|
CATH 22F FOLEY 30CC 2WY ROUND
|
Facility
|
IP
|
$7.68
|
|
| Hospital Charge Code |
2720020861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$7.30 |
| Rate for Payer: Aetna of VT Commercial |
$7.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6.14
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cigna Commercial |
$6.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.14
|
| Rate for Payer: Multiplan Commercial |
$7.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.53
|
| Rate for Payer: United Healthcare Commercial |
$7.30
|
|
|
CATH 22F FOLEY 30CC 2WY ROUND
|
Facility
|
OP
|
$7.68
|
|
| Hospital Charge Code |
2720020861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$7.30 |
| Rate for Payer: Aetna of VT Commercial |
$7.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6.11
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cigna Commercial |
$6.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$3.46
|
| Rate for Payer: Multiplan Commercial |
$7.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3.46
|
| Rate for Payer: United Healthcare Commercial |
$7.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.46
|
| Rate for Payer: United Healthcare VA CCN |
$3.46
|
|
|
CATH 22F FOLEY 30CC LUBRI-SIL
|
Facility
|
IP
|
$10.29
|
|
| Hospital Charge Code |
2720021121
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$9.78 |
| Rate for Payer: Aetna of VT Commercial |
$9.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.23
|
| Rate for Payer: Cash Price |
$5.14
|
| Rate for Payer: Cigna Commercial |
$8.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.23
|
| Rate for Payer: Multiplan Commercial |
$9.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.75
|
| Rate for Payer: United Healthcare Commercial |
$9.78
|
|
|
CATH 22F FOLEY 30CC LUBRI-SIL
|
Facility
|
OP
|
$10.29
|
|
| Hospital Charge Code |
2720021121
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$9.78 |
| Rate for Payer: Aetna of VT Commercial |
$9.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$9.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$9.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$6.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.18
|
| Rate for Payer: Cash Price |
$5.14
|
| Rate for Payer: Cigna Commercial |
$8.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.63
|
| Rate for Payer: Multiplan Commercial |
$9.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.63
|
| Rate for Payer: United Healthcare Commercial |
$9.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.63
|
| Rate for Payer: United Healthcare VA CCN |
$4.63
|
|
|
CATH 24F FOLEY 30CC 3WY ROUND
|
Facility
|
IP
|
$18.13
|
|
| Hospital Charge Code |
2720021131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna of VT Commercial |
$17.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$15.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$15.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.50
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cigna Commercial |
$14.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.50
|
| Rate for Payer: Multiplan Commercial |
$16.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.41
|
| Rate for Payer: United Healthcare Commercial |
$17.22
|
|
|
CATH 24F FOLEY 30CC 3WY ROUND
|
Facility
|
OP
|
$18.13
|
|
| Hospital Charge Code |
2720021131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.03 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna of VT Commercial |
$17.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$16.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$16.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$10.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$15.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$14.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$8.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.41
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cigna Commercial |
$14.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$16.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.16
|
| Rate for Payer: United Healthcare Commercial |
$17.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.16
|
| Rate for Payer: United Healthcare VA CCN |
$8.16
|
|
|
CATH 24F FOLEY 5CC 3 LUBRI-SIL
|
Facility
|
OP
|
$11.07
|
|
| Hospital Charge Code |
2720021111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$10.52 |
| Rate for Payer: Aetna of VT Commercial |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$9.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$9.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$6.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.80
|
| Rate for Payer: Cash Price |
$5.54
|
| Rate for Payer: Cigna Commercial |
$8.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.98
|
| Rate for Payer: Multiplan Commercial |
$10.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.98
|
| Rate for Payer: United Healthcare Commercial |
$10.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.98
|
| Rate for Payer: United Healthcare VA CCN |
$4.98
|
|
|
CATH 24F FOLEY 5CC 3 LUBRI-SIL
|
Facility
|
IP
|
$11.07
|
|
| Hospital Charge Code |
2720021111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$10.52 |
| Rate for Payer: Aetna of VT Commercial |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.86
|
| Rate for Payer: Cash Price |
$5.54
|
| Rate for Payer: Cigna Commercial |
$8.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.86
|
| Rate for Payer: Multiplan Commercial |
$10.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.41
|
| Rate for Payer: United Healthcare Commercial |
$10.52
|
|
|
CATH 8F FOLEY 3CC 2WY ROUND
|
Facility
|
OP
|
$3.34
|
|
| Hospital Charge Code |
2720020781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Aetna of VT Commercial |
$3.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.66
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cigna Commercial |
