|
CONZ OF CERVIX W/SCOPE LEEP
|
Facility
|
OP
|
$4,924.00
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
5105746101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,180.84 |
| Max. Negotiated Rate |
$4,677.80 |
| Rate for Payer: Aetna of VT Commercial |
$4,677.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,411.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,180.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,411.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,964.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,185.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,988.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,215.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,914.58
|
| Rate for Payer: Cash Price |
$2,462.00
|
| Rate for Payer: Cigna Commercial |
$3,939.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,939.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,939.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,215.80
|
| Rate for Payer: Multiplan Commercial |
$4,579.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,185.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,215.80
|
| Rate for Payer: United Healthcare Commercial |
$4,677.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,215.80
|
| Rate for Payer: United Healthcare VA CCN |
$2,215.80
|
|
|
CONZ OF CERVIX W/SCOPE LEEP
|
Facility
|
IP
|
$5,825.00
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
9605746101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4,311.08 |
| Max. Negotiated Rate |
$5,533.75 |
| Rate for Payer: Aetna of VT Commercial |
$5,533.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,311.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,311.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,951.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,893.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,660.00
|
| Rate for Payer: Cash Price |
$2,912.50
|
| Rate for Payer: Cigna Commercial |
$4,660.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,660.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,660.00
|
| Rate for Payer: Multiplan Commercial |
$5,417.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,951.25
|
| Rate for Payer: United Healthcare Commercial |
$5,533.75
|
|
|
CONZ OF CERVIX W/SCOPE LEEP
|
Facility
|
IP
|
$902.00
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
9605746102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$667.57 |
| Max. Negotiated Rate |
$856.90 |
| Rate for Payer: Aetna of VT Commercial |
$856.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$667.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$667.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$766.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$757.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$721.60
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cigna Commercial |
$721.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$721.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$721.60
|
| Rate for Payer: Multiplan Commercial |
$838.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$766.70
|
| Rate for Payer: United Healthcare Commercial |
$856.90
|
|
|
CONZ OF CERVIX W/SCOPE LEEP
|
Facility
|
OP
|
$5,825.00
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
9605746101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,579.89 |
| Max. Negotiated Rate |
$5,533.75 |
| Rate for Payer: Aetna of VT Commercial |
$5,533.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,218.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,579.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,218.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,506.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,951.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,718.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,621.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,630.88
|
| Rate for Payer: Cash Price |
$2,912.50
|
| Rate for Payer: Cigna Commercial |
$4,660.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,660.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,660.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,621.25
|
| Rate for Payer: Multiplan Commercial |
$5,417.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,951.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,621.25
|
| Rate for Payer: United Healthcare Commercial |
$5,533.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,621.25
|
| Rate for Payer: United Healthcare VA CCN |
$2,621.25
|
|
|
CONZ OF CERVIX W/SCOPE LEEP
|
Professional
|
Both
|
$5,825.00
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
9605746101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$168.53 |
| Max. Negotiated Rate |
$5,475.50 |
| Rate for Payer: Aetna of VT Commercial |
$5,475.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,218.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$173.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,218.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$235.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$643.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$643.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$193.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$643.06
|
| Rate for Payer: Cash Price |
$2,912.50
|
| Rate for Payer: Cash Price |
$2,912.50
|
| Rate for Payer: Cigna Commercial |
$296.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$531.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$531.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$323.98
|
| Rate for Payer: Multiplan Commercial |
$5,417.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$239.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$168.53
|
| Rate for Payer: United Healthcare Commercial |
$259.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.53
|
| Rate for Payer: United Healthcare VA CCN |
$168.53
|
|
|
CONZ OF CERVIX W/SCOPE LEEP
|
Facility
|
OP
|
$902.00
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
9605746102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$399.50 |
| Max. Negotiated Rate |
$856.90 |
| Rate for Payer: Aetna of VT Commercial |
$856.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$808.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$399.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$808.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$543.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$766.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$730.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$405.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$717.09
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cigna Commercial |
