|
DIHYDROTESTOSTERONE (DHT)
|
Facility
|
IP
|
$191.26
|
|
|
Service Code
|
CPT 82642
|
| Hospital Charge Code |
3008264201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.55 |
| Max. Negotiated Rate |
$181.70 |
| Rate for Payer: Aetna of VT Commercial |
$181.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$141.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$141.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$162.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$160.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$153.01
|
| Rate for Payer: Cash Price |
$95.63
|
| Rate for Payer: Cigna Commercial |
$153.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$153.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$153.01
|
| Rate for Payer: Multiplan Commercial |
$177.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$162.57
|
| Rate for Payer: United Healthcare Commercial |
$181.70
|
|
|
DILATE URETHRA STRICTURE
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
9825360001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$193.64 |
| Rate for Payer: Aetna of VT Commercial |
$193.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$184.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$60.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$184.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$82.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$181.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$181.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$68.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$181.57
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$102.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$137.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$137.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.58
|
| Rate for Payer: Multiplan Commercial |
$191.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.16
|
| Rate for Payer: United Healthcare Commercial |
$91.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.16
|
| Rate for Payer: United Healthcare VA CCN |
$59.16
|
|
|
DILATE URETHRA STRICTURE
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
9825360001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$152.46 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Aetna of VT Commercial |
$195.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$152.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$152.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$175.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$173.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$164.80
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$164.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$164.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$164.80
|
| Rate for Payer: Multiplan Commercial |
$191.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.10
|
| Rate for Payer: United Healthcare Commercial |
$195.70
|
|
|
DILATE URETHRA STRICTURE
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
9825360001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$91.24 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Aetna of VT Commercial |
$195.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$184.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$91.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$184.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$124.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$175.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$166.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$163.77
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$164.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$164.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$164.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$92.70
|
| Rate for Payer: Multiplan Commercial |
$191.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$92.70
|
| Rate for Payer: United Healthcare Commercial |
$195.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.70
|
| Rate for Payer: United Healthcare VA CCN |
$92.70
|
|
|
DILATION AND CURETTAGE
|
Facility
|
OP
|
$1,026.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
9605812001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$454.42 |
| Max. Negotiated Rate |
$974.70 |
| Rate for Payer: Aetna of VT Commercial |
$974.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$919.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$454.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$919.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$617.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$872.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$831.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$461.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$815.67
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$820.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$820.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$820.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$461.70
|
| Rate for Payer: Multiplan Commercial |
$954.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$872.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$461.70
|
| Rate for Payer: United Healthcare Commercial |
$974.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.70
|
| Rate for Payer: United Healthcare VA CCN |
$461.70
|
|
|
DILATION AND CURETTAGE
|
Professional
|
Both
|
$1,026.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
9605812001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$218.04 |
| Max. Negotiated Rate |
$964.44 |
| Rate for Payer: Aetna of VT Commercial |
$964.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$919.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$224.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$919.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$305.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$391.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$391.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$250.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.59
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$385.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$459.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$459.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$278.75
|
| Rate for Payer: Multiplan Commercial |
$954.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$309.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$218.04
|
| Rate for Payer: United Healthcare Commercial |
$335.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$218.04
|
| Rate for Payer: United Healthcare VA CCN |
$218.04
|
|
|
DILATION AND CURETTAGE
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
9605812002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$218.04 |
| Max. Negotiated Rate |
$772.68 |
| Rate for Payer: Aetna of VT Commercial |
$772.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$736.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$224.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$736.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$305.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$391.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$391.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$250.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.59
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$385.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$459.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$459.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$278.75
|
| Rate for Payer: Multiplan Commercial |
$764.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$309.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$218.04
|
| Rate for Payer: United Healthcare Commercial |
$335.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$218.04
|
| Rate for Payer: United Healthcare VA CCN |
$218.04
|
|
|
DILATION AND CURETTAGE
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
5105812001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$151.72 |
| Max. Negotiated Rate |
$194.75 |
| Rate for Payer: Aetna of VT Commercial |
$194.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$151.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$151.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$174.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$172.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$164.00
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cigna Commercial |
$164.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$164.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$164.00
|
