|
DESTRUCT B9 LESIONS UP TO 14
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
9601711001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$247.93 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Aetna of VT Commercial |
$318.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$247.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$247.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$284.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$281.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$268.00
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$268.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$268.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$268.00
|
| Rate for Payer: Multiplan Commercial |
$311.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$284.75
|
| Rate for Payer: United Healthcare Commercial |
$318.25
|
|
|
DESTRUCT B9 LESIONS UP TO 14
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
9601711002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$66.37 |
| Max. Negotiated Rate |
$230.30 |
| Rate for Payer: Aetna of VT Commercial |
$230.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$219.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$219.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$167.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$167.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$167.47
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$74.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$174.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$174.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$108.45
|
| Rate for Payer: Multiplan Commercial |
$227.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.37
|
| Rate for Payer: United Healthcare Commercial |
$102.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.37
|
| Rate for Payer: United Healthcare VA CCN |
$66.37
|
|
|
DESTRUCT B9 LESIONS UP TO 14
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
9601711001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$148.37 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Aetna of VT Commercial |
$318.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$300.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$148.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$300.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$201.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$284.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$271.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$150.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$266.32
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$268.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$268.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$268.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$150.75
|
| Rate for Payer: Multiplan Commercial |
$311.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$284.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$150.75
|
| Rate for Payer: United Healthcare Commercial |
$318.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.75
|
| Rate for Payer: United Healthcare VA CCN |
$150.75
|
|
|
DESTRUCT B9 LESIONS UP TO 14
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
5101711001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.37 |
| Max. Negotiated Rate |
$174.86 |
| Rate for Payer: Aetna of VT Commercial |
$85.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$167.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$167.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$167.47
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cigna Commercial |
$74.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$174.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$174.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$108.45
|
| Rate for Payer: Multiplan Commercial |
$84.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.37
|
| Rate for Payer: United Healthcare Commercial |
$102.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.37
|
| Rate for Payer: United Healthcare VA CCN |
$66.37
|
|
|
DESTRUCT B9 LESIONS UP TO 14
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
9601711002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$108.51 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna of VT Commercial |
$232.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$219.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$108.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$219.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$147.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$208.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$198.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$110.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$194.78
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$196.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$110.25
|
| Rate for Payer: Multiplan Commercial |
$227.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$208.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$110.25
|
| Rate for Payer: United Healthcare Commercial |
$232.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.25
|
| Rate for Payer: United Healthcare VA CCN |
$110.25
|
|
|
DESTRUCT B9 LESIONS UP TO 14
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
9601711001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$66.37 |
| Max. Negotiated Rate |
$314.90 |
| Rate for Payer: Aetna of VT Commercial |
$314.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$300.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$300.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$167.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$167.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$167.47
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$74.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$174.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$174.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$108.45
|
| Rate for Payer: Multiplan Commercial |
$311.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.37
|
| Rate for Payer: United Healthcare Commercial |
$102.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.37
|
| Rate for Payer: United Healthcare VA CCN |
$66.37
|
|
|
DESTRUCT B9 LESIONS UP TO 14
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
9601711002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$181.32 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna of VT Commercial |
$232.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$181.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$181.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$208.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.00
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$196.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.00
|
| Rate for Payer: Multiplan Commercial |
$227.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$208.25
|
| Rate for Payer: United Healthcare Commercial |
$232.75
|
|
|
DESTRUCT B9 LESIONS UP TO 14
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
5101711001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.35 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Aetna of VT Commercial |
$86.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$77.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$76.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$72.80
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cigna Commercial |
$72.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$72.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$72.80
|
| Rate for Payer: Multiplan Commercial |
$84.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$77.35
|
| Rate for Payer: United Healthcare Commercial |
$86.45
|
|
|
DESTRUCT B9 LESIONS UP TO 14
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
5101711001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Aetna of VT Commercial |
$86.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$40.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$77.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$72.34
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cigna Commercial |
$72.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$72.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$72.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$40.95
|
| Rate for Payer: Multiplan Commercial |
$84.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$77.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.95
|
| Rate for Payer: United Healthcare Commercial |
$86.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.95
|
| Rate for Payer: United Healthcare VA CCN |
$40.95
|
|
|
DESTRUCT BENIGN LESIONS 15/>
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