$721.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$721.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$721.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$405.90
|
| Rate for Payer: Multiplan Commercial |
$838.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$766.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$405.90
|
| Rate for Payer: United Healthcare Commercial |
$856.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$405.90
|
| Rate for Payer: United Healthcare VA CCN |
$405.90
|
|
|
CONZ OF CERVIX W/SCOPE LEEP
|
Professional
|
Both
|
$4,924.00
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
5105746101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$168.53 |
| Max. Negotiated Rate |
$4,628.56 |
| Rate for Payer: Aetna of VT Commercial |
$4,628.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,411.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$173.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,411.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$235.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$643.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$643.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$193.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$643.06
|
| Rate for Payer: Cash Price |
$2,462.00
|
| Rate for Payer: Cash Price |
$2,462.00
|
| Rate for Payer: Cigna Commercial |
$296.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$531.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$531.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$323.98
|
| Rate for Payer: Multiplan Commercial |
$4,579.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$239.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$168.53
|
| Rate for Payer: United Healthcare Commercial |
$259.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.53
|
| Rate for Payer: United Healthcare VA CCN |
$168.53
|
|
|
CONZ OF CERVIX W/SCOPE LEEP
|
Facility
|
OP
|
$902.00
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
9825746101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$399.50 |
| Max. Negotiated Rate |
$856.90 |
| Rate for Payer: Aetna of VT Commercial |
$856.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$808.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$399.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$808.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$543.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$766.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$730.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$405.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$717.09
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cigna Commercial |
$721.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$721.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$721.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$405.90
|
| Rate for Payer: Multiplan Commercial |
$838.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$766.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$405.90
|
| Rate for Payer: United Healthcare Commercial |
$856.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$405.90
|
| Rate for Payer: United Healthcare VA CCN |
$405.90
|
|
|
CONZ OF CERVIX W/SCOPE LEEP
|
Facility
|
IP
|
$902.00
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
9825746101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$667.57 |
| Max. Negotiated Rate |
$856.90 |
| Rate for Payer: Aetna of VT Commercial |
$856.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$667.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$667.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$766.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$757.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$721.60
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cigna Commercial |
$721.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$721.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$721.60
|
| Rate for Payer: Multiplan Commercial |
$838.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$766.70
|
| Rate for Payer: United Healthcare Commercial |
$856.90
|
|
|
CONZ OF CERVIX W/SCOPE LEEP
|
Professional
|
Both
|
$902.00
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
9825746101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$168.53 |
| Max. Negotiated Rate |
$847.88 |
| Rate for Payer: Aetna of VT Commercial |
$847.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$808.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$173.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$808.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$235.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$643.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$643.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$193.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$643.06
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cigna Commercial |
$296.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$531.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$531.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$323.98
|
| Rate for Payer: Multiplan Commercial |
$838.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$239.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$168.53
|
| Rate for Payer: United Healthcare Commercial |
$259.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.53
|
| Rate for Payer: United Healthcare VA CCN |
$168.53
|
|
|
CONZ OF CERVIX W/SCOPE LEEP
|
Professional
|
Both
|
$902.00
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
9605746102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$168.53 |
| Max. Negotiated Rate |
$847.88 |
| Rate for Payer: Aetna of VT Commercial |
$847.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$808.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$173.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$808.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$235.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$643.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$643.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$193.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$643.06
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cigna Commercial |
$296.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$531.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$531.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$323.98
|
| Rate for Payer: Multiplan Commercial |
$838.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$239.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$168.53
|
| Rate for Payer: United Healthcare Commercial |
$259.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.53
|
| Rate for Payer: United Healthcare VA CCN |
$168.53
|
|
|
CONZ OF CERVIX W/SCOPE LEEP
|
Facility
|
IP
|
$4,924.00
