|
DRAINAGE OF GUM LESION
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
9814180002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$151.40 |
| Max. Negotiated Rate |
$464.42 |
| Rate for Payer: Aetna of VT Commercial |
$411.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$155.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$211.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$369.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$369.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$174.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$369.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$234.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$464.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$464.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$286.95
|
| Rate for Payer: Multiplan Commercial |
$407.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$214.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$151.40
|
| Rate for Payer: United Healthcare Commercial |
$232.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.40
|
| Rate for Payer: United Healthcare VA CCN |
$151.40
|
|
|
DRAINAGE OF GUM LESION
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
9824180001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$193.99 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Aetna of VT Commercial |
$416.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$193.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$263.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$372.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$354.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$197.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$348.21
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$350.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$197.10
|
| Rate for Payer: Multiplan Commercial |
$407.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$372.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$197.10
|
| Rate for Payer: United Healthcare Commercial |
$416.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.10
|
| Rate for Payer: United Healthcare VA CCN |
$197.10
|
|
|
DRAINAGE OF GUM LESION
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
9814180002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$193.99 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Aetna of VT Commercial |
$416.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$193.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$263.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$372.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$354.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$197.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$348.21
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$350.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$197.10
|
| Rate for Payer: Multiplan Commercial |
$407.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$372.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$197.10
|
| Rate for Payer: United Healthcare Commercial |
$416.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.10
|
| Rate for Payer: United Healthcare VA CCN |
$197.10
|
|
|
DRAINAGE OF GUM LESION
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
9824180001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$324.16 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Aetna of VT Commercial |
$416.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$324.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$324.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$372.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$367.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$350.40
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$350.40
|
| Rate for Payer: Multiplan Commercial |
$407.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$372.30
|
| Rate for Payer: United Healthcare Commercial |
$416.10
|
|
|
DRAINAGE OF GUM LESION
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
9814180001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$151.40 |
| Max. Negotiated Rate |
$464.42 |
| Rate for Payer: Aetna of VT Commercial |
$411.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$155.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$211.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$369.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$369.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$174.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$369.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$234.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$464.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$464.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$286.95
|
| Rate for Payer: Multiplan Commercial |
$407.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$214.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$151.40
|
| Rate for Payer: United Healthcare Commercial |
$232.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.40
|
| Rate for Payer: United Healthcare VA CCN |
$151.40
|
|
|
DRAINAGE OF GUM LESION
|
Facility
|
IP
|
$523.46
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
4504180001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$387.41 |
| Max. Negotiated Rate |
$497.29 |
| Rate for Payer: Aetna of VT Commercial |
$497.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$387.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$387.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$444.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$439.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$418.77
|
| Rate for Payer: Cash Price |
$261.73
|
| Rate for Payer: Cigna Commercial |
$418.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$418.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$418.77
|
| Rate for Payer: Multiplan Commercial |
$486.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$444.94
|
| Rate for Payer: United Healthcare Commercial |
$497.29
|
|
|
DRAINAGE OF GUM LESION
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
9824180001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$151.40 |
| Max. Negotiated Rate |
$464.42 |
| Rate for Payer: Aetna of VT Commercial |
$411.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$155.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$211.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$369.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$369.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$174.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$369.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$234.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$464.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$464.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$286.95
|
| Rate for Payer: Multiplan Commercial |
$407.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$214.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$151.40
|
| Rate for Payer: United Healthcare Commercial |
$232.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.40
|
| Rate for Payer: United Healthcare VA CCN |
$151.40
|
|
|
DRAINAGE OF GUM LESION
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
9814180002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$324.16 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Aetna of VT Commercial |
$416.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$324.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$324.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$372.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$367.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$350.40
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$350.40
|
| Rate for Payer: Multiplan Commercial |
$407.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$372.30
|
| Rate for Payer: United Healthcare Commercial |
$416.10
|
|
|
DRAINAGE OF GUM LESION
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
9814180001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$193.99 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Aetna of VT Commercial |
$416.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$193.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$263.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$372.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$354.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$197.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$348.21
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$350.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$197.10
|
| Rate for Payer: Multiplan Commercial |
$407.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$372.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$197.10
|
| Rate for Payer: United Healthcare Commercial |
