|
CAST PLASTER 4" X 5 YD
|
Facility
|
OP
|
$1.48
|
|
| Hospital Charge Code |
2700016391
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna of VT Commercial |
$1.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.18
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cigna Commercial |
$1.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.67
|
| Rate for Payer: United Healthcare Commercial |
$1.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.67
|
| Rate for Payer: United Healthcare VA CCN |
$0.67
|
|
|
CAST PLASTER 4" X 5 YD
|
Facility
|
IP
|
$1.48
|
|
| Hospital Charge Code |
2700016391
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna of VT Commercial |
$1.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.18
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cigna Commercial |
$1.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.26
|
| Rate for Payer: United Healthcare Commercial |
$1.41
|
|
|
CAST PLASTER 5
|
Facility
|
OP
|
$9.46
|
|
| Hospital Charge Code |
2700016401
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$8.99 |
| Rate for Payer: Aetna of VT Commercial |
$8.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7.52
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cigna Commercial |
$7.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.26
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.26
|
| Rate for Payer: United Healthcare Commercial |
$8.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.26
|
| Rate for Payer: United Healthcare VA CCN |
$4.26
|
|
|
CAST PLASTER 5
|
Facility
|
IP
|
$9.46
|
|
| Hospital Charge Code |
2700016401
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$8.99 |
| Rate for Payer: Aetna of VT Commercial |
$8.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7.57
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cigna Commercial |
$7.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7.57
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.04
|
| Rate for Payer: United Healthcare Commercial |
$8.99
|
|
|
CAST SUP SHRT LEG FIBERGLASS
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS Q4038
|
| Hospital Charge Code |
270Q403801
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.09 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Aetna of VT Commercial |
$81.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$77.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$77.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$51.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$69.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$38.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$68.37
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$68.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$68.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$68.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$38.70
|
| Rate for Payer: Multiplan Commercial |
$79.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.70
|
| Rate for Payer: United Healthcare Commercial |
$81.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.70
|
| Rate for Payer: United Healthcare VA CCN |
$38.70
|
|
|
CAST SUP SHRT LEG FIBERGLASS
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS Q4038
|
| Hospital Charge Code |
270Q403801
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$63.65 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Aetna of VT Commercial |
$81.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$68.80
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$68.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$68.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$68.80
|
| Rate for Payer: Multiplan Commercial |
$79.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.10
|
| Rate for Payer: United Healthcare Commercial |
$81.70
|
|
|
CAST SUP SHRT LEG FIBERGLASS
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS Q4038
|
| Hospital Charge Code |
270Q403801
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.94 |
| Max. Negotiated Rate |
$80.84 |
| Rate for Payer: Aetna of VT Commercial |
$80.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$77.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$52.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$77.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$72.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.17
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$41.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$41.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$51.45
|
| Rate for Payer: Multiplan Commercial |
$79.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.45
|
| Rate for Payer: United Healthcare Commercial |
$79.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.45
|
| Rate for Payer: United Healthcare VA CCN |
$51.45
|
|
|
CAST SUP SHT LEG SPLNT FBRGL
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS Q4046
|
| Hospital Charge Code |
270Q404601
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$81.41 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Aetna of VT Commercial |
$104.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$93.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna Commercial |
$88.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.00
|
| Rate for Payer: Multiplan Commercial |
$102.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.50
|
| Rate for Payer: United Healthcare Commercial |
$104.50
|
|
|
CAST SUP SHT LEG SPLNT FBRGL
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS Q4046
|
| Hospital Charge Code |
270Q404601
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.72 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Aetna of VT Commercial |
$104.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$98.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$98.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$66.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$93.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.45
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna Commercial |
