|
CAN SHT THD SCW HD 4X22MM
|
Facility
|
IP
|
$330.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.73 |
| Max. Negotiated Rate |
$314.14 |
| Rate for Payer: Aetna of VT Commercial |
$314.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$244.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$244.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$281.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$277.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$264.54
|
| Rate for Payer: Cash Price |
$165.34
|
| Rate for Payer: Cigna Commercial |
$264.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$264.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$264.54
|
| Rate for Payer: Multiplan Commercial |
$307.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$281.07
|
| Rate for Payer: United Healthcare Commercial |
$314.14
|
|
|
CAN SHT THD SCW HD 4X22MM
|
Facility
|
OP
|
$330.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.45 |
| Max. Negotiated Rate |
$314.14 |
| Rate for Payer: Aetna of VT Commercial |
$314.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$296.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$146.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$296.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$199.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$281.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$267.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$148.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$262.88
|
| Rate for Payer: Cash Price |
$165.34
|
| Rate for Payer: Cigna Commercial |
$264.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$264.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$264.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$148.80
|
| Rate for Payer: Multiplan Commercial |
$307.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$281.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$148.80
|
| Rate for Payer: United Healthcare Commercial |
$314.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.80
|
| Rate for Payer: United Healthcare VA CCN |
$148.80
|
|
|
CAN SHT THD SCW HDLS 3.0X32MM
|
Facility
|
OP
|
$343.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$152.04 |
| Max. Negotiated Rate |
$326.13 |
| Rate for Payer: Aetna of VT Commercial |
$326.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$307.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$152.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$307.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$206.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$291.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$154.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$272.92
|
| Rate for Payer: Cash Price |
$171.65
|
| Rate for Payer: Cigna Commercial |
$274.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$274.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$274.63
|
| Rate for Payer: Martins Point Health Care Commercial |
$154.48
|
| Rate for Payer: Multiplan Commercial |
$319.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$291.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$154.48
|
| Rate for Payer: United Healthcare Commercial |
$326.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.48
|
| Rate for Payer: United Healthcare VA CCN |
$154.48
|
|
|
CAN SHT THD SCW HDLS 3.0X32MM
|
Facility
|
IP
|
$343.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.07 |
| Max. Negotiated Rate |
$326.13 |
| Rate for Payer: Aetna of VT Commercial |
$326.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$254.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$254.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$291.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$288.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$274.63
|
| Rate for Payer: Cash Price |
$171.65
|
| Rate for Payer: Cigna Commercial |
$274.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$274.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$274.63
|
| Rate for Payer: Multiplan Commercial |
$319.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$291.80
|
| Rate for Payer: United Healthcare Commercial |
$326.13
|
|
|
CAN SHT THD SCW HDLS 3.5X36MM
|
Facility
|
IP
|
$343.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780069531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.07 |
| Max. Negotiated Rate |
$326.13 |
| Rate for Payer: Aetna of VT Commercial |
$326.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$254.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$254.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$291.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$288.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$274.63
|
| Rate for Payer: Cash Price |
$171.65
|
| Rate for Payer: Cigna Commercial |
$274.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$274.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$274.63
|
| Rate for Payer: Multiplan Commercial |
$319.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$291.80
|
| Rate for Payer: United Healthcare Commercial |
$326.13
|
|
|
CAN SHT THD SCW HDLS 3.5X36MM
|
Facility
|
OP
|
$343.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780069531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$152.04 |
| Max. Negotiated Rate |
$326.13 |
| Rate for Payer: Aetna of VT Commercial |
$326.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$307.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$152.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$307.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$206.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$291.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$154.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$272.92
|
| Rate for Payer: Cash Price |
$171.65
|
| Rate for Payer: Cigna Commercial |
$274.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$274.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$274.63
|
| Rate for Payer: Martins Point Health Care Commercial |
$154.48
|
| Rate for Payer: Multiplan Commercial |
$319.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$291.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$154.48
|
| Rate for Payer: United Healthcare Commercial |
$326.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.48
|
| Rate for Payer: United Healthcare VA CCN |
$154.48
|
|
|
CAN SHT THD SCW HDLS 3X22MM
|
Facility
|
OP
|
$1,494.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780075691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.69 |
| Max. Negotiated Rate |
$1,419.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,419.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,338.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$661.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,338.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$899.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,269.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,210.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$672.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,187.73
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cigna Commercial |
$1,195.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,195.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,195.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$672.30
|
| Rate for Payer: Multiplan Commercial |
$1,389.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,269.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$672.30
|
| Rate for Payer: United Healthcare Commercial |
$1,419.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$672.30
|
| Rate for Payer: United Healthcare VA CCN |
$672.30
|
|
|
CAN SHT THD SCW HDLS 3X22MM
|
Facility
|
IP
|
$1,494.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780075691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.71 |
| Max. Negotiated Rate |
