|
CERULOPLASMIN
|
Facility
|
IP
|
$191.85
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
3008239001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.99 |
| Max. Negotiated Rate |
$182.26 |
| Rate for Payer: Aetna of VT Commercial |
$182.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$141.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$141.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$163.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$161.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$153.48
|
| Rate for Payer: Cash Price |
$95.92
|
| Rate for Payer: Cigna Commercial |
$153.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$153.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$153.48
|
| Rate for Payer: Multiplan Commercial |
$178.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$163.07
|
| Rate for Payer: United Healthcare Commercial |
$182.26
|
|
|
CERULOPLASMIN
|
Professional
|
Both
|
$191.85
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
3008239001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$180.34 |
| Rate for Payer: Aetna of VT Commercial |
$180.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$52.92
|
| 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 |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$18.36
|
| Rate for Payer: Cash Price |
$95.92
|
| Rate for Payer: Cash Price |
$95.92
|
| Rate for Payer: Cigna Commercial |
$13.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$10.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$10.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$178.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.74
|
| Rate for Payer: United Healthcare Commercial |
$16.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.74
|
| Rate for Payer: United Healthcare VA CCN |
$10.74
|
|
|
CERULOPLASMIN
|
Facility
|
OP
|
$191.85
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
3008239001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$182.26 |
| Rate for Payer: Aetna of VT Commercial |
$182.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$84.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$115.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$163.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$155.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$86.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$152.52
|
| Rate for Payer: Cash Price |
$95.92
|
| Rate for Payer: Cash Price |
$95.92
|
| Rate for Payer: Cigna Commercial |
$153.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$153.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$153.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.33
|
| Rate for Payer: Multiplan Commercial |
$178.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$163.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$86.33
|
| Rate for Payer: United Healthcare Commercial |
$182.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.74
|
| Rate for Payer: United Healthcare VA CCN |
$86.33
|
|
|
CESAREAN DELIVERY ONLY
|
Facility
|
OP
|
$2,585.00
|
|
|
Service Code
|
CPT 59514
|
| Hospital Charge Code |
9695951401
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$1,144.90 |
| Max. Negotiated Rate |
$2,455.75 |
| Rate for Payer: Aetna of VT Commercial |
$2,455.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,315.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,144.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,315.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,556.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,197.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,093.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,163.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,055.07
|
| Rate for Payer: Cash Price |
$1,292.50
|
| Rate for Payer: Cigna Commercial |
$2,068.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,068.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,068.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,163.25
|
| Rate for Payer: Multiplan Commercial |
$2,404.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,197.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,163.25
|
| Rate for Payer: United Healthcare Commercial |
$2,455.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,163.25
|
| Rate for Payer: United Healthcare VA CCN |
$1,163.25
|
|
|
CESAREAN DELIVERY ONLY
|
Facility
|
IP
|
$2,585.00
|
|
|
Service Code
|
CPT 59514
|
| Hospital Charge Code |
9695951401
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$1,913.16 |
| Max. Negotiated Rate |
$2,455.75 |
| Rate for Payer: Aetna of VT Commercial |
$2,455.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,913.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,913.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,197.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,171.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,068.00
|
| Rate for Payer: Cash Price |
$1,292.50
|
| Rate for Payer: Cigna Commercial |
$2,068.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,068.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,068.00
|
| Rate for Payer: Multiplan Commercial |
$2,404.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,197.25
|
| Rate for Payer: United Healthcare Commercial |
$2,455.75
|
|
|
CESAREAN DELIVERY ONLY
|
Professional
|
Both
|
$2,585.00
|
|
|
Service Code
|
CPT 59514
|
| Hospital Charge Code |
9695951401
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$804.66 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna of VT Commercial |
$2,429.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,315.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$828.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,315.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,126.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,550.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,550.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$925.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,550.39
|
| Rate for Payer: Cash Price |
$1,292.50
|
| Rate for Payer: Cash Price |
$1,292.50
|
| Rate for Payer: Cash Price |
$1,292.50
|
| Rate for Payer: Cigna Commercial |
$1,357.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,399.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,399.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,055.43
|
| Rate for Payer: Multiplan Commercial |
$2,404.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,800.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$804.66
|
| Rate for Payer: United Healthcare Commercial |
$1,237.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$804.66
|
| Rate for Payer: United Healthcare VA CCN |
$804.66
|
|
|
CESAREAN DELIVERY ONLY W/POSTP
|
Facility
|
IP
|
$2,635.00
|
|
|
Service Code
|
CPT 59515
|
| Hospital Charge Code |
9695951501
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$1,950.16 |
| Max. Negotiated Rate |
$2,503.25 |
| Rate for Payer: Aetna of VT Commercial |
$2,503.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,950.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,950.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,239.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,213.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,108.00
|
| Rate for Payer: Cash Price |
$1,317.50
|
| Rate for Payer: Cigna Commercial |
$2,108.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,108.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,108.00
|
| Rate for Payer: Multiplan Commercial |
$2,450.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,239.75
|
| Rate for Payer: United Healthcare Commercial |
$2,503.25
|
|
|
CESAREAN DELIVERY ONLY W/POSTP
|
Professional
|
Both
|
$2,635.00
|
|
|
Service Code
|
CPT 59515
|
| Hospital Charge Code |
9695951501
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$1,194.50 |
| Max. Negotiated Rate |
$2,476.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,476.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,360.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,230.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,360.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,672.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,714.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,714.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,373.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,714.71