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
5105746101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,644.25 |
| Max. Negotiated Rate |
$4,677.80 |
| Rate for Payer: Aetna of VT Commercial |
$4,677.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,644.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,644.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,185.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,136.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,939.20
|
| Rate for Payer: Cash Price |
$2,462.00
|
| Rate for Payer: Cigna Commercial |
$3,939.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,939.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,939.20
|
| Rate for Payer: Multiplan Commercial |
$4,579.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,185.40
|
| Rate for Payer: United Healthcare Commercial |
$4,677.80
|
|
|
COOMBS TEST DIRECT
|
Professional
|
Both
|
$109.60
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
3008688001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$103.02 |
| Rate for Payer: Aetna of VT Commercial |
$103.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$26.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$26.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$7.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9.22
|
| Rate for Payer: Cash Price |
$54.80
|
| Rate for Payer: Cash Price |
$54.80
|
| Rate for Payer: Cigna Commercial |
$6.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.31
|
| Rate for Payer: Multiplan Commercial |
$101.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare Commercial |
$8.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare VA CCN |
$5.39
|
|
|
COOMBS TEST DIRECT
|
Facility
|
OP
|
$109.60
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
3008688001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$104.12 |
| Rate for Payer: Aetna of VT Commercial |
$104.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$26.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$26.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$65.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$93.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$88.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.13
|
| Rate for Payer: Cash Price |
$54.80
|
| Rate for Payer: Cash Price |
$54.80
|
| Rate for Payer: Cigna Commercial |
$87.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$87.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$87.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.32
|
| Rate for Payer: Multiplan Commercial |
$101.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.32
|
| Rate for Payer: United Healthcare Commercial |
$104.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare VA CCN |
$49.32
|
|
|
COOMBS TEST DIRECT
|
Facility
|
IP
|
$109.60
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
3008688001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.11 |
| Max. Negotiated Rate |
$104.12 |
| Rate for Payer: Aetna of VT Commercial |
$104.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$93.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.68
|
| Rate for Payer: Cash Price |
$54.80
|
| Rate for Payer: Cigna Commercial |
$87.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$87.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$87.68
|
| Rate for Payer: Multiplan Commercial |
$101.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.16
|
| Rate for Payer: United Healthcare Commercial |
$104.12
|
|
|
COOMBS TEST INDIRECT QUAL
|
Facility
|
IP
|
$106.01
|
|
|
Service Code
|
CPT 86885
|
| Hospital Charge Code |
3008688501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.46 |
| Max. Negotiated Rate |
$100.71 |
| Rate for Payer: Aetna of VT Commercial |
$100.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$78.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$78.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$90.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.81
|
| Rate for Payer: Cash Price |
$53.01
|
| Rate for Payer: Cigna Commercial |
$84.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.81
|
| Rate for Payer: Multiplan Commercial |
$98.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$90.11
|
| Rate for Payer: United Healthcare Commercial |
$100.71
|
|
|
COOMBS TEST INDIRECT QUAL
|
Facility
|
OP
|
$106.01
|
|
|
Service Code
|
CPT 86885
|
| Hospital Charge Code |
3008688501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$100.71 |
| Rate for Payer: Aetna of VT Commercial |
$100.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$28.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$46.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$28.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$63.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$90.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$47.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.28
|
| Rate for Payer: Cash Price |
$53.01
|
| Rate for Payer: Cash Price |
$53.01
|
| Rate for Payer: Cigna Commercial |
$84.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.70
|
| Rate for Payer: Multiplan Commercial |
$98.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$90.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.70
|
| Rate for Payer: United Healthcare Commercial |
$100.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.72
|
| Rate for Payer: United Healthcare VA CCN |
$47.70
|
|
|
COOMBS TEST INDIRECT QUAL
|
Professional
|
Both
|
$106.01
|
|
|
Service Code
|
CPT 86885
|
| Hospital Charge Code |
3008688501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$99.65 |
| Rate for Payer: Aetna of VT Commercial |
$99.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$28.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$28.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$8.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9.77
|
| Rate for Payer: Cash Price |
$53.01
|
| Rate for Payer: Cash Price |
$53.01
|
| Rate for Payer: Cigna Commercial |
$6.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.64
|
| Rate for Payer: Multiplan Commercial |
$98.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.72
|
| Rate for Payer: United Healthcare Commercial |
$8.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.72
|
| Rate for Payer: United Healthcare VA CCN |
$5.72
|
|
|
COOMBS TEST INDIRECT TITER
|
Facility
|
OP
|
$107.82
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
3008688601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$102.43 |
| Rate for Payer: Aetna of VT Commercial |
$102.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$47.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$64.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$91.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$48.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$85.72
