|
DRAINAGE OF HEMATOMA/FLUID
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
9811014001
|
|
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 HYDROCELE
|
Facility
|
IP
|
$1,030.20
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
5105500001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$762.45 |
| Max. Negotiated Rate |
$978.69 |
| Rate for Payer: Aetna of VT Commercial |
$978.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$762.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$762.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$875.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$865.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$824.16
|
| Rate for Payer: Cash Price |
$515.10
|
| Rate for Payer: Cigna Commercial |
$824.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$824.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$824.16
|
| Rate for Payer: Multiplan Commercial |
$958.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$875.67
|
| Rate for Payer: United Healthcare Commercial |
$978.69
|
|
|
DRAINAGE OF HYDROCELE
|
Facility
|
OP
|
$3,293.13
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
9605500001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,458.53 |
| Max. Negotiated Rate |
$3,128.47 |
| Rate for Payer: Aetna of VT Commercial |
$3,128.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,950.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,458.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,950.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,982.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,799.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,667.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,481.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,618.04
|
| Rate for Payer: Cash Price |
$1,646.57
|
| Rate for Payer: Cigna Commercial |
$2,634.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,634.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,634.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,481.91
|
| Rate for Payer: Multiplan Commercial |
$3,062.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,799.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,481.91
|
| Rate for Payer: United Healthcare Commercial |
$3,128.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,481.91
|
| Rate for Payer: United Healthcare VA CCN |
$1,481.91
|
|
|
DRAINAGE OF HYDROCELE
|
Facility
|
IP
|
$3,293.13
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
9605500001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,437.25 |
| Max. Negotiated Rate |
$3,128.47 |
| Rate for Payer: Aetna of VT Commercial |
$3,128.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,437.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,437.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,799.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,766.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,634.50
|
| Rate for Payer: Cash Price |
$1,646.57
|
| Rate for Payer: Cigna Commercial |
$2,634.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,634.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,634.50
|
| Rate for Payer: Multiplan Commercial |
$3,062.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,799.16
|
| Rate for Payer: United Healthcare Commercial |
$3,128.47
|
|
|
DRAINAGE OF HYDROCELE
|
Facility
|
OP
|
$1,030.20
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
5105500001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$456.28 |
| Max. Negotiated Rate |
$978.69 |
| Rate for Payer: Aetna of VT Commercial |
$978.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$922.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$456.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$922.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$620.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$875.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$834.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$463.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$819.01
|
| Rate for Payer: Cash Price |
$515.10
|
| Rate for Payer: Cigna Commercial |
$824.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$824.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$824.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$463.59
|
| Rate for Payer: Multiplan Commercial |
$958.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$875.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$463.59
|
| Rate for Payer: United Healthcare Commercial |
$978.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$463.59
|
| Rate for Payer: United Healthcare VA CCN |
$463.59
|
|
|
DRAINAGE OF HYDROCELE
|
Facility
|
IP
|
$1,030.20
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
9605500002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$762.45 |
| Max. Negotiated Rate |
$978.69 |
| Rate for Payer: Aetna of VT Commercial |
$978.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$762.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$762.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$875.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$865.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$824.16
|
| Rate for Payer: Cash Price |
$515.10
|
| Rate for Payer: Cigna Commercial |
$824.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$824.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$824.16
|
| Rate for Payer: Multiplan Commercial |
$958.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$875.67
|
| Rate for Payer: United Healthcare Commercial |
$978.69
|
|
|
DRAINAGE OF HYDROCELE
|
Professional
|
Both
|
$1,030.20
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
5105500001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$968.39 |
| Rate for Payer: Aetna of VT Commercial |
$968.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$922.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$922.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$111.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$234.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$234.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$91.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$234.39
|
| Rate for Payer: Cash Price |
$515.10
|
| Rate for Payer: Cash Price |
$515.10
|
| Rate for Payer: Cigna Commercial |
$138.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$185.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$185.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$113.35
|
| Rate for Payer: Multiplan Commercial |
$958.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.30
|
| Rate for Payer: United Healthcare Commercial |
$121.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.30
|
| Rate for Payer: United Healthcare VA CCN |
$79.30
|
|
|
DRAINAGE OF HYDROCELE
|
Facility
|
OP
|
$1,030.20
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
9605500002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$456.28 |
| Max. Negotiated Rate |
$978.69 |
| Rate for Payer: Aetna of VT Commercial |
$978.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$922.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$456.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$922.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$620.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$875.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$834.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$463.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$819.01
|
| Rate for Payer: Cash Price |
$515.10
|
| Rate for Payer: Cigna Commercial |
$824.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$824.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$824.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$463.59
|
| Rate for Payer: Multiplan Commercial |
$958.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$875.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$463.59
|
| Rate for Payer: United Healthcare Commercial |
$978.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$463.59
|
| Rate for Payer: United Healthcare VA CCN |
$463.59
|
|
|
DRAINAGE OF HYDROCELE
|
Professional
|
Both
|
$1,030.20
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
9605500002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$968.39 |
| Rate for Payer: Aetna of VT Commercial |
$968.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$922.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$922.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$111.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$234.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$234.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$91.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$234.39
|
| Rate for Payer: Cash Price |
$515.10
|
| Rate for Payer: Cash Price |
$515.10
|
| Rate for Payer: Cigna Commercial |
$138.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$185.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$185.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$113.35