$416.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.10
|
| Rate for Payer: United Healthcare VA CCN |
$197.10
|
|
|
DRAINAGE OF HEMATOMA/FLUID
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
9811014001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$112.76 |
| Max. Negotiated Rate |
$407.96 |
| Rate for Payer: Aetna of VT Commercial |
$407.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$388.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$388.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$207.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$207.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$129.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.20
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cigna Commercial |
$205.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$261.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$261.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$160.62
|
| Rate for Payer: Multiplan Commercial |
$403.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$160.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.76
|
| Rate for Payer: United Healthcare Commercial |
$173.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.76
|
| Rate for Payer: United Healthcare VA CCN |
$112.76
|
|
|
DRAINAGE OF HEMATOMA/FLUID
|
Facility
|
IP
|
$1,323.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
9601014001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$979.15 |
| Max. Negotiated Rate |
$1,256.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,256.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$979.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$979.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,124.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,111.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,058.40
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cigna Commercial |
$1,058.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,058.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,058.40
|
| Rate for Payer: Multiplan Commercial |
$1,230.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,124.55
|
| Rate for Payer: United Healthcare Commercial |
$1,256.85
|
|
|
DRAINAGE OF HEMATOMA/FLUID
|
Facility
|
OP
|
$890.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
5101014001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$394.18 |
| Max. Negotiated Rate |
$845.50 |
| Rate for Payer: Aetna of VT Commercial |
$845.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$797.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$394.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$797.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$535.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$756.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$720.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$400.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$707.55
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cigna Commercial |
$712.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$712.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$712.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$400.50
|
| Rate for Payer: Multiplan Commercial |
$827.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$756.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$400.50
|
| Rate for Payer: United Healthcare Commercial |
$845.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$400.50
|
| Rate for Payer: United Healthcare VA CCN |
$400.50
|
|
|
DRAINAGE OF HEMATOMA/FLUID
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
9601014002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$112.76 |
| Max. Negotiated Rate |
$407.96 |
| Rate for Payer: Aetna of VT Commercial |
$407.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$388.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$388.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$207.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$207.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$129.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.20
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cigna Commercial |
$205.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$261.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$261.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$160.62
|
| Rate for Payer: Multiplan Commercial |
$403.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$160.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.76
|
| Rate for Payer: United Healthcare Commercial |
$173.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.76
|
| Rate for Payer: United Healthcare VA CCN |
$112.76
|
|
|
DRAINAGE OF HEMATOMA/FLUID
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
9601014002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$192.22 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna of VT Commercial |
$412.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$388.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$192.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$388.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$261.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$368.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$351.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$195.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$345.03
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cigna Commercial |
$347.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$347.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$347.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$195.30
|
| Rate for Payer: Multiplan Commercial |
$403.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$368.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$195.30
|
| Rate for Payer: United Healthcare Commercial |
$412.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.30
|
| Rate for Payer: United Healthcare VA CCN |
$195.30
|
|
|
DRAINAGE OF HEMATOMA/FLUID
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
9811014001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna of VT Commercial |
$412.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$321.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$321.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$368.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$364.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$347.20
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cigna Commercial |
$347.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$347.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$347.20
|
| Rate for Payer: Multiplan Commercial |
$403.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$368.90
|
| Rate for Payer: United Healthcare Commercial |
$412.30
|
|
|
DRAINAGE OF HEMATOMA/FLUID
|
Professional
|
Both
|
$890.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
5101014001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.76 |
| Max. Negotiated Rate |
$836.60 |
| Rate for Payer: Aetna of VT Commercial |
$836.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$797.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$797.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$207.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$207.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$129.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.20
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cigna Commercial |
$205.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$261.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$261.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$160.62
|
| Rate for Payer: Multiplan Commercial |
$827.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$160.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.76
|
| Rate for Payer: United Healthcare Commercial |
$173.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.76
|
| Rate for Payer: United Healthcare VA CCN |
$112.76
|
|
|
DRAINAGE OF HEMATOMA/FLUID
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
9811014002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$112.76 |
| Max. Negotiated Rate |
$407.96 |
| Rate for Payer: Aetna of VT Commercial |
$407.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$388.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$388.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$207.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$207.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$129.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.20
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cigna Commercial |
$205.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$261.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$261.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$160.62
|
| Rate for Payer: Multiplan Commercial |