|
| Rate for Payer: Cash Price |
$53.91
|
| Rate for Payer: Cash Price |
$53.91
|
| Rate for Payer: Cigna Commercial |
$86.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$86.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$86.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$48.52
|
| Rate for Payer: Multiplan Commercial |
$100.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$48.52
|
| Rate for Payer: United Healthcare Commercial |
$102.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare VA CCN |
$48.52
|
|
|
COOMBS TEST INDIRECT TITER
|
Professional
|
Both
|
$107.82
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
3008688601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$101.35 |
| Rate for Payer: Aetna of VT Commercial |
$101.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$7.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$5.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.86
|
| Rate for Payer: Cash Price |
$53.91
|
| Rate for Payer: Cash Price |
$53.91
|
| Rate for Payer: Cigna Commercial |
$6.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.11
|
| Rate for Payer: Multiplan Commercial |
$100.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare Commercial |
$7.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare VA CCN |
$5.18
|
|
|
COOMBS TEST INDIRECT TITER
|
Facility
|
IP
|
$107.82
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
3008688601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$102.43 |
| Rate for Payer: Aetna of VT Commercial |
$102.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$79.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$79.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$91.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$86.26
|
| Rate for Payer: Cash Price |
$53.91
|
| Rate for Payer: Cigna Commercial |
$86.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$86.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$86.26
|
| Rate for Payer: Multiplan Commercial |
$100.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.65
|
| Rate for Payer: United Healthcare Commercial |
$102.43
|
|
|
CORRECTION HALLUX VALGUS
|
Facility
|
OP
|
$2,098.00
|
|
|
Service Code
|
CPT 28297
|
| Hospital Charge Code |
9822829701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$929.20 |
| Max. Negotiated Rate |
$1,993.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,993.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,879.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$929.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,879.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,263.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,783.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,699.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$944.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,667.91
|
| Rate for Payer: Cash Price |
$1,049.00
|
| Rate for Payer: Cigna Commercial |
$1,678.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,678.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,678.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$944.10
|
| Rate for Payer: Multiplan Commercial |
$1,951.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,783.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$944.10
|
| Rate for Payer: United Healthcare Commercial |
$1,993.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$944.10
|
| Rate for Payer: United Healthcare VA CCN |
$944.10
|
|
|
CORRECTION HALLUX VALGUS
|
Facility
|
IP
|
$1,758.00
|
|
|
Service Code
|
CPT 28296
|
| Hospital Charge Code |
9822829601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,301.10 |
| Max. Negotiated Rate |
$1,670.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,670.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,301.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,301.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,494.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,476.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,406.40
|
| Rate for Payer: Cash Price |
$879.00
|
| Rate for Payer: Cigna Commercial |
$1,406.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,406.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,406.40
|
| Rate for Payer: Multiplan Commercial |
$1,634.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,494.30
|
| Rate for Payer: United Healthcare Commercial |
$1,670.10
|
|
|
CORRECTION HALLUX VALGUS
|
Facility
|
OP
|
$2,189.00
|
|
|
Service Code
|
CPT 28299
|
| Hospital Charge Code |
9822829901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$969.51 |
| Max. Negotiated Rate |
$2,079.55 |
| Rate for Payer: Aetna of VT Commercial |
$2,079.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,961.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$969.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,961.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,317.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,860.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,773.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$985.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,740.26
|
| Rate for Payer: Cash Price |
$1,094.50
|
| Rate for Payer: Cigna Commercial |
$1,751.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,751.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,751.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$985.05
|
| Rate for Payer: Multiplan Commercial |
$2,035.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,860.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$985.05
|
| Rate for Payer: United Healthcare Commercial |
$2,079.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$985.05
|
| Rate for Payer: United Healthcare VA CCN |
$985.05
|
|
|
CORRECTION HALLUX VALGUS
|
Facility
|
IP
|
$2,189.00
|
|
|
Service Code
|
CPT 28299
|
| Hospital Charge Code |
9822829901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,620.08 |
| Max. Negotiated Rate |
$2,079.55 |
| Rate for Payer: Aetna of VT Commercial |
$2,079.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,620.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,620.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,860.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,838.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,751.20
|
| Rate for Payer: Cash Price |
$1,094.50
|
| Rate for Payer: Cigna Commercial |
$1,751.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,751.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,751.20
|
| Rate for Payer: Multiplan Commercial |
$2,035.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,860.65
|
| Rate for Payer: United Healthcare Commercial |
$2,079.55
|
|