$88.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$102.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$104.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.50
|
| Rate for Payer: United Healthcare VA CCN |
$49.50
|
|
|
CAST SUP SHT LEG SPLNT FBRGL
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS Q4046
|
| Hospital Charge Code |
270Q404601
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$103.40 |
| Rate for Payer: Aetna of VT Commercial |
$103.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$98.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$24.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$98.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.82
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$23.32
|
| Rate for Payer: Multiplan Commercial |
$102.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.32
|
| Rate for Payer: United Healthcare Commercial |
$35.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.32
|
| Rate for Payer: United Healthcare VA CCN |
$23.32
|
|
|
CATECHOLAMINES FRACTIONATED
|
Professional
|
Both
|
$269.87
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
3008238401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$253.68 |
| Rate for Payer: Aetna of VT Commercial |
$253.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$35.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$43.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$43.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.15
|
| Rate for Payer: Cash Price |
$134.94
|
| Rate for Payer: Cash Price |
$134.94
|
| Rate for Payer: Cigna Commercial |
$30.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$24.90
|
| Rate for Payer: Multiplan Commercial |
$250.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.25
|
| Rate for Payer: United Healthcare Commercial |
$38.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.25
|
| Rate for Payer: United Healthcare VA CCN |
$25.25
|
|
|
CATECHOLAMINES FRACTIONATED
|
Facility
|
OP
|
$269.87
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
3008238401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$256.38 |
| Rate for Payer: Aetna of VT Commercial |
$256.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$119.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$162.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$229.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$218.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$121.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$214.55
|
| Rate for Payer: Cash Price |
$134.94
|
| Rate for Payer: Cash Price |
$134.94
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$215.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$215.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.44
|
| Rate for Payer: Multiplan Commercial |
$250.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$229.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.44
|
| Rate for Payer: United Healthcare Commercial |
$256.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.25
|
| Rate for Payer: United Healthcare VA CCN |
$121.44
|
|
|
CATECHOLAMINES FRACTIONATED
|
Facility
|
IP
|
$269.87
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
3008238401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$199.73 |
| Max. Negotiated Rate |
$256.38 |
| Rate for Payer: Aetna of VT Commercial |
$256.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$199.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$199.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$229.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$226.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$215.90
|
| Rate for Payer: Cash Price |
$134.94
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$215.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$215.90
|
| Rate for Payer: Multiplan Commercial |
$250.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$229.39
|
| Rate for Payer: United Healthcare Commercial |
$256.38
|
|
|
CATH 14F FOLEY 5CC 2WY ROUND
|
Facility
|
IP
|
$3.31
|
|
| Hospital Charge Code |
2720020801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Aetna of VT Commercial |
$3.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.65
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cigna Commercial |
$2.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.65
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.81
|
| Rate for Payer: United Healthcare Commercial |
$3.14
|
|
|
CATH 14F FOLEY 5CC 2WY ROUND
|
Facility
|
OP
|
$3.31
|
|
| Hospital Charge Code |
2720020801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Aetna of VT Commercial |
$3.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.63
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cigna Commercial |
$2.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.49
|
| Rate for Payer: United Healthcare Commercial |
$3.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.49
|
| Rate for Payer: United Healthcare VA CCN |
$1.49
|
|
|
CATH 14F SELF
|
Facility
|
IP
|
$0.49
|
|
| Hospital Charge Code |
2720017461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Aetna of VT Commercial |
$0.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.39
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna Commercial |
$0.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.42
|
| Rate for Payer: United Healthcare Commercial |
$0.47
|
|
|
CATH 14F SELF
|
Facility
|
OP
|
$0.49
|
|
| Hospital Charge Code |
2720017461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Aetna of VT Commercial |
$0.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.39
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna Commercial |
$0.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.22
|
| Rate for Payer: United Healthcare Commercial |
$0.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.22
|
| Rate for Payer: United Healthcare VA CCN |
$0.22
|
|
|
CATH 16FR COUNSIL 2WAY 5CC
|
Facility
|
IP
|
$24.99
|
|
| Hospital Charge Code |
2720072081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$23.74 |
