|
COMPLEX DRAINAGE WOUND
|
Professional
|
Both
|
$707.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
9821018001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$167.26 |
| Max. Negotiated Rate |
$664.58 |
| Rate for Payer: Aetna of VT Commercial |
$664.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$633.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$172.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$633.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$234.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$328.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$328.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$192.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$328.11
|
| Rate for Payer: Cash Price |
$353.50
|
| Rate for Payer: Cash Price |
$353.50
|
| Rate for Payer: Cigna Commercial |
$305.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$406.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$406.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$246.60
|
| Rate for Payer: Multiplan Commercial |
$657.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$237.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$167.26
|
| Rate for Payer: United Healthcare Commercial |
$257.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$167.26
|
| Rate for Payer: United Healthcare VA CCN |
$167.26
|
|
|
COMPLEX DRAINAGE WOUND
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
9821018001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$313.13 |
| Max. Negotiated Rate |
$671.65 |
| Rate for Payer: Aetna of VT Commercial |
$671.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$633.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$313.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$633.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$425.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$600.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$572.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$318.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$562.07
|
| Rate for Payer: Cash Price |
$353.50
|
| Rate for Payer: Cigna Commercial |
$565.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$565.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$565.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$318.15
|
| Rate for Payer: Multiplan Commercial |
$657.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$318.15
|
| Rate for Payer: United Healthcare Commercial |
$671.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$318.15
|
| Rate for Payer: United Healthcare VA CCN |
$318.15
|
|
|
COMPREHEN METABOLIC PANEL
|
Facility
|
IP
|
$115.81
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
3008005301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.71 |
| Max. Negotiated Rate |
$110.02 |
| Rate for Payer: Aetna of VT Commercial |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$85.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$85.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$98.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$92.65
|
| Rate for Payer: Cash Price |
$57.91
|
| Rate for Payer: Cigna Commercial |
$92.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.65
|
| Rate for Payer: Multiplan Commercial |
$107.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$98.44
|
| Rate for Payer: United Healthcare Commercial |
$110.02
|
|
|
COMPREHEN METABOLIC PANEL
|
Facility
|
OP
|
$115.81
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
3008005301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$110.02 |
| Rate for Payer: Aetna of VT Commercial |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$52.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$51.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$52.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$69.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$98.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$93.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$52.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$92.07
|
| Rate for Payer: Cash Price |
$57.91
|
| Rate for Payer: Cash Price |
$57.91
|
| Rate for Payer: Cigna Commercial |
$92.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$52.11
|
| Rate for Payer: Multiplan Commercial |
$107.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$98.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.11
|
| Rate for Payer: United Healthcare Commercial |
$110.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.56
|
| Rate for Payer: United Healthcare VA CCN |
$52.11
|
|
|
CONIZATION OF CERVIX
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
9825752201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$400.82 |
| Max. Negotiated Rate |
$859.75 |
| Rate for Payer: Aetna of VT Commercial |
$859.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$810.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$400.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$810.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$544.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$769.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$733.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$407.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$719.48
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cigna Commercial |
$724.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$724.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$724.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$407.25
|
| Rate for Payer: Multiplan Commercial |
$841.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$769.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$407.25
|
| Rate for Payer: United Healthcare Commercial |
$859.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$407.25
|
| Rate for Payer: United Healthcare VA CCN |
$407.25
|
|
|
CONIZATION OF CERVIX
|
Facility
|
OP
|
$2,804.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
9605752201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,241.89 |
| Max. Negotiated Rate |
$2,663.80 |
| Rate for Payer: Aetna of VT Commercial |
$2,663.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,512.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,241.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,512.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,688.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,383.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,271.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,261.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,229.18
|
| Rate for Payer: Cash Price |
$1,402.00
|
| Rate for Payer: Cigna Commercial |
$2,243.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,243.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,243.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,261.80
|
| Rate for Payer: Multiplan Commercial |
$2,607.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,383.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,261.80