|
| Rate for Payer: Cash Price |
$1,317.50
|
| Rate for Payer: Cash Price |
$1,317.50
|
| Rate for Payer: Cigna Commercial |
$1,312.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,072.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,072.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,194.50
|
| Rate for Payer: Multiplan Commercial |
$2,450.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,696.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,194.51
|
| Rate for Payer: United Healthcare Commercial |
$1,837.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,194.51
|
| Rate for Payer: United Healthcare VA CCN |
$1,194.51
|
|
|
CESAREAN DELIVERY ONLY W/POSTP
|
Facility
|
OP
|
$2,635.00
|
|
|
Service Code
|
CPT 59515
|
| Hospital Charge Code |
9695951501
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$1,167.04 |
| Max. Negotiated Rate |
$2,503.25 |
| Rate for Payer: Aetna of VT Commercial |
$2,503.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,360.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,167.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,360.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,586.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,239.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,134.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,185.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,094.82
|
| Rate for Payer: Cash Price |
$1,317.50
|
| Rate for Payer: Cigna Commercial |
$2,108.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,108.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,108.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,185.75
|
| Rate for Payer: Multiplan Commercial |
$2,450.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,239.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,185.75
|
| Rate for Payer: United Healthcare Commercial |
$2,503.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,185.75
|
| Rate for Payer: United Healthcare VA CCN |
$1,185.75
|
|
|
CHANGE CYSTOSTOMY TUBE SIMPLE
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
9825170501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna of VT Commercial |
$247.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$233.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$115.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$233.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$221.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$211.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$117.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$208.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$117.45
|
| Rate for Payer: Multiplan Commercial |
$242.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$221.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$117.45
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$117.45
|
| Rate for Payer: United Healthcare VA CCN |
$117.45
|
|
|
CHANGE CYSTOSTOMY TUBE SIMPLE
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
9825170501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$193.17 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna of VT Commercial |
$247.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$193.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$193.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$221.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$219.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$208.80
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$208.80
|
| Rate for Payer: Multiplan Commercial |
$242.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$221.85
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
|
|
CHANGE CYSTOSTOMY TUBE SIMPLE
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
9815170501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna of VT Commercial |
$247.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$233.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$115.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$233.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$221.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$211.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$117.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$208.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$117.45
|
| Rate for Payer: Multiplan Commercial |
$242.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$221.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$117.45
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$117.45
|
| Rate for Payer: United Healthcare VA CCN |
$117.45
|
|
|
CHANGE CYSTOSTOMY TUBE SIMPLE
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
9815170502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna of VT Commercial |
$245.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$233.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$233.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$68.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$170.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$56.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$170.36
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$84.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$150.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$150.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$92.48
|
| Rate for Payer: Multiplan Commercial |
$242.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$48.79
|
| Rate for Payer: United Healthcare Commercial |
$75.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.79
|
| Rate for Payer: United Healthcare VA CCN |
$48.79
|
|
|
CHANGE CYSTOSTOMY TUBE SIMPLE
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
9815170502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna of VT Commercial |
$247.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$233.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$115.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$233.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$221.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$211.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$117.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$208.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$117.45
|
| Rate for Payer: Multiplan Commercial |
$242.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$221.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$117.45
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$117.45
|
| Rate for Payer: United Healthcare VA CCN |
$117.45
|
|
|
CHANGE CYSTOSTOMY TUBE SIMPLE
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
9825170501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna of VT Commercial |
$245.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$233.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$233.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$68.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$170.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$56.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$170.36
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$84.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$150.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$150.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$92.48
|
| Rate for Payer: Multiplan Commercial |
$242.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$48.79
|
| Rate for Payer: United Healthcare Commercial |
$75.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.79
|
| Rate for Payer: United Healthcare VA CCN |
$48.79
|
|
|
CHANGE CYSTOSTOMY TUBE SIMPLE
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
9815170501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$193.17 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna of VT Commercial |
$247.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$193.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$193.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$221.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$219.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$208.80
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$208.80
|
