|
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
|
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
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
5105170501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$170.36 |
| Rate for Payer: Aetna of VT Commercial |
$169.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$161.26
|
| 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 |
$161.26
|
| 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 |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| 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 |
$167.40
|
| 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
|
$180.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
5105170501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.72 |
| 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 |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$108.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.10
|
| 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: Martins Point Health Care Commercial |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$167.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$81.00
|
| Rate for Payer: United Healthcare Commercial |
$171.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.00
|
| Rate for Payer: United Healthcare VA CCN |
$81.00
|
|
|
CHARCOAL IN WATER SUSP
|
Facility
|
OP
|
$66.35
|
|
|
Service Code
|
NDC 574052174
|
| Hospital Charge Code |
2500000586
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.39 |
| Max. Negotiated Rate |
$63.03 |
| Rate for Payer: Aetna of VT Commercial |
$63.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$29.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$39.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$56.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$53.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.75
|
| Rate for Payer: Cash Price |
$33.17
|
| Rate for Payer: Cigna Commercial |
$53.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$53.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$53.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.86
|
| Rate for Payer: Multiplan Commercial |
$61.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$29.86
|
| Rate for Payer: United Healthcare Commercial |
$63.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.86
|
| Rate for Payer: United Healthcare VA CCN |
$29.86
|
|
|
CHARCOAL IN WATER SUSP
|
Facility
|
OP
|
$66.35
|
|
| Hospital Charge Code |
2500000586
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.39 |
| Max. Negotiated Rate |
$63.03 |
| Rate for Payer: Aetna of VT Commercial |
$63.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$29.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$39.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$56.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$53.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.75
|
| Rate for Payer: Cash Price |
$33.17
|
| Rate for Payer: Cigna Commercial |
$53.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$53.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$53.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.86
|
| Rate for Payer: Multiplan Commercial |
$61.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$29.86
|
| Rate for Payer: United Healthcare Commercial |
$63.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.86
|
| Rate for Payer: United Healthcare VA CCN |
$29.86
|
|
|
CHARCOAL IN WATER SUSP
|
Facility
|
IP
|
$66.35
|
|
| Hospital Charge Code |
2500000586
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.11 |
| Max. Negotiated Rate |
$63.03 |
| Rate for Payer: Aetna of VT Commercial |
$63.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$49.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$49.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$56.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$55.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$53.08
|
| Rate for Payer: Cash Price |
$33.17
|
| Rate for Payer: Cigna Commercial |
$53.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$53.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$53.08
|
| Rate for Payer: Multiplan Commercial |
$61.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.40
|
| Rate for Payer: United Healthcare Commercial |
$63.03
|
|
|
CHARCOAL IN WATER SUSP
|
Facility
|
IP
|
$66.35
|
|
|
Service Code
|
NDC 574052174
|
| Hospital Charge Code |
2500000586
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.11 |
| Max. Negotiated Rate |
$63.03 |
| Rate for Payer: Aetna of VT Commercial |
$63.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$49.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$49.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$56.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$55.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$53.08
|
| Rate for Payer: Cash Price |
$33.17
|
| Rate for Payer: Cigna Commercial |
$53.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$53.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$53.08
|
| Rate for Payer: Multiplan Commercial |
$61.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.40
|
| Rate for Payer: United Healthcare Commercial |
$63.03
|
|
|
CHEM CAUT OF GANLTJ TISSUE
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
5101725001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.11 |
| Max. Negotiated Rate |
$109.25 |
| Rate for Payer: Aetna of VT Commercial |
$109.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$85.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$85.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$96.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$92.00
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$106.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$97.75
|
| Rate for Payer: United Healthcare Commercial |
$109.25
|
|
|
CHEM CAUT OF GANLTJ TISSUE
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
9601725002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$76.62 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Aetna of VT Commercial |
$164.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$154.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$154.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$104.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$147.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$140.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$137.53
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$138.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.85
|
| Rate for Payer: Multiplan Commercial |
$160.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$147.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$77.85
|
| Rate for Payer: United Healthcare Commercial |
$164.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.85
|
| Rate for Payer: United Healthcare VA CCN |
$77.85
|
|
|
CHEM CAUT OF GANLTJ TISSUE