9601711102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$147.93 |
| Max. Negotiated Rate |
$317.30 |
| Rate for Payer: Aetna of VT Commercial |
$317.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$299.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$147.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$299.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$201.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$283.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$270.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$150.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$265.53
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$267.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$267.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$267.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$150.30
|
| Rate for Payer: Multiplan Commercial |
$310.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$283.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$150.30
|
| Rate for Payer: United Healthcare Commercial |
$317.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.30
|
| Rate for Payer: United Healthcare VA CCN |
$150.30
|
|
|
DESTRUCT BENIGN LESIONS 15/>
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
9601711101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$213.48 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Aetna of VT Commercial |
$457.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$431.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$213.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$431.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$290.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$409.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$390.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$216.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$383.19
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna Commercial |
$385.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$385.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$385.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$216.90
|
| Rate for Payer: Multiplan Commercial |
$448.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$409.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$216.90
|
| Rate for Payer: United Healthcare Commercial |
$457.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$216.90
|
| Rate for Payer: United Healthcare VA CCN |
$216.90
|
|
|
DESTRUCT BENIGN LESIONS 15/>
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
9601711102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$80.59 |
| Max. Negotiated Rate |
$313.96 |
| Rate for Payer: Aetna of VT Commercial |
$313.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$299.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$83.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$299.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$112.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$169.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.63
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$89.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$205.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$205.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$126.84
|
| Rate for Payer: Multiplan Commercial |
$310.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.59
|
| Rate for Payer: United Healthcare Commercial |
$123.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.59
|
| Rate for Payer: United Healthcare VA CCN |
$80.59
|
|
|
DESTRUCT BENIGN LESIONS 15/>
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
5101711101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$140.60 |
| Rate for Payer: Aetna of VT Commercial |
$140.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$132.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$65.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$132.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$89.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$125.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$119.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$66.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$117.66
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cigna Commercial |
$118.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$118.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$118.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$66.60
|
| Rate for Payer: Multiplan Commercial |
$137.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$125.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.60
|
| Rate for Payer: United Healthcare Commercial |
$140.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.60
|
| Rate for Payer: United Healthcare VA CCN |
$66.60
|
|
|
DESTRUCT BENIGN LESIONS 15/>
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
9601711101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$356.73 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Aetna of VT Commercial |
$457.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$356.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$356.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$409.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$404.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$385.60
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna Commercial |
$385.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$385.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$385.60
|
| Rate for Payer: Multiplan Commercial |
$448.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$409.70
|
| Rate for Payer: United Healthcare Commercial |
$457.90
|
|
|
DESTRUCT BENIGN LESIONS 15/>
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
5101711101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.53 |
| Max. Negotiated Rate |
$140.60 |
| Rate for Payer: Aetna of VT Commercial |
$140.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$109.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$109.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$125.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$118.40
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cigna Commercial |
$118.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$118.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$118.40
|
| Rate for Payer: Multiplan Commercial |
$137.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$125.80
|
| Rate for Payer: United Healthcare Commercial |
$140.60
|
|
|
DESTRUCT BENIGN LESIONS 15/>
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
5101711101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.59 |
| Max. Negotiated Rate |
$205.21 |
| Rate for Payer: Aetna of VT Commercial |
$139.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$132.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$83.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$132.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$112.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$169.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.63
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cigna Commercial |
$89.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$205.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$205.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$126.84
|
| Rate for Payer: Multiplan Commercial |
$137.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.59
|
| Rate for Payer: United Healthcare Commercial |
$123.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.59
|
| Rate for Payer: United Healthcare VA CCN |
$80.59
|
|
|
DESTRUCT BENIGN LESIONS 15/>
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
9601711102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$247.19 |
| Max. Negotiated Rate |
$317.30 |
| Rate for Payer: Aetna of VT Commercial |
$317.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$247.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$247.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$283.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$280.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$267.20
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$267.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$267.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$267.20
|
| Rate for Payer: Multiplan Commercial |
$310.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$283.90
|
| Rate for Payer: United Healthcare Commercial |
$317.30
|
|
|
DESTRUCT BENIGN LESIONS 15/>
|
Professional
|
Both
|
$482.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
9601711101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$80.59 |
| Max. Negotiated Rate |
$453.08 |
| Rate for Payer: Aetna of VT Commercial |