|
| Rate for Payer: United Healthcare Commercial |
$2,663.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,261.80
|
| Rate for Payer: United Healthcare VA CCN |
$1,261.80
|
|
|
CONIZATION OF CERVIX
|
Facility
|
IP
|
$1,899.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
5105752201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,405.45 |
| Max. Negotiated Rate |
$1,804.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,804.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,405.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,405.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,614.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,595.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,519.20
|
| Rate for Payer: Cash Price |
$949.50
|
| Rate for Payer: Cigna Commercial |
$1,519.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,519.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,519.20
|
| Rate for Payer: Multiplan Commercial |
$1,766.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,614.15
|
| Rate for Payer: United Healthcare Commercial |
$1,804.05
|
|
|
CONIZATION OF CERVIX
|
Professional
|
Both
|
$976.00
|
|
|
Service Code
|
CPT 57520
|
| Hospital Charge Code |
9825752001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$279.09 |
| Max. Negotiated Rate |
$917.44 |
| Rate for Payer: Aetna of VT Commercial |
$917.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$874.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$287.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$874.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$390.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$543.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$543.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$320.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$543.65
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cigna Commercial |
$492.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$546.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$546.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$331.44
|
| Rate for Payer: Multiplan Commercial |
$907.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$396.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$279.09
|
| Rate for Payer: United Healthcare Commercial |
$429.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$279.09
|
| Rate for Payer: United Healthcare VA CCN |
$279.09
|
|
|
CONIZATION OF CERVIX
|
Facility
|
IP
|
$2,804.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
9605752201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,075.24 |
| Max. Negotiated Rate |
$2,663.80 |
| Rate for Payer: Aetna of VT Commercial |
$2,663.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,075.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,075.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,383.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,355.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,243.20
|
| Rate for Payer: Cash Price |
$1,402.00
|
| Rate for Payer: Cigna Commercial |
$2,243.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,243.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,243.20
|
| Rate for Payer: Multiplan Commercial |
$2,607.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,383.40
|
| Rate for Payer: United Healthcare Commercial |
$2,663.80
|
|
|
CONIZATION OF CERVIX
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
9605752202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$400.82 |
| Max. Negotiated Rate |
$859.75 |
| Rate for Payer: Aetna of VT Commercial |
$859.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$810.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$400.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$810.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$544.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$769.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$733.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$407.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$719.48
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cigna Commercial |
$724.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$724.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$724.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$407.25
|
| Rate for Payer: Multiplan Commercial |
$841.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$769.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$407.25
|
| Rate for Payer: United Healthcare Commercial |
$859.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$407.25
|
| Rate for Payer: United Healthcare VA CCN |
$407.25
|
|
|
CONIZATION OF CERVIX
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
9605752202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$669.79 |
| Max. Negotiated Rate |
$859.75 |
| Rate for Payer: Aetna of VT Commercial |
$859.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$669.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$669.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$769.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$760.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$724.00
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cigna Commercial |
$724.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$724.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$724.00
|
| Rate for Payer: Multiplan Commercial |
$841.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$769.25
|
| Rate for Payer: United Healthcare Commercial |
$859.75
|
|
|
CONIZATION OF CERVIX
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
9825752201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$669.79 |
| Max. Negotiated Rate |
$859.75 |
| Rate for Payer: Aetna of VT Commercial |
$859.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$669.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$669.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$769.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$760.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$724.00
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cigna Commercial |
$724.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$724.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$724.00
|
| Rate for Payer: Multiplan Commercial |
$841.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$769.25
|
| Rate for Payer: United Healthcare Commercial |
$859.75
|
|
|
CONIZATION OF CERVIX
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
9825752201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$239.75 |
| Max. Negotiated Rate |
$850.70 |
| Rate for Payer: Aetna of VT Commercial |
$850.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$810.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$246.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$810.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$335.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$444.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$444.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$275.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$444.31