$1,419.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,419.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,105.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,105.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,269.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,254.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,195.20
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cigna Commercial |
$1,195.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,195.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,195.20
|
| Rate for Payer: Multiplan Commercial |
$1,389.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,269.90
|
| Rate for Payer: United Healthcare Commercial |
$1,419.30
|
|
|
CAN SHT THD SCW HDLS 4.0X46MM
|
Facility
|
OP
|
$376.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.70 |
| Max. Negotiated Rate |
$357.56 |
| Rate for Payer: Aetna of VT Commercial |
$357.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$337.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$166.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$337.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$226.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$319.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$304.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$169.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$299.22
|
| Rate for Payer: Cash Price |
$188.19
|
| Rate for Payer: Cigna Commercial |
$301.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$301.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$301.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$169.37
|
| Rate for Payer: Multiplan Commercial |
$350.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$319.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$169.37
|
| Rate for Payer: United Healthcare Commercial |
$357.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.37
|
| Rate for Payer: United Healthcare VA CCN |
$169.37
|
|
|
CAN SHT THD SCW HDLS 4.0X46MM
|
Facility
|
IP
|
$376.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.56 |
| Max. Negotiated Rate |
$357.56 |
| Rate for Payer: Aetna of VT Commercial |
$357.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$278.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$278.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$319.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$316.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$301.10
|
| Rate for Payer: Cash Price |
$188.19
|
| Rate for Payer: Cigna Commercial |
$301.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$301.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$301.10
|
| Rate for Payer: Multiplan Commercial |
$350.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$319.92
|
| Rate for Payer: United Healthcare Commercial |
$357.56
|
|
|
CAN ST THD SCW HDLS 3X24MM
|
Facility
|
IP
|
$1,494.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780075701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.71 |
| Max. Negotiated Rate |
$1,419.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,419.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,105.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,105.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,269.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,254.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,195.20
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cigna Commercial |
$1,195.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,195.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,195.20
|
| Rate for Payer: Multiplan Commercial |
$1,389.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,269.90
|
| Rate for Payer: United Healthcare Commercial |
$1,419.30
|
|
|
CAN ST THD SCW HDLS 3X24MM
|
Facility
|
OP
|
$1,494.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780075701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.69 |
| Max. Negotiated Rate |
$1,419.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,419.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,338.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$661.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,338.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$899.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,269.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,210.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$672.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,187.73
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cigna Commercial |
$1,195.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,195.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,195.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$672.30
|
| Rate for Payer: Multiplan Commercial |
$1,389.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,269.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$672.30
|
| Rate for Payer: United Healthcare Commercial |
$1,419.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$672.30
|
| Rate for Payer: United Healthcare VA CCN |
$672.30
|
|
|
CANTHOTOMY SEPARATE PROCEDURE
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
9816771501
|
|
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
|
|
|
CANTHOTOMY SEPARATE PROCEDURE
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
9816771501
|
|
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
|
|
|
CANTHOTOMY SEPARATE PROCEDURE
|
Facility
|
IP
|
$3,423.57
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
4506771501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,533.78 |
| Max. Negotiated Rate |
$3,252.39 |
| Rate for Payer: Aetna of VT Commercial |
$3,252.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,533.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,533.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,910.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,875.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,738.86
|
| Rate for Payer: Cash Price |
$1,711.79
|
| Rate for Payer: Cigna Commercial |
$2,738.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,738.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,738.86
|
| Rate for Payer: Multiplan Commercial |
$3,183.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,910.03
|
| Rate for Payer: United Healthcare Commercial |
$3,252.39
|
|
|
CANTHOTOMY SEPARATE PROCEDURE
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
9816771502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$503.27 |
| Max. Negotiated Rate |
$646.00 |
| Rate for Payer: Aetna of VT Commercial |
$646.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$503.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$503.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$578.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$571.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$544.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cigna Commercial |
$544.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$544.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$544.00
|
| Rate for Payer: Multiplan Commercial |
$632.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$578.00
|
| Rate for Payer: United Healthcare Commercial |
$646.00
|
|
|
CANTHOTOMY SEPARATE PROCEDURE
|
Professional
|
Both
|
$680.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
9816771502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$101.74 |
| Max. Negotiated Rate |
$639.20 |
| Rate for Payer: Aetna of VT Commercial |
$639.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$609.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$104.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$609.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$142.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$447.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$447.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$447.93
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cigna Commercial |