|
| Rate for Payer: Multiplan Commercial |
$958.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.30
|
| Rate for Payer: United Healthcare Commercial |
$121.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.30
|
| Rate for Payer: United Healthcare VA CCN |
$79.30
|
|
|
DRAINAGE OF HYDROCELE
|
Professional
|
Both
|
$3,293.13
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
9605500001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$3,095.54 |
| Rate for Payer: Aetna of VT Commercial |
$3,095.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,950.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,950.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$111.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$234.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$234.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$91.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$234.39
|
| Rate for Payer: Cash Price |
$1,646.57
|
| Rate for Payer: Cash Price |
$1,646.57
|
| Rate for Payer: Cigna Commercial |
$138.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$185.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$185.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$113.35
|
| Rate for Payer: Multiplan Commercial |
$3,062.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.30
|
| Rate for Payer: United Healthcare Commercial |
$121.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.30
|
| Rate for Payer: United Healthcare VA CCN |
$79.30
|
|
|
DRAINAGE OF MOUTH LESION
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
9824080001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$115.52 |
| Max. Negotiated Rate |
$317.72 |
| Rate for Payer: Aetna of VT Commercial |
$317.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$302.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$118.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$302.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$161.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$277.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$277.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$132.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$277.14
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$180.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$314.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$314.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$194.86
|
| Rate for Payer: Multiplan Commercial |
$314.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$115.52
|
| Rate for Payer: United Healthcare Commercial |
$177.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.52
|
| Rate for Payer: United Healthcare VA CCN |
$115.52
|
|
|
DRAINAGE OF MOUTH LESION
|
Professional
|
Both
|
$411.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
9814080001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$115.52 |
| Max. Negotiated Rate |
$386.34 |
| Rate for Payer: Aetna of VT Commercial |
$386.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$368.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$118.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$368.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$161.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$277.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$277.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$132.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$277.14
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$180.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$314.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$314.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$194.86
|
| Rate for Payer: Multiplan Commercial |
$382.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$115.52
|
| Rate for Payer: United Healthcare Commercial |
$177.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.52
|
| Rate for Payer: United Healthcare VA CCN |
$115.52
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
9824080001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$250.15 |
| Max. Negotiated Rate |
$321.10 |
| Rate for Payer: Aetna of VT Commercial |
$321.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$250.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$250.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$287.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$270.40
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$270.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$270.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$270.40
|
| Rate for Payer: Multiplan Commercial |
$314.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$287.30
|
| Rate for Payer: United Healthcare Commercial |
$321.10
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
OP
|
$349.18
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
4504080001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.65 |
| Max. Negotiated Rate |
$331.72 |
| Rate for Payer: Aetna of VT Commercial |
$331.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$312.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$154.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$312.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$210.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$296.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$282.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$157.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$277.60
|
| Rate for Payer: Cash Price |
$174.59
|
| Rate for Payer: Cigna Commercial |
$279.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$279.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$279.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$157.13
|
| Rate for Payer: Multiplan Commercial |
$324.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$296.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$157.13
|
| Rate for Payer: United Healthcare Commercial |
$331.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.13
|
| Rate for Payer: United Healthcare VA CCN |
$157.13
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
IP
|
$349.18
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
4504080001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.43 |
| Max. Negotiated Rate |
$331.72 |
| Rate for Payer: Aetna of VT Commercial |
$331.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$296.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$293.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$279.34
|
| Rate for Payer: Cash Price |
$174.59
|
| Rate for Payer: Cigna Commercial |
$279.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$279.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$279.34
|
| Rate for Payer: Multiplan Commercial |
$324.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$296.80
|
| Rate for Payer: United Healthcare Commercial |
$331.72
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
9824080001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$149.70 |
| Max. Negotiated Rate |
$321.10 |
| Rate for Payer: Aetna of VT Commercial |
$321.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$302.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$302.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$203.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$287.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$273.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$152.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$268.71
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$270.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$270.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$270.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$152.10
|
| Rate for Payer: Multiplan Commercial |
$314.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$287.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$152.10
|
| Rate for Payer: United Healthcare Commercial |
$321.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.10
|
| Rate for Payer: United Healthcare VA CCN |
$152.10
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
9814080002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$250.15 |
| Max. Negotiated Rate |
$321.10 |
| Rate for Payer: Aetna of VT Commercial |
$321.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$250.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$250.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$287.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$270.40
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$270.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$270.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$270.40
|
| Rate for Payer: Multiplan Commercial |
$314.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$287.30
|
| Rate for Payer: United Healthcare Commercial |
$321.10
|
|
|
DRAINAGE OF MOUTH LESION
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
9814080002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$115.52 |