| Rate for Payer: Multiplan Commercial |
$190.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$174.25
|
| Rate for Payer: United Healthcare Commercial |
$194.75
|
|
|
DILATION AND CURETTAGE
|
Facility
|
IP
|
$822.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
9605812002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$608.36 |
| Max. Negotiated Rate |
$780.90 |
| Rate for Payer: Aetna of VT Commercial |
$780.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$608.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$608.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$698.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$690.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$657.60
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$657.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$657.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$657.60
|
| Rate for Payer: Multiplan Commercial |
$764.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$698.70
|
| Rate for Payer: United Healthcare Commercial |
$780.90
|
|
|
DILATION AND CURETTAGE
|
Facility
|
OP
|
$822.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
9605812002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$364.06 |
| Max. Negotiated Rate |
$780.90 |
| Rate for Payer: Aetna of VT Commercial |
$780.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$736.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$364.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$736.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$494.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$698.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$665.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$369.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$653.49
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$657.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$657.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$657.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$369.90
|
| Rate for Payer: Multiplan Commercial |
$764.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$698.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$369.90
|
| Rate for Payer: United Healthcare Commercial |
$780.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$369.90
|
| Rate for Payer: United Healthcare VA CCN |
$369.90
|
|
|
DILATION AND CURETTAGE
|
Professional
|
Both
|
$1,026.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
9825812001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$218.04 |
| Max. Negotiated Rate |
$964.44 |
| Rate for Payer: Aetna of VT Commercial |
$964.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$919.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$224.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$919.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$305.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$391.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$391.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$250.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.59
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$385.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$459.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$459.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$278.75
|
| Rate for Payer: Multiplan Commercial |
$954.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$309.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$218.04
|
| Rate for Payer: United Healthcare Commercial |
$335.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$218.04
|
| Rate for Payer: United Healthcare VA CCN |
$218.04
|
|
|
DILATION AND CURETTAGE
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
5105812001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$183.66 |
| Max. Negotiated Rate |
$459.79 |
| Rate for Payer: Aetna of VT Commercial |
$192.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$183.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$224.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$183.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$305.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$391.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$391.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$250.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.59
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cigna Commercial |
$385.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$459.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$459.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$278.75
|
| Rate for Payer: Multiplan Commercial |
$190.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$309.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$218.04
|
| Rate for Payer: United Healthcare Commercial |
$335.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$218.04
|
| Rate for Payer: United Healthcare VA CCN |
$218.04
|
|
|
DILATION AND CURETTAGE
|
Facility
|
IP
|
$1,026.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
9605812001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$759.34 |
| Max. Negotiated Rate |
$974.70 |
| Rate for Payer: Aetna of VT Commercial |
$974.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$759.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$759.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$872.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$861.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$820.80
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$820.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$820.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$820.80
|
| Rate for Payer: Multiplan Commercial |
$954.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$872.10
|
| Rate for Payer: United Healthcare Commercial |
$974.70
|
|
|
DILATION AND CURETTAGE
|
Facility
|
OP
|
$1,026.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
9825812001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$454.42 |
| Max. Negotiated Rate |
$974.70 |
| Rate for Payer: Aetna of VT Commercial |
$974.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$919.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$454.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$919.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$617.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$872.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$831.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$461.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$815.67
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$820.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$820.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$820.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$461.70
|
| Rate for Payer: Multiplan Commercial |
$954.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$872.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$461.70
|
| Rate for Payer: United Healthcare Commercial |
$974.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.70
|
| Rate for Payer: United Healthcare VA CCN |
$461.70
|
|
|
DILATION AND CURETTAGE
|
Facility
|
IP
|
$1,026.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
9825812001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$759.34 |
| Max. Negotiated Rate |
$974.70 |
| Rate for Payer: Aetna of VT Commercial |
$974.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$759.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$759.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$872.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$861.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$820.80
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$820.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$820.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$820.80
|
| Rate for Payer: Multiplan Commercial |
$954.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$872.10
|
| Rate for Payer: United Healthcare Commercial |
$974.70
|
|
|
DILATION AND CURETTAGE
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
5105812001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.79 |
| Max. Negotiated Rate |
$194.75 |
| Rate for Payer: Aetna of VT Commercial |
$194.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$183.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$90.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$183.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$123.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$174.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$166.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$162.97
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cigna Commercial |