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
9601725002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Aetna of VT Commercial |
$164.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$128.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$128.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$147.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$138.40
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$138.40
|
| Rate for Payer: Multiplan Commercial |
$160.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$147.05
|
| Rate for Payer: United Healthcare Commercial |
$164.35
|
|
|
CHEM CAUT OF GANLTJ TISSUE
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
9601725001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$35.33 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna of VT Commercial |
$270.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$109.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$109.91
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$39.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$130.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$130.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.62
|
| Rate for Payer: Multiplan Commercial |
$267.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$50.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.33
|
| Rate for Payer: United Healthcare Commercial |
$54.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.33
|
| Rate for Payer: United Healthcare VA CCN |
$35.33
|
|
|
CHEM CAUT OF GANLTJ TISSUE
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
9601725001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$127.56 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna of VT Commercial |
$273.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$127.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$173.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$244.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$233.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$228.96
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$230.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$230.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$230.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$129.60
|
| Rate for Payer: Multiplan Commercial |
$267.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$244.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$129.60
|
| Rate for Payer: United Healthcare Commercial |
$273.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.60
|
| Rate for Payer: United Healthcare VA CCN |
$129.60
|
|
|
CHEM CAUT OF GANLTJ TISSUE
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
9821725001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$35.33 |
| Max. Negotiated Rate |
$162.62 |
| Rate for Payer: Aetna of VT Commercial |
$162.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$154.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$154.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$109.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$109.91
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$39.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$130.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$130.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.62
|
| Rate for Payer: Multiplan Commercial |
$160.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$50.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.33
|
| Rate for Payer: United Healthcare Commercial |
$54.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.33
|
| Rate for Payer: United Healthcare VA CCN |
$35.33
|
|
|
CHEM CAUT OF GANLTJ TISSUE
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
9601725002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$35.33 |
| Max. Negotiated Rate |
$162.62 |
| Rate for Payer: Aetna of VT Commercial |
$162.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$154.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$154.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$109.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$109.91
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$39.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$130.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$130.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.62
|
| Rate for Payer: Multiplan Commercial |
$160.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$50.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.33
|
| Rate for Payer: United Healthcare Commercial |
$54.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.33
|
| Rate for Payer: United Healthcare VA CCN |
$35.33
|
|
|
CHEM CAUT OF GANLTJ TISSUE
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
9821725001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Aetna of VT Commercial |
$164.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$128.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$128.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$147.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$138.40
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$138.40
|
| Rate for Payer: Multiplan Commercial |
$160.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$147.05
|
| Rate for Payer: United Healthcare Commercial |
$164.35
|
|
|
CHEM CAUT OF GANLTJ TISSUE
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
9601725001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$213.15 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna of VT Commercial |
$273.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$213.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$213.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$244.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$241.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$230.40
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$230.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$230.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$230.40
|
| Rate for Payer: Multiplan Commercial |
$267.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$244.80
|
| Rate for Payer: United Healthcare Commercial |
$273.60
|
|
|
CHEM CAUT OF GANLTJ TISSUE
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
5101725001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.93 |
| Max. Negotiated Rate |
$109.25 |
| Rate for Payer: Aetna of VT Commercial |
$109.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$69.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$93.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$91.42
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$106.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$97.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.75
|
| Rate for Payer: United Healthcare Commercial |
$109.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.75
|
| Rate for Payer: United Healthcare VA CCN |