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cigna Commercial |
$423.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$468.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$468.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$283.75
|
| Rate for Payer: Multiplan Commercial |
$841.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$340.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$239.75
|
| Rate for Payer: United Healthcare Commercial |
$368.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$239.75
|
| Rate for Payer: United Healthcare VA CCN |
$239.75
|
|
|
CONIZATION OF CERVIX
|
Facility
|
OP
|
$976.00
|
|
|
Service Code
|
CPT 57520
|
| Hospital Charge Code |
9825752001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$432.27 |
| Max. Negotiated Rate |
$927.20 |
| Rate for Payer: Aetna of VT Commercial |
$927.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$874.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$432.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$874.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$587.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$829.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$790.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$439.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$775.92
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cigna Commercial |
$780.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$780.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$780.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$439.20
|
| Rate for Payer: Multiplan Commercial |
$907.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$829.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$439.20
|
| Rate for Payer: United Healthcare Commercial |
$927.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$439.20
|
| Rate for Payer: United Healthcare VA CCN |
$439.20
|
|
|
CONIZATION OF CERVIX
|
Facility
|
IP
|
$976.00
|
|
|
Service Code
|
CPT 57520
|
| Hospital Charge Code |
9825752001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$722.34 |
| Max. Negotiated Rate |
$927.20 |
| Rate for Payer: Aetna of VT Commercial |
$927.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$722.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$722.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$829.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$780.80
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cigna Commercial |
$780.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$780.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$780.80
|
| Rate for Payer: Multiplan Commercial |
$907.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$829.60
|
| Rate for Payer: United Healthcare Commercial |
$927.20
|
|
|
CONIZATION OF CERVIX
|
Facility
|
OP
|
$1,899.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
5105752201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$841.07 |
| Max. Negotiated Rate |
$1,804.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,804.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,701.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$841.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,701.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,143.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,614.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,538.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$854.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,509.70
|
| Rate for Payer: Cash Price |
$949.50
|
| Rate for Payer: Cigna Commercial |
$1,519.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,519.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,519.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$854.55
|
| Rate for Payer: Multiplan Commercial |
$1,766.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,614.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$854.55
|
| Rate for Payer: United Healthcare Commercial |
$1,804.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$854.55
|
| Rate for Payer: United Healthcare VA CCN |
$854.55
|
|
|
CONIZATION OF CERVIX
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
9605752202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$239.75 |
| Max. Negotiated Rate |
$850.70 |
| Rate for Payer: Aetna of VT Commercial |
$850.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$810.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$246.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$810.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$335.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$444.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$444.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$275.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$444.31
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cigna Commercial |
$423.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$468.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$468.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$283.75
|
| Rate for Payer: Multiplan Commercial |
$841.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$340.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$239.75
|
| Rate for Payer: United Healthcare Commercial |
$368.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$239.75
|
| Rate for Payer: United Healthcare VA CCN |
$239.75
|
|
|
CONIZATION OF CERVIX
|
Professional
|
Both
|
$2,804.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
9605752201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$239.75 |
| Max. Negotiated Rate |
$2,635.76 |
| Rate for Payer: Aetna of VT Commercial |
$2,635.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,512.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$246.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,512.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$335.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$444.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$444.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$275.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$444.31
|
| Rate for Payer: Cash Price |
$1,402.00
|
| Rate for Payer: Cash Price |
$1,402.00
|
| Rate for Payer: Cigna Commercial |
$423.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$468.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$468.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$283.75
|
| Rate for Payer: Multiplan Commercial |
$2,607.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$340.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$239.75
|
| Rate for Payer: United Healthcare Commercial |
$368.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$239.75
|
| Rate for Payer: United Healthcare VA CCN |
$239.75
|
|
|
CONIZATION OF CERVIX