$403.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$160.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.76
|
| Rate for Payer: United Healthcare Commercial |
$173.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.76
|
| Rate for Payer: United Healthcare VA CCN |
$112.76
|
|
|
DRAINAGE OF HEMATOMA/FLUID
|
Facility
|
IP
|
$890.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
5101014001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$658.69 |
| Max. Negotiated Rate |
$845.50 |
| Rate for Payer: Aetna of VT Commercial |
$845.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$658.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$756.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$747.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$712.00
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cigna Commercial |
$712.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$712.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$712.00
|
| Rate for Payer: Multiplan Commercial |
$827.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$756.50
|
| Rate for Payer: United Healthcare Commercial |
$845.50
|
|
|
DRAINAGE OF HEMATOMA/FLUID
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
9601014002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna of VT Commercial |
$412.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$321.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$321.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$368.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$364.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$347.20
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cigna Commercial |
$347.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$347.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$347.20
|
| Rate for Payer: Multiplan Commercial |
$403.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$368.90
|
| Rate for Payer: United Healthcare Commercial |
$412.30
|
|
|
DRAINAGE OF HEMATOMA/FLUID
|
Professional
|
Both
|
$1,323.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
9601014001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$112.76 |
| Max. Negotiated Rate |
$1,243.62 |
| Rate for Payer: Aetna of VT Commercial |
$1,243.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,185.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,185.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$207.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$207.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$129.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.20
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cigna Commercial |
$205.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$261.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$261.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$160.62
|
| Rate for Payer: Multiplan Commercial |
$1,230.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$160.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.76
|
| Rate for Payer: United Healthcare Commercial |
$173.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.76
|
| Rate for Payer: United Healthcare VA CCN |
$112.76
|
|
|
DRAINAGE OF HEMATOMA/FLUID
|
Facility
|
IP
|
$889.24
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
4501014001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$658.13 |
| Max. Negotiated Rate |
$844.78 |
| Rate for Payer: Aetna of VT Commercial |
$844.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$658.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$658.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$755.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$746.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$711.39
|
| Rate for Payer: Cash Price |
$444.62
|
| Rate for Payer: Cigna Commercial |
$711.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$711.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$711.39
|
| Rate for Payer: Multiplan Commercial |
$826.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$755.85
|
| Rate for Payer: United Healthcare Commercial |
$844.78
|
|
|
DRAINAGE OF HEMATOMA/FLUID
|
Facility
|
OP
|
$1,323.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
9601014001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$585.96 |
| Max. Negotiated Rate |
$1,256.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,256.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,185.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$585.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,185.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$796.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,124.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,071.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$595.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,051.79
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cigna Commercial |
$1,058.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,058.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,058.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$595.35
|
| Rate for Payer: Multiplan Commercial |
$1,230.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,124.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$595.35
|
| Rate for Payer: United Healthcare Commercial |
$1,256.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$595.35
|
| Rate for Payer: United Healthcare VA CCN |
$595.35
|
|
|
DRAINAGE OF HEMATOMA/FLUID
|
Facility
|
OP
|
$889.24
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
4501014001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.84 |
| Max. Negotiated Rate |
$844.78 |
| Rate for Payer: Aetna of VT Commercial |
$844.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$796.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$393.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$796.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$535.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$755.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$720.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$400.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$706.95
|
| Rate for Payer: Cash Price |
$444.62
|
| Rate for Payer: Cigna Commercial |
$711.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$711.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$711.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$400.16
|
| Rate for Payer: Multiplan Commercial |
$826.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$755.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$400.16
|
| Rate for Payer: United Healthcare Commercial |
$844.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$400.16
|
| Rate for Payer: United Healthcare VA CCN |
$400.16
|
|
|
DRAINAGE OF HEMATOMA/FLUID
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
9811014002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$192.22 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna of VT Commercial |
$412.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$388.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$192.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$388.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$261.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$368.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$351.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$195.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$345.03
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cigna Commercial |
$347.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$347.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$347.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$195.30
|
| Rate for Payer: Multiplan Commercial |
$403.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$368.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$195.30
|
| Rate for Payer: United Healthcare Commercial |
$412.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.30
|
| Rate for Payer: United Healthcare VA CCN |
$195.30
|
|
|
DRAINAGE OF HEMATOMA/FLUID
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
9811014002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna of VT Commercial |
$412.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$321.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$321.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$368.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$364.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$347.20
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cigna Commercial |
$347.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$347.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$347.20
|
| Rate for Payer: Multiplan Commercial |
$403.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$368.90
|
| Rate for Payer: United Healthcare Commercial |
$412.30
|
|