$2.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$3.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.50
|
| Rate for Payer: United Healthcare Commercial |
$3.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.50
|
| Rate for Payer: United Healthcare VA CCN |
$1.50
|
|
|
CATH 8F FOLEY 3CC 2WY ROUND
|
Facility
|
IP
|
$3.34
|
|
| Hospital Charge Code |
2720020781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Aetna of VT Commercial |
$3.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.67
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cigna Commercial |
$2.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$3.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.84
|
| Rate for Payer: United Healthcare Commercial |
$3.17
|
|
|
CATHETERIZE FOR URINE SPEC
|
Facility
|
IP
|
$217.28
|
|
|
Service Code
|
HCPCS P9612
|
| Hospital Charge Code |
300P961201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$160.81 |
| Max. Negotiated Rate |
$206.42 |
| Rate for Payer: Aetna of VT Commercial |
$206.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$182.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$173.82
|
| Rate for Payer: Cash Price |
$108.64
|
| Rate for Payer: Cigna Commercial |
$173.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$173.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$173.82
|
| Rate for Payer: Multiplan Commercial |
$202.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$184.69
|
| Rate for Payer: United Healthcare Commercial |
$206.42
|
|
|
CATHETERIZE FOR URINE SPEC
|
Facility
|
OP
|
$217.28
|
|
|
Service Code
|
HCPCS P9612
|
| Hospital Charge Code |
300P961201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$206.42 |
| Rate for Payer: Aetna of VT Commercial |
$206.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$43.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$96.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$43.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$176.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$172.74
|
| Rate for Payer: Cash Price |
$108.64
|
| Rate for Payer: Cash Price |
$108.64
|
| Rate for Payer: Cigna Commercial |
$173.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$173.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$173.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$97.78
|
| Rate for Payer: Multiplan Commercial |
$202.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$184.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$97.78
|
| Rate for Payer: United Healthcare Commercial |
$206.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.09
|
| Rate for Payer: United Healthcare VA CCN |
$97.78
|
|
|
CATHETERIZE FOR URINE SPEC
|
Professional
|
Both
|
$217.28
|
|
|
Service Code
|
HCPCS P9612
|
| Hospital Charge Code |
300P961201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$204.24 |
| Rate for Payer: Aetna of VT Commercial |
$204.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$43.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$43.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$12.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$10.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9.09
|
| Rate for Payer: Cash Price |
$108.64
|
| Rate for Payer: Cash Price |
$108.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$9.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$9.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.09
|
| Rate for Payer: Multiplan Commercial |
$202.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.09
|
| Rate for Payer: United Healthcare Commercial |
$13.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.09
|
| Rate for Payer: United Healthcare VA CCN |
$9.09
|
|
|
CATHETERIZE URINE SPEC
|
Facility
|
IP
|
$641.08
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
6365170101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$474.46 |
| Max. Negotiated Rate |
$609.03 |
| Rate for Payer: Aetna of VT Commercial |
$609.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$474.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$474.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$544.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$538.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$512.86
|
| Rate for Payer: Cash Price |
$320.54
|
| Rate for Payer: Cigna Commercial |
$512.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$512.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$512.86
|
| Rate for Payer: Multiplan Commercial |
$596.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$544.92
|
| Rate for Payer: United Healthcare Commercial |
$609.03
|
|
|
CATHETERIZE URINE SPEC
|
Professional
|
Both
|
$641.08
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
6365170101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$602.62 |
| Rate for Payer: Aetna of VT Commercial |
$602.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$574.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$574.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$79.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$79.63
|
| Rate for Payer: Cash Price |
$320.54
|
| Rate for Payer: Cash Price |
$320.54
|
| Rate for Payer: Cigna Commercial |
$41.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$41.59
|
| Rate for Payer: Multiplan Commercial |
$596.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.28
|
| Rate for Payer: United Healthcare Commercial |
$35.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.28
|
| Rate for Payer: United Healthcare VA CCN |
$23.28
|
|
|
CATHETERIZE URINE SPEC
|
Facility
|
OP
|
$641.08
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
6365170101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$283.93 |
| Max. Negotiated Rate |
$609.03 |
| Rate for Payer: Aetna of VT Commercial |