|
Professional
|
Both
|
$1,899.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
5105752201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$239.75 |
| Max. Negotiated Rate |
$1,785.06 |
| Rate for Payer: Aetna of VT Commercial |
$1,785.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,701.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$246.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,701.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$335.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$444.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$444.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$275.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$444.31
|
| Rate for Payer: Cash Price |
$949.50
|
| Rate for Payer: Cash Price |
$949.50
|
| Rate for Payer: Cigna Commercial |
$423.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$468.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$468.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$283.75
|
| Rate for Payer: Multiplan Commercial |
$1,766.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$340.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$239.75
|
| Rate for Payer: United Healthcare Commercial |
$368.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$239.75
|
| Rate for Payer: United Healthcare VA CCN |
$239.75
|
|
|
CONT ISOVUE 370 100 VIAL
|
Facility
|
OP
|
$72.03
|
|
| Hospital Charge Code |
2780015691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$68.43 |
| Rate for Payer: Aetna of VT Commercial |
$68.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$61.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$32.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.26
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cigna Commercial |
$57.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$57.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$57.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$32.41
|
| Rate for Payer: Multiplan Commercial |
$66.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.41
|
| Rate for Payer: United Healthcare Commercial |
$68.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.41
|
| Rate for Payer: United Healthcare VA CCN |
$32.41
|
|
|
CONT ISOVUE 370 100 VIAL
|
Facility
|
IP
|
$72.03
|
|
| Hospital Charge Code |
2780015691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.31 |
| Max. Negotiated Rate |
$68.43 |
| Rate for Payer: Aetna of VT Commercial |
$68.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$53.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$53.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$61.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$60.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.62
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cigna Commercial |
$57.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$57.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$57.62
|
| Rate for Payer: Multiplan Commercial |
$66.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.23
|
| Rate for Payer: United Healthcare Commercial |
$68.43
|
|
|
CONT ISOVUE 370 100 VIAL
|
Facility
|
OP
|
$63.14
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
2550015691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$59.98 |
| Rate for Payer: Aetna of VT Commercial |
$59.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$38.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$53.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$51.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$28.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$50.20
|
| Rate for Payer: Cash Price |
$31.57
|
| Rate for Payer: Cash Price |
$31.57
|
| Rate for Payer: Cigna Commercial |
$50.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$50.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$50.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$28.41
|
| Rate for Payer: Multiplan Commercial |
$58.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$28.41
|
| Rate for Payer: United Healthcare Commercial |
$59.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.41
|
| Rate for Payer: United Healthcare VA CCN |
$28.41
|
|
|
CONT ISOVUE 370 100 VIAL
|
Facility
|
IP
|
$63.14
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
2550015691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.73 |
| Max. Negotiated Rate |
$59.98 |
| Rate for Payer: Aetna of VT Commercial |
$59.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$46.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$46.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$53.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$53.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$50.51
|
| Rate for Payer: Cash Price |
$31.57
|
| Rate for Payer: Cigna Commercial |
$50.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$50.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$50.51
|
| Rate for Payer: Multiplan Commercial |
$58.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.67
|
| Rate for Payer: United Healthcare Commercial |
$59.98
|
|
|
CONTRAST BATH THERAPY
|
Facility
|
IP
|
$143.73
|
|
|
Service Code
|
CPT 97034 GO
|
| Hospital Charge Code |
4309703401
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$106.37 |
| Max. Negotiated Rate |
$136.54 |
| Rate for Payer: Aetna of VT Commercial |
$136.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$120.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.98
|
| Rate for Payer: Cash Price |
$71.86
|
| Rate for Payer: Cigna Commercial |
$114.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$114.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$114.98
|
| Rate for Payer: Multiplan Commercial |
$133.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.17
|
| Rate for Payer: United Healthcare Commercial |
$136.54
|
|
|
CONTRAST BATH THERAPY
|
Facility
|
OP
|
$143.73
|
|
|
Service Code
|
CPT 97034 GO
|
| Hospital Charge Code |
4309703401
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$63.66 |
| Max. Negotiated Rate |
$136.54 |
| Rate for Payer: Aetna of VT Commercial |
$136.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$128.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$63.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$128.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$86.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$116.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.27
|
| Rate for Payer: Cash Price |
$71.86
|
| Rate for Payer: Cigna Commercial |
$114.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$114.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$114.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$64.68
|
| Rate for Payer: Multiplan Commercial |
$133.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.68
|
| Rate for Payer: United Healthcare Commercial |
$136.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.68
|
| Rate for Payer: United Healthcare VA CCN |
$64.68
|
|