$164.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$164.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$164.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$92.25
|
| Rate for Payer: Multiplan Commercial |
$190.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$174.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$194.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.25
|
| Rate for Payer: United Healthcare VA CCN |
$92.25
|
|
|
DILATION OF URETHRA
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
9825366001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$145.06 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Aetna of VT Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$145.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$145.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$164.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$156.80
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cigna Commercial |
$156.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$156.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$156.80
|
| Rate for Payer: Multiplan Commercial |
$182.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$166.60
|
| Rate for Payer: United Healthcare Commercial |
$186.20
|
|
|
DILATION OF URETHRA
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
9825366001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$86.81 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Aetna of VT Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$175.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$86.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$175.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$117.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$158.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.82
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cigna Commercial |
$156.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$156.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$156.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$88.20
|
| Rate for Payer: Multiplan Commercial |
$182.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$166.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$88.20
|
| Rate for Payer: United Healthcare Commercial |
$186.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.20
|
| Rate for Payer: United Healthcare VA CCN |
$88.20
|
|
|
DILATION OF URETHRA
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
5105366101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.48 |
| Max. Negotiated Rate |
$148.35 |
| Rate for Payer: Aetna of VT Commercial |
$127.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$121.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$121.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$148.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$148.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$148.35
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$65.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.89
|
| Rate for Payer: Multiplan Commercial |
$126.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.48
|
| Rate for Payer: United Healthcare Commercial |
$57.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.48
|
| Rate for Payer: United Healthcare VA CCN |
$37.48
|
|
|
DILATION OF URETHRA
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
9605366101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$138.40 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Aetna of VT Commercial |
$177.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$138.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$138.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$158.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$157.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$149.60
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$149.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$149.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$149.60
|
| Rate for Payer: Multiplan Commercial |
$173.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.95
|
| Rate for Payer: United Healthcare Commercial |
$177.65
|
|
|
DILATION OF URETHRA
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
9605366102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$138.40 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Aetna of VT Commercial |
$177.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$138.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$138.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$158.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$157.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$149.60
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$149.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$149.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$149.60
|
| Rate for Payer: Multiplan Commercial |
$173.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.95
|
| Rate for Payer: United Healthcare Commercial |
$177.65
|
|
|
DILATION OF URETHRA
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
9605366102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$82.82 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Aetna of VT Commercial |
$177.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$167.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$82.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$167.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$112.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$158.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$151.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$148.66
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$149.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$149.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$149.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$84.15
|
| Rate for Payer: Multiplan Commercial |
$173.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$84.15
|
| Rate for Payer: United Healthcare Commercial |
$177.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.15
|
| Rate for Payer: United Healthcare VA CCN |
$84.15
|
|
|
DILATION OF URETHRA
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
5105366101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.81 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna of VT Commercial |
$119.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$75.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$102.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$56.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$100.17
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$100.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$100.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$100.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.70
|
| Rate for Payer: Multiplan Commercial |
$117.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.70
|
| Rate for Payer: United Healthcare Commercial |
$119.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.70
|
| Rate for Payer: United Healthcare VA CCN |
$56.70
|
|
|
DILATION OF URETHRA
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
9825366001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$38.76 |
| Max. Negotiated Rate |
$184.24 |
| Rate for Payer: Aetna of VT Commercial |
$184.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$175.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$175.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$151.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$151.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$151.67
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cigna Commercial |
$67.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$71.85
|
| Rate for Payer: Multiplan Commercial |
$182.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.76
|
| Rate for Payer: United Healthcare Commercial |
$59.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.76
|
| Rate for Payer: United Healthcare VA CCN |
$38.76
|
|
|
DILATION OF URETHRA
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
5105366101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.25 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna of VT Commercial |
$119.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$105.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$100.80
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$100.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$100.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$117.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.10
|
| Rate for Payer: United Healthcare Commercial |
$119.70
|
|
