
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
9813660001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$13.90 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna of VT Commercial |
$164.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$156.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$156.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$44.13
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$25.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.10
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.90
|
| Rate for Payer: United Healthcare Commercial |
$21.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.90
|
| Rate for Payer: United Healthcare VA CCN |
$13.90
|
|
|
WITHDRAWAL OF ARTERIAL BLOOD
|
Facility
|
IP
|
$182.37
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
3003660001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$134.97 |
| Max. Negotiated Rate |
$173.25 |
| Rate for Payer: Aetna of VT Commercial |
$173.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$134.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$134.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$153.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$145.90
|
| Rate for Payer: Cash Price |
$91.18
|
| Rate for Payer: Cigna Commercial |
$145.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$145.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$145.90
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.01
|
| Rate for Payer: United Healthcare Commercial |
$173.25
|
|
|
WITHDRAWAL OF ARTERIAL BLOOD
|
Facility
|
IP
|
$182.37
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
4103660001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$134.97 |
| Max. Negotiated Rate |
$173.25 |
| Rate for Payer: Aetna of VT Commercial |
$173.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$134.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$134.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$153.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$145.90
|
| Rate for Payer: Cash Price |
$91.18
|
| Rate for Payer: Cigna Commercial |
$145.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$145.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$145.90
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.01
|
| Rate for Payer: United Healthcare Commercial |
$173.25
|
|
|
WITHDRAWAL OF ARTERIAL BLOOD
|
Facility
|
IP
|
$182.37
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
4503660001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.97 |
| Max. Negotiated Rate |
$173.25 |
| Rate for Payer: Aetna of VT Commercial |
$173.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$134.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$134.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$153.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$145.90
|
| Rate for Payer: Cash Price |
$91.18
|
| Rate for Payer: Cigna Commercial |
$145.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$145.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$145.90
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.01
|
| Rate for Payer: United Healthcare Commercial |
$173.25
|
|
|
WITHDRAWAL OF ARTERIAL BLOOD
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
9813660001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$77.51 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Aetna of VT Commercial |
$166.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$156.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$77.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$156.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$105.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$148.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$141.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$139.12
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$140.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$78.75
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$148.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$78.75
|
| Rate for Payer: United Healthcare Commercial |
$166.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.75
|
| Rate for Payer: United Healthcare VA CCN |
$78.75
|
|
|
WITHDRAWAL OF ARTERIAL BLOOD
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
9813660002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$77.51 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Aetna of VT Commercial |
$166.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$156.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$77.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$156.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$105.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$148.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$141.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$139.12
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$140.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$78.75
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$148.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$78.75
|
| Rate for Payer: United Healthcare Commercial |
$166.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.75
|
| Rate for Payer: United Healthcare VA CCN |
$78.75
|
|
|
WITHDRAWAL OF ARTERIAL BLOOD
|
Facility
|
OP
|
$182.37
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
4103660001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$80.77 |
| Max. Negotiated Rate |
$173.25 |
| Rate for Payer: Aetna of VT Commercial |
$173.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$80.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$109.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$82.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.98
|
| Rate for Payer: Cash Price |
$91.18
|
| Rate for Payer: Cigna Commercial |
$145.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$145.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$145.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$82.07
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$82.07
|
| Rate for Payer: United Healthcare Commercial |
$173.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.07
|
| Rate for Payer: United Healthcare VA CCN |
$82.07
|
|
|
WITHDRAWAL OF ARTERIAL BLOOD
|
Facility
|
OP
|
$182.37
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
4503660001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.77 |
| Max. Negotiated Rate |
$173.25 |
| Rate for Payer: Aetna of VT Commercial |
$173.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$80.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$109.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$82.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.98
|
| Rate for Payer: Cash Price |
$91.18
|
| Rate for Payer: Cigna Commercial |
$145.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$145.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$145.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$82.07
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$82.07
|
| Rate for Payer: United Healthcare Commercial |
$173.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.07
|
| Rate for Payer: United Healthcare VA CCN |
$82.07
|
|
|
WITHDRAWAL OF ARTERIAL BLOOD
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
9813660001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$129.52 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Aetna of VT Commercial |
$166.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$129.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$129.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$148.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$140.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$148.75
|
| Rate for Payer: United Healthcare Commercial |
$166.25
|
|
|
WITHDRAWAL OF ARTERIAL BLOOD
|
Professional
|
Both
|
$182.37
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
3003660001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.90 |
| Max. Negotiated Rate |
$171.43 |
| Rate for Payer: Aetna of VT Commercial |
$171.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$44.13
|
| Rate for Payer: Cash Price |
$91.18
|
| Rate for Payer: Cash Price |
$91.18
|
| Rate for Payer: Cigna Commercial |
$25.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.10
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.90
|
| Rate for Payer: United Healthcare Commercial |
$21.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.90
|
| Rate for Payer: United Healthcare VA CCN |
$13.90
|
|
|
WOUND CLOSURE BY ADHESIVE
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS G0168
|
| Hospital Charge Code |
981G016802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna of VT Commercial |
$133.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$119.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.80
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$112.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.80
|
| Rate for Payer: Multiplan Commercial |