$51.75
|
|
|
CHEM CAUT OF GANLTJ TISSUE
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
9821725001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$76.62 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Aetna of VT Commercial |
$164.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$154.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$154.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$104.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$147.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$140.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$137.53
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$138.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.85
|
| Rate for Payer: Multiplan Commercial |
$160.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$147.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$77.85
|
| Rate for Payer: United Healthcare Commercial |
$164.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.85
|
| Rate for Payer: United Healthcare VA CCN |
$77.85
|
|
|
CHEM CAUT OF GANLTJ TISSUE
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
5101725001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.33 |
| Max. Negotiated Rate |
$130.64 |
| Rate for Payer: Aetna of VT Commercial |
$108.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$109.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$109.91
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$39.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$130.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$130.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.62
|
| Rate for Payer: Multiplan Commercial |
$106.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$50.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.33
|
| Rate for Payer: United Healthcare Commercial |
$54.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.33
|
| Rate for Payer: United Healthcare VA CCN |
$35.33
|
|
|
CHEMILUMINESCENT ASSAY
|
Professional
|
Both
|
$185.09
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
3008239701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$173.98 |
| Rate for Payer: Aetna of VT Commercial |
$173.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.54
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cigna Commercial |
$17.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.92
|
| Rate for Payer: Multiplan Commercial |
$172.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.12
|
| Rate for Payer: United Healthcare Commercial |
$21.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.12
|
| Rate for Payer: United Healthcare VA CCN |
$14.12
|
|
|
CHEMILUMINESCENT ASSAY
|
Facility
|
IP
|
$185.09
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
3008239701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.99 |
| Max. Negotiated Rate |
$175.84 |
| Rate for Payer: Aetna of VT Commercial |
$175.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$136.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$136.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$157.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$155.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$148.07
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cigna Commercial |
$148.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.07
|
| Rate for Payer: Multiplan Commercial |
$172.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$157.33
|
| Rate for Payer: United Healthcare Commercial |
$175.84
|
|
|
CHEMILUMINESCENT ASSAY
|
Facility
|
OP
|
$185.09
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
3008239701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$175.84 |
| Rate for Payer: Aetna of VT Commercial |
$175.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$111.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$157.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$83.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$147.15
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cigna Commercial |
$148.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.29
|
| Rate for Payer: Multiplan Commercial |
$172.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$157.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.29
|
| Rate for Payer: United Healthcare Commercial |
$175.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.12
|
| Rate for Payer: United Healthcare VA CCN |
$83.29
|
|
|
CHEMO ADM SUBQ/IM ANTINEOPL
|
Facility
|
OP
|
$241.08
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
3319640201
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$106.77 |
| Max. Negotiated Rate |
$229.03 |
| Rate for Payer: Aetna of VT Commercial |
$229.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$215.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$106.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$215.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$145.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$204.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$195.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$108.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$191.66
|
| Rate for Payer: Cash Price |
$120.54
|
| Rate for Payer: Cigna Commercial |
$192.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$192.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$192.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$108.49
|
| Rate for Payer: Multiplan Commercial |
$224.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$204.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$108.49
|
| Rate for Payer: United Healthcare Commercial |
$229.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.49
|
| Rate for Payer: United Healthcare VA CCN |
$108.49
|
|
|
CHEMO ADM SUBQ/IM ANTINEOPL
|
Professional
|
Both
|
$241.08
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
3319640201
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$34.42 |
| Max. Negotiated Rate |
$226.62 |
| Rate for Payer: Aetna of VT Commercial |
$226.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$215.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$215.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$48.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$56.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$56.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.50
|
| Rate for Payer: Cash Price |
$120.54
|
| Rate for Payer: Cash Price |
$120.54
|
| Rate for Payer: Cigna Commercial |
$53.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$55.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$55.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.42
|
| Rate for Payer: Multiplan Commercial |
$224.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.43
|
| Rate for Payer: United Healthcare Commercial |
$52.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.43
|
| Rate for Payer: United Healthcare VA CCN |
$34.43
|
|