| Rate for Payer: Aetna of VT Commercial |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$18.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$18.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.99
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cigna Commercial |
$19.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.99
|
| Rate for Payer: Multiplan Commercial |
$23.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.24
|
| Rate for Payer: United Healthcare Commercial |
$23.74
|
|
|
CATH 16FR COUNSIL 2WAY 5CC
|
Facility
|
OP
|
$24.99
|
|
| Hospital Charge Code |
2720072081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$23.74 |
| Rate for Payer: Aetna of VT Commercial |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$22.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$22.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.87
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cigna Commercial |
$19.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$23.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.25
|
| Rate for Payer: United Healthcare Commercial |
$23.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.25
|
| Rate for Payer: United Healthcare VA CCN |
$11.25
|
|
|
CATH 18F FOLEY 5CC 2WY ROUND
|
Facility
|
OP
|
$6.20
|
|
| Hospital Charge Code |
2720020821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$5.89 |
| Rate for Payer: Aetna of VT Commercial |
$5.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.93
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cigna Commercial |
$4.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.79
|
| Rate for Payer: Multiplan Commercial |
$5.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.79
|
| Rate for Payer: United Healthcare Commercial |
$5.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.79
|
| Rate for Payer: United Healthcare VA CCN |
$2.79
|
|
|
CATH 18F FOLEY 5CC 2WY ROUND
|
Facility
|
IP
|
$6.20
|
|
| Hospital Charge Code |
2720020821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$5.89 |
| Rate for Payer: Aetna of VT Commercial |
$5.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.96
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cigna Commercial |
$4.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.96
|
| Rate for Payer: Multiplan Commercial |
$5.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.27
|
| Rate for Payer: United Healthcare Commercial |
$5.89
|
|
|
CATH 18FR COUDE 5CC 2WY
|
Facility
|
OP
|
$12.70
|
|
| Hospital Charge Code |
2720020561
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$12.06 |
| Rate for Payer: Aetna of VT Commercial |
$12.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$11.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$11.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$7.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$10.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$10.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$5.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$10.10
|
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: Cigna Commercial |
$10.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$10.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$10.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.71
|
| Rate for Payer: Multiplan Commercial |
$11.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.71
|
| Rate for Payer: United Healthcare Commercial |
$12.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.71
|
| Rate for Payer: United Healthcare VA CCN |
$5.71
|
|
|
CATH 18FR COUDE 5CC 2WY
|
Facility
|
IP
|
$12.70
|
|
| Hospital Charge Code |
2720020561
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$12.06 |
| Rate for Payer: Aetna of VT Commercial |
$12.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$9.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$9.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$10.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$10.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$10.16
|
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: Cigna Commercial |
$10.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$10.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$10.16
|
| Rate for Payer: Multiplan Commercial |
$11.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.79
|
| Rate for Payer: United Healthcare Commercial |
$12.06
|
|
|
CATH 20F LIBRISIL 5CC 2WY
|
Facility
|
OP
|
$16.61
|
|
| Hospital Charge Code |
2720020591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$15.78 |
| Rate for Payer: Aetna of VT Commercial |
$15.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$14.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$14.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$10.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$14.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$7.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.20
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Cigna Commercial |
$13.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.47
|
| Rate for Payer: Multiplan Commercial |
$15.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$7.47
|
| Rate for Payer: United Healthcare Commercial |
$15.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.47
|
| Rate for Payer: United Healthcare VA CCN |
$7.47
|
|
|
CATH 20F LIBRISIL 5CC 2WY
|
Facility
|
IP
|
$16.61
|
|
| Hospital Charge Code |
2720020591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$15.78 |
| Rate for Payer: Aetna of VT Commercial |
$15.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$12.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$12.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$14.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.29
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Cigna Commercial |
$13.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.29
|
| Rate for Payer: Multiplan Commercial |
$15.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.12
|
| Rate for Payer: United Healthcare Commercial |
$15.78
|
|