$131.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$119.85
|
| Rate for Payer: United Healthcare Commercial |
$133.95
|
|
|
WOUND CLOSURE BY ADHESIVE
|
Facility
|
OP
|
$140.62
|
|
|
Service Code
|
HCPCS G0168
|
| Hospital Charge Code |
450G016801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.28 |
| Max. Negotiated Rate |
$133.59 |
| Rate for Payer: Aetna of VT Commercial |
$133.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$119.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$111.79
|
| Rate for Payer: Cash Price |
$70.31
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.28
|
| Rate for Payer: Multiplan Commercial |
$130.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$119.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.28
|
| Rate for Payer: United Healthcare Commercial |
$133.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.28
|
| Rate for Payer: United Healthcare VA CCN |
$63.28
|
|
|
WOUND CLOSURE BY ADHESIVE
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS G0168
|
| Hospital Charge Code |
981G016802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$62.45 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna of VT Commercial |
$133.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$119.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.09
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$112.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.45
|
| Rate for Payer: Multiplan Commercial |
$131.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$119.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.45
|
| Rate for Payer: United Healthcare Commercial |
$133.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.45
|
| Rate for Payer: United Healthcare VA CCN |
$63.45
|
|
|
WOUND CLOSURE BY ADHESIVE
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS G0168
|
| Hospital Charge Code |
981G016802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$155.67 |
| Rate for Payer: Aetna of VT Commercial |
$132.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$155.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.67
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$152.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$152.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.38
|
| Rate for Payer: Multiplan Commercial |
$131.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.11
|
| Rate for Payer: United Healthcare Commercial |
$20.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.11
|
| Rate for Payer: United Healthcare VA CCN |
$13.11
|
|
|
WOUND CLOSURE BY ADHESIVE
|
Facility
|
IP
|
$140.62
|
|
|
Service Code
|
HCPCS G0168
|
| Hospital Charge Code |
450G016801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.07 |
| Max. Negotiated Rate |
$133.59 |
| Rate for Payer: Aetna of VT Commercial |
$133.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$119.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.50
|
| Rate for Payer: Cash Price |
$70.31
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.50
|
| Rate for Payer: Multiplan Commercial |
$130.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$119.53
|
| Rate for Payer: United Healthcare Commercial |
$133.59
|
|
|
WOUND(S) CARE NON-SELECTIVE
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
9829760201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$65.13 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Aetna of VT Commercial |
$83.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.40
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$70.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$70.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$70.40
|
| Rate for Payer: Multiplan Commercial |
$81.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.80
|
| Rate for Payer: United Healthcare Commercial |
$83.60
|
|
|
WOUND(S) CARE NON-SELECTIVE
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
9829760201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$38.98 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Aetna of VT Commercial |
$83.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$78.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$78.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$71.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.96
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$70.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$70.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$70.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$81.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.60
|
| Rate for Payer: United Healthcare Commercial |
$83.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.60
|
| Rate for Payer: United Healthcare VA CCN |
$39.60
|
|
|
WOUND(S) CARE NON-SELECTIVE
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
9829760201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$128.58 |
| Rate for Payer: Aetna of VT Commercial |
$82.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$78.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$78.84
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$99.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$128.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$128.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$102.98
|
| Rate for Payer: Multiplan Commercial |
$81.84
|
| Rate for Payer: United Healthcare Commercial |
$74.80
|
| Rate for Payer: United Healthcare VA CCN |
$35.20
|
|
|
WRIST ENDOSCOPY/SURGERY
|
Facility
|
OP
|
$1,892.00
|
|
|
Service Code
|
CPT 29848
|
| Hospital Charge Code |
9822984801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$837.97 |
| Max. Negotiated Rate |
$1,797.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,797.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,695.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$837.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,695.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,138.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,608.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,532.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$851.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,504.14
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Cigna Commercial |
$1,513.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,513.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,513.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$851.40
|
| Rate for Payer: Multiplan Commercial |
$1,759.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,608.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$851.40
|
| Rate for Payer: United Healthcare Commercial |
$1,797.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$851.40
|
| Rate for Payer: United Healthcare VA CCN |
$851.40
|
|
|
WRIST ENDOSCOPY/SURGERY
|
Facility
|
IP
|
$1,892.00
|
|
|
Service Code
|
CPT 29848
|
| Hospital Charge Code |
9822984801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,400.27 |
| Max. Negotiated Rate |
$1,797.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,797.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,400.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,400.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,608.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,589.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,513.60
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Cigna Commercial |
$1,513.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,513.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,513.60
|
| Rate for Payer: Multiplan Commercial |
$1,759.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,608.20
|
| Rate for Payer: United Healthcare Commercial |
$1,797.40
|
|
|
WRIST ENDOSCOPY/SURGERY
|
Professional
|
Both
|
$1,892.00
|
|
|
Service Code
|
CPT 29848
|
| Hospital Charge Code |
9822984801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$491.96 |
| Max. Negotiated Rate |
$1,778.48 |
| Rate for Payer: Aetna of VT Commercial |
$1,778.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,695.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$506.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,695.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$688.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$767.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$767.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$565.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$767.77
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Cigna Commercial |
$929.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$815.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$815.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$491.96
|
| Rate for Payer: Multiplan Commercial |
$1,759.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$698.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$491.96
|
| Rate for Payer: United Healthcare Commercial |
$756.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$491.96
|
| Rate for Payer: United Healthcare VA CCN |
$491.96
|
|