| Rate for Payer: Multiplan Commercial |
$242.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$221.85
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
|
|
CHANGE CYSTOSTOMY TUBE SIMPLE
|
Facility
|
OP
|
$179.92
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
4505170501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.69 |
| Max. Negotiated Rate |
$170.92 |
| Rate for Payer: Aetna of VT Commercial |
$170.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$161.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$161.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$108.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.04
|
| Rate for Payer: Cash Price |
$89.96
|
| Rate for Payer: Cigna Commercial |
$143.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.96
|
| Rate for Payer: Multiplan Commercial |
$167.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.96
|
| Rate for Payer: United Healthcare Commercial |
$170.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.96
|
| Rate for Payer: United Healthcare VA CCN |
$80.96
|
|
|
CHANGE CYSTOSTOMY TUBE SIMPLE
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
9815170501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna of VT Commercial |
$245.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$233.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$233.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$68.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$170.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$56.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$170.36
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$84.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$150.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$150.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$92.48
|
| Rate for Payer: Multiplan Commercial |
$242.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$48.79
|
| Rate for Payer: United Healthcare Commercial |
$75.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.79
|
| Rate for Payer: United Healthcare VA CCN |
$48.79
|
|
|
CHANGE CYSTOSTOMY TUBE SIMPLE
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
9815170502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$193.17 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna of VT Commercial |
$247.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$193.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$193.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$221.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$219.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$208.80
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$208.80
|
| Rate for Payer: Multiplan Commercial |
$242.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$221.85
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
|
|
CHANGE CYSTOSTOMY TUBE SIMPLE
|
Facility
|
IP
|
$179.92
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
4505170501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.16 |
| Max. Negotiated Rate |
$170.92 |
| Rate for Payer: Aetna of VT Commercial |
$170.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$133.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$133.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$151.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.94
|
| Rate for Payer: Cash Price |
$89.96
|
| Rate for Payer: Cigna Commercial |
$143.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.94
|
| Rate for Payer: Multiplan Commercial |
$167.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.93
|
| Rate for Payer: United Healthcare Commercial |
$170.92
|
|
|
CHANGE OF BLADDER TUBE
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
5105170501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$133.22 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of VT Commercial |
$171.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$133.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$133.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$151.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$144.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$167.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.00
|
| Rate for Payer: United Healthcare Commercial |
$171.00
|
|
|
CHANGE OF BLADDER TUBE
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
9605170501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$326.38 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna of VT Commercial |
$418.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$326.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$326.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$352.80
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$352.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$352.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$352.80
|
| Rate for Payer: Multiplan Commercial |
$410.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$374.85
|
| Rate for Payer: United Healthcare Commercial |
$418.95
|
|
|
CHANGE OF BLADDER TUBE
|
Professional
|
Both
|
$441.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
9605170501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$414.54 |
| Rate for Payer: Aetna of VT Commercial |
$414.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$395.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$395.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$68.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$170.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$56.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$170.36
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$84.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$150.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$150.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$92.48
|
| Rate for Payer: Multiplan Commercial |
$410.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$48.79
|
| Rate for Payer: United Healthcare Commercial |
$75.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.79
|
| Rate for Payer: United Healthcare VA CCN |
$48.79
|
|
|
CHANGE OF BLADDER TUBE
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
9605170502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna of VT Commercial |
$245.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$233.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$233.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$68.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$170.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$56.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$170.36
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$84.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$150.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$150.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$92.48
|
| Rate for Payer: Multiplan Commercial |
$242.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$48.79
|
| Rate for Payer: United Healthcare Commercial |
$75.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.79
|
| Rate for Payer: United Healthcare VA CCN |
$48.79
|
|
|
CHANGE OF BLADDER TUBE
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
9605170501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$195.32 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna of VT Commercial |
$418.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$395.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$195.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$395.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$265.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$357.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$198.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$350.60
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$352.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$352.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$352.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$198.45
|
| Rate for Payer: Multiplan Commercial |
$410.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$374.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$198.45
|
| Rate for Payer: United Healthcare Commercial |
$418.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.45
|
| Rate for Payer: United Healthcare VA CCN |
$198.45
|
|