| Max. Negotiated Rate |
$317.72 |
| Rate for Payer: Aetna of VT Commercial |
$317.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$302.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$118.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$302.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$161.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$277.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$277.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$132.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$277.14
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$180.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$314.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$314.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$194.86
|
| Rate for Payer: Multiplan Commercial |
$314.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$115.52
|
| Rate for Payer: United Healthcare Commercial |
$177.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.52
|
| Rate for Payer: United Healthcare VA CCN |
$115.52
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
9814080001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$304.18 |
| Max. Negotiated Rate |
$390.45 |
| Rate for Payer: Aetna of VT Commercial |
$390.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$304.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$304.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$349.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$345.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$328.80
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$328.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$328.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$328.80
|
| Rate for Payer: Multiplan Commercial |
$382.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$349.35
|
| Rate for Payer: United Healthcare Commercial |
$390.45
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
9814080002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$149.70 |
| Max. Negotiated Rate |
$321.10 |
| Rate for Payer: Aetna of VT Commercial |
$321.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$302.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$302.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$203.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$287.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$273.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$152.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$268.71
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$270.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$270.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$270.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$152.10
|
| Rate for Payer: Multiplan Commercial |
$314.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$287.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$152.10
|
| Rate for Payer: United Healthcare Commercial |
$321.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.10
|
| Rate for Payer: United Healthcare VA CCN |
$152.10
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
9814080001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$182.03 |
| Max. Negotiated Rate |
$390.45 |
| Rate for Payer: Aetna of VT Commercial |
$390.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$368.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$182.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$368.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$247.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$349.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$332.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$184.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$326.75
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$328.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$328.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$328.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$184.95
|
| Rate for Payer: Multiplan Commercial |
$382.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$349.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$184.95
|
| Rate for Payer: United Healthcare Commercial |
$390.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.95
|
| Rate for Payer: United Healthcare VA CCN |
$184.95
|
|
|
DRAINAGE OF NOSE LESION
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
CPT 30020
|
| Hospital Charge Code |
9813002001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$116.60 |
| Max. Negotiated Rate |
$499.14 |
| Rate for Payer: Aetna of VT Commercial |
$499.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$475.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$120.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$475.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$163.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$337.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$337.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$134.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.74
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$185.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$407.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$407.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$251.50
|
| Rate for Payer: Multiplan Commercial |
$493.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$116.60
|
| Rate for Payer: United Healthcare Commercial |
$179.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.60
|
| Rate for Payer: United Healthcare VA CCN |
$116.60
|
|
|
DRAINAGE OF NOSE LESION
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
CPT 30020
|
| Hospital Charge Code |
9813002002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$116.60 |
| Max. Negotiated Rate |
$499.14 |
| Rate for Payer: Aetna of VT Commercial |
$499.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$475.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$120.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$475.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$163.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$337.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$337.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$134.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.74
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$185.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$407.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$407.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$251.50
|
| Rate for Payer: Multiplan Commercial |
$493.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$116.60
|
| Rate for Payer: United Healthcare Commercial |
$179.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.60
|
| Rate for Payer: United Healthcare VA CCN |
$116.60
|
|
|
DRAINAGE OF NOSE LESION
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
CPT 30020
|
| Hospital Charge Code |
9823002001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$392.99 |
| Max. Negotiated Rate |
$504.45 |
| Rate for Payer: Aetna of VT Commercial |
$504.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$392.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$392.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$451.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$446.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$424.80
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$424.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$424.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$424.80
|
| Rate for Payer: Multiplan Commercial |
$493.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$451.35
|
| Rate for Payer: United Healthcare Commercial |
$504.45
|
|
|
DRAINAGE OF NOSE LESION
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
CPT 30020
|
| Hospital Charge Code |
9813002001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$235.18 |
| Max. Negotiated Rate |
$504.45 |
| Rate for Payer: Aetna of VT Commercial |
$504.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$475.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$235.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$475.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$319.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$451.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$430.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$238.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$422.14
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$424.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$424.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$424.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$238.95
|
| Rate for Payer: Multiplan Commercial |
$493.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$451.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$238.95
|
| Rate for Payer: United Healthcare Commercial |
$504.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$238.95
|
| Rate for Payer: United Healthcare VA CCN |
$238.95
|
|