$187.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$396.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$396.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$245.32
|
| Rate for Payer: Multiplan Commercial |
$632.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$144.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$101.74
|
| Rate for Payer: United Healthcare Commercial |
$156.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$101.74
|
| Rate for Payer: United Healthcare VA CCN |
$101.74
|
|
|
CANTHOTOMY SEPARATE PROCEDURE
|
Facility
|
OP
|
$3,423.57
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
4506771501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,516.30 |
| Max. Negotiated Rate |
$3,252.39 |
| Rate for Payer: Aetna of VT Commercial |
$3,252.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,067.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,516.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,067.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,060.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,910.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,773.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,540.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,721.74
|
| Rate for Payer: Cash Price |
$1,711.79
|
| Rate for Payer: Cigna Commercial |
$2,738.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,738.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,738.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,540.61
|
| Rate for Payer: Multiplan Commercial |
$3,183.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,910.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,540.61
|
| Rate for Payer: United Healthcare Commercial |
$3,252.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,540.61
|
| Rate for Payer: United Healthcare VA CCN |
$1,540.61
|
|
|
CANTHOTOMY SEPARATE PROCEDURE
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
9816771502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$301.17 |
| Max. Negotiated Rate |
$646.00 |
| Rate for Payer: Aetna of VT Commercial |
$646.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$609.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$301.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$609.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$409.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$578.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$550.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$540.60
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cigna Commercial |
$544.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$544.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$544.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$306.00
|
| Rate for Payer: Multiplan Commercial |
$632.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$578.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$306.00
|
| Rate for Payer: United Healthcare Commercial |
$646.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$306.00
|
| Rate for Payer: United Healthcare VA CCN |
$306.00
|
|
|
CANTHOTOMY SEPARATE PROCEDURE
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
9816771501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$447.93 |
| 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 |
$104.79
|
| 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 |
$142.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$447.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$447.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$447.93
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$187.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$396.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$396.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$245.32
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$144.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$101.74
|
| Rate for Payer: United Healthcare Commercial |
$156.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$101.74
|
| Rate for Payer: United Healthcare VA CCN |
$101.74
|
|
|
CAPILLARY BLOOD DRAW
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
9813641602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$20.90 |
| Rate for Payer: Aetna of VT Commercial |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$19.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$19.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$17.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$17.49
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$17.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$17.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$17.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$20.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.90
|
| Rate for Payer: United Healthcare Commercial |
$20.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.90
|
| Rate for Payer: United Healthcare VA CCN |
$9.90
|
|
|
CAPILLARY BLOOD DRAW
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
9813641602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$16.28 |
| Max. Negotiated Rate |
$20.90 |
| Rate for Payer: Aetna of VT Commercial |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$16.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$16.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$18.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$17.60
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$17.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$17.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$20.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.70
|
| Rate for Payer: United Healthcare Commercial |
$20.90
|
|
|
CAPILLARY BLOOD DRAW
|
Facility
|
OP
|
$23.78
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
3003641601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$22.59 |
| Rate for Payer: Aetna of VT Commercial |
$22.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$14.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$14.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$14.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$10.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$18.91
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cigna Commercial |
$19.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.70
|
| Rate for Payer: Multiplan Commercial |
$22.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.70
|
| Rate for Payer: United Healthcare Commercial |
$22.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.70
|
| Rate for Payer: United Healthcare VA CCN |
$10.70
|
|
|
CAPILLARY BLOOD DRAW
|
Facility
|
IP
|
$23.78
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
3003641601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$22.59 |
| Rate for Payer: Aetna of VT Commercial |
$22.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$17.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$17.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.02
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cigna Commercial |
$19.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.02
|
| Rate for Payer: Multiplan Commercial |
$22.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.21
|
| Rate for Payer: United Healthcare Commercial |
$22.59
|
|
|
CAPILLARY BLOOD DRAW
|
Facility
|
IP
|
$23.78
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
4503641601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$22.59 |
| Rate for Payer: Aetna of VT Commercial |
$22.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$17.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$17.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.02
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cigna Commercial |
$19.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.02
|
| Rate for Payer: Multiplan Commercial |
$22.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.21
|
| Rate for Payer: United Healthcare Commercial |
$22.59
|
|