$609.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$574.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$283.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$574.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$385.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$544.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$519.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$288.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$509.66
|
| Rate for Payer: Cash Price |
$320.54
|
| Rate for Payer: Cigna Commercial |
$512.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$512.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$512.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$288.49
|
| Rate for Payer: Multiplan Commercial |
$596.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$544.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$288.49
|
| Rate for Payer: United Healthcare Commercial |
$609.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.49
|
| Rate for Payer: United Healthcare VA CCN |
$288.49
|
|
|
CATH FOLEY 12FR COUDE 10CC 2WY
|
Facility
|
IP
|
$6.66
|
|
| Hospital Charge Code |
2720071741
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$6.33 |
| Rate for Payer: Aetna of VT Commercial |
$6.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5.33
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cigna Commercial |
$5.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.33
|
| Rate for Payer: Multiplan Commercial |
$6.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.66
|
| Rate for Payer: United Healthcare Commercial |
$6.33
|
|
|
CATH FOLEY 12FR COUDE 10CC 2WY
|
Facility
|
OP
|
$6.66
|
|
| Hospital Charge Code |
2720071741
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$6.33 |
| Rate for Payer: Aetna of VT Commercial |
$6.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5.29
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cigna Commercial |
$5.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$6.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.66
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3.00
|
| Rate for Payer: United Healthcare Commercial |
$6.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.00
|
| Rate for Payer: United Healthcare VA CCN |
$3.00
|
|
|
CATH INTERMITTENT 18FR
|
Facility
|
OP
|
$3.14
|
|
| Hospital Charge Code |
2720071751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: Aetna of VT Commercial |
$2.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.50
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: Cigna Commercial |
$2.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.41
|
| Rate for Payer: Multiplan Commercial |
$2.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.41
|
| Rate for Payer: United Healthcare Commercial |
$2.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.41
|
| Rate for Payer: United Healthcare VA CCN |
$1.41
|
|
|
CATH INTERMITTENT 18FR
|
Facility
|
IP
|
$3.14
|
|
| Hospital Charge Code |
2720071751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: Aetna of VT Commercial |
$2.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.51
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: Cigna Commercial |
$2.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.51
|
| Rate for Payer: Multiplan Commercial |
$2.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.67
|
| Rate for Payer: United Healthcare Commercial |
$2.98
|
|
|
CATHJ UMBILICAL VEIN DX/THER N
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
3603651001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
|
|
CATHJ UMBILICAL VEIN DX/THER N
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
3603651001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
CATH TRAY 18F FOLEY
|
Facility
|
OP
|
$18.43
|
|
| Hospital Charge Code |
2720029381
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$17.51 |
| Rate for Payer: Aetna of VT Commercial |
$17.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$16.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$16.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$15.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$14.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$8.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.65
|
| Rate for Payer: Cash Price |
$9.21
|
| Rate for Payer: Cigna Commercial |
$14.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.29
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.29
|
| Rate for Payer: United Healthcare Commercial |
$17.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.29
|
| Rate for Payer: United Healthcare VA CCN |
$8.29
|
|
|
CATH TRAY 18F FOLEY
|
Facility
|
IP
|
$18.43
|
|
| Hospital Charge Code |
2720029381
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$17.51 |
| Rate for Payer: Aetna of VT Commercial |
$17.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$13.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$13.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$15.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$15.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.74
|
| Rate for Payer: Cash Price |
$9.21
|
| Rate for Payer: Cigna Commercial |
$14.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.74
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.67
|
| Rate for Payer: United Healthcare Commercial |
$17.51
|
|
|
CATH VESSEL UMBIL 3.5FR
|
Facility
|
IP
|
$14.01
|
|
| Hospital Charge Code |
2720019771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$13.31 |
| Rate for Payer: Aetna of VT Commercial |
$13.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$10.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$10.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.21
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.21
|
| Rate for Payer: Multiplan Commercial |
$13.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.91
|
| Rate for Payer: United Healthcare Commercial |
$13.31
|
|