$453.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$431.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$83.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$431.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$112.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$169.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.63
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna Commercial |
$89.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$205.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$205.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$126.84
|
| Rate for Payer: Multiplan Commercial |
$448.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.59
|
| Rate for Payer: United Healthcare Commercial |
$123.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.59
|
| Rate for Payer: United Healthcare VA CCN |
$80.59
|
|
|
DESTRUCTION ANAL LESION(S)
|
Facility
|
IP
|
$2,342.60
|
|
|
Service Code
|
CPT 46910
|
| Hospital Charge Code |
9824691001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,733.76 |
| Max. Negotiated Rate |
$2,225.47 |
| Rate for Payer: Aetna of VT Commercial |
$2,225.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,733.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,733.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,991.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,967.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,874.08
|
| Rate for Payer: Cash Price |
$1,171.30
|
| Rate for Payer: Cigna Commercial |
$1,874.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,874.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,874.08
|
| Rate for Payer: Multiplan Commercial |
$2,178.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,991.21
|
| Rate for Payer: United Healthcare Commercial |
$2,225.47
|
|
|
DESTRUCTION ANAL LESION(S)
|
Facility
|
OP
|
$2,342.60
|
|
|
Service Code
|
CPT 46910
|
| Hospital Charge Code |
9824691001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,037.54 |
| Max. Negotiated Rate |
$2,225.47 |
| Rate for Payer: Aetna of VT Commercial |
$2,225.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,098.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,037.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,098.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,410.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,991.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,897.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,054.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,862.37
|
| Rate for Payer: Cash Price |
$1,171.30
|
| Rate for Payer: Cigna Commercial |
$1,874.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,874.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,874.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,054.17
|
| Rate for Payer: Multiplan Commercial |
$2,178.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,991.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,054.17
|
| Rate for Payer: United Healthcare Commercial |
$2,225.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,054.17
|
| Rate for Payer: United Healthcare VA CCN |
$1,054.17
|
|
|
DESTRUCTION ANAL LESION(S)
|
Professional
|
Both
|
$2,342.60
|
|
|
Service Code
|
CPT 46910
|
| Hospital Charge Code |
9824691001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$127.35 |
| Max. Negotiated Rate |
$2,202.04 |
| Rate for Payer: Aetna of VT Commercial |
$2,202.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,098.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$131.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,098.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$178.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$340.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$340.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$146.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$340.95
|
| Rate for Payer: Cash Price |
$1,171.30
|
| Rate for Payer: Cash Price |
$1,171.30
|
| Rate for Payer: Cigna Commercial |
$233.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$409.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$409.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$251.65
|
| Rate for Payer: Multiplan Commercial |
$2,178.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$127.35
|
| Rate for Payer: United Healthcare Commercial |
$195.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.35
|
| Rate for Payer: United Healthcare VA CCN |
$127.35
|
|
|
DESTRUCTION PENIS LESION(S)
|
Professional
|
Both
|
$489.00
|
|
|
Service Code
|
CPT 54050
|
| Hospital Charge Code |
5105405001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.87 |
| Max. Negotiated Rate |
$459.66 |
| Rate for Payer: Aetna of VT Commercial |
$459.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$438.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$105.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$438.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$144.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$196.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.38
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cigna Commercial |
$178.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$225.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$225.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$138.84
|
| Rate for Payer: Multiplan Commercial |
$454.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$102.87
|
| Rate for Payer: United Healthcare Commercial |
$158.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.87
|
| Rate for Payer: United Healthcare VA CCN |
$102.87
|
|
|
DESTRUCTION PENIS LESION(S)
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
CPT 54050
|
| Hospital Charge Code |
9605405001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$303.83 |
| Max. Negotiated Rate |
$651.70 |
| Rate for Payer: Aetna of VT Commercial |
$651.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$614.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$303.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$614.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$412.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$583.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$555.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$308.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$545.37
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cigna Commercial |
$548.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$548.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$548.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$308.70
|
| Rate for Payer: Multiplan Commercial |
$637.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$583.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$308.70
|
| Rate for Payer: United Healthcare Commercial |
$651.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$308.70
|
| Rate for Payer: United Healthcare VA CCN |
$308.70
|
|
|
DESTRUCTION PENIS LESION(S)
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 54050
|
| Hospital Charge Code |
9605405002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$145.80 |
| Max. Negotiated Rate |
$187.15 |
| Rate for Payer: Aetna of VT Commercial |
$187.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$167.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$165.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$157.60
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cigna Commercial |
$157.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$157.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$157.60
|
| Rate for Payer: Multiplan Commercial |
$183.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$167.45
|
| Rate for Payer: United Healthcare Commercial |
$187.15
|
|
|
DESTRUCTION PENIS LESION(S)
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
CPT 54050
|
| Hospital Charge Code |
9605405002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$102.87 |
| Max. Negotiated Rate |
$225.78 |
| Rate for Payer: Aetna of VT Commercial |
$185.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$176.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$105.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$176.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$144.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$196.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.38
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cigna Commercial |
$178.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$225.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$225.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$138.84
|
| Rate for Payer: Multiplan Commercial |
$183.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$102.87
|
| Rate for Payer: United Healthcare Commercial |
$158.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.87
|
| Rate for Payer: United Healthcare VA CCN |
$102.87
|
|
