|
DRESSG CVP TRAY
|
Facility
|
IP
|
$4.15
|
|
| Hospital Charge Code |
2720029621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna of VT Commercial |
$3.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3.32
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cigna Commercial |
$3.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3.32
|
| Rate for Payer: Multiplan Commercial |
$3.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.53
|
| Rate for Payer: United Healthcare Commercial |
$3.94
|
|
|
DRESSG CVP TRAY
|
Facility
|
OP
|
$4.15
|
|
| Hospital Charge Code |
2720029621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna of VT Commercial |
$3.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3.30
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cigna Commercial |
$3.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$3.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.87
|
| Rate for Payer: United Healthcare Commercial |
$3.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.87
|
| Rate for Payer: United Healthcare VA CCN |
$1.87
|
|
|
DRESSG OPTILOCK 3X3
|
Facility
|
IP
|
$1.60
|
|
| Hospital Charge Code |
2720062451
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna of VT Commercial |
$1.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.28
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna Commercial |
$1.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.36
|
| Rate for Payer: United Healthcare Commercial |
$1.52
|
|
|
DRESSG OPTILOCK 3X3
|
Facility
|
OP
|
$1.60
|
|
| Hospital Charge Code |
2720062451
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna of VT Commercial |
$1.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.27
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna Commercial |
$1.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.72
|
| Rate for Payer: United Healthcare Commercial |
$1.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.72
|
| Rate for Payer: United Healthcare VA CCN |
$0.72
|
|
|
DRESSG OPTILOCK 5X5.5
|
Facility
|
OP
|
$2.23
|
|
| Hospital Charge Code |
2720062461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna of VT Commercial |
$2.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.77
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cigna Commercial |
$1.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$2.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$2.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.00
|
| Rate for Payer: United Healthcare VA CCN |
$1.00
|
|
|
DRESSG OPTILOCK 5X5.5
|
Facility
|
IP
|
$2.23
|
|
| Hospital Charge Code |
2720062461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna of VT Commercial |
$2.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.78
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cigna Commercial |
$1.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.78
|
| Rate for Payer: Multiplan Commercial |
$2.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.90
|
| Rate for Payer: United Healthcare Commercial |
$2.12
|
|
|
DRESSG TEGADERM 4x4
|
Facility
|
IP
|
$0.49
|
|
| Hospital Charge Code |
2720010211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Aetna of VT Commercial |
$0.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.39
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna Commercial |
$0.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.42
|
| Rate for Payer: United Healthcare Commercial |
$0.47
|
|
|
DRESSG TEGADERM 4x4
|
Facility
|
OP
|
$0.49
|
|
| Hospital Charge Code |
2720010211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Aetna of VT Commercial |
$0.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.39
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna Commercial |
$0.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.22
|
| Rate for Payer: United Healthcare Commercial |
$0.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.22
|
| Rate for Payer: United Healthcare VA CCN |
$0.22
|
|
|
DRESSG TEGADERM 6x8
|
Facility
|
IP
|
$1.21
|
|
| Hospital Charge Code |
2720010221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Aetna of VT Commercial |
$1.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.97
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$0.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.97
|
| Rate for Payer: Multiplan Commercial |
$1.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.03
|
| Rate for Payer: United Healthcare Commercial |
$1.15
|
|
|
DRESSG TEGADERM 6x8
|
Facility
|
OP
|
$1.21
|
|
| Hospital Charge Code |
2720010221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Aetna of VT Commercial |
$1.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.96
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$0.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.54
|
| Rate for Payer: United Healthcare Commercial |
$1.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.54
|
| Rate for Payer: United Healthcare VA CCN |
$0.54
|
|
|
DRESSG TEGADERM 8x12
|
Facility
|
OP
|
$1.74
|
|
| Hospital Charge Code |
2720049711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.65 |
| Rate for Payer: Aetna of VT Commercial |
$1.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.38
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Cigna Commercial |
$1.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$1.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.78
|
| Rate for Payer: United Healthcare Commercial |
$1.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.78
|
| Rate for Payer: United Healthcare VA CCN |
$0.78
|
|
|
DRESSG TEGADERM 8x12
|
Facility
|
IP
|
$1.74
|
|
| Hospital Charge Code |
2720049711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$1.65 |
| Rate for Payer: Aetna of VT Commercial |
$1.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.39
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Cigna Commercial |
$1.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$1.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.48
|
| Rate for Payer: United Healthcare Commercial |
$1.65
|
|
|
DRG OF SKENE'S GLAND ABSC/CYST
|
Professional
|
Both
|
$1,585.00
|
|
|
Service Code
|
CPT 53060
|
| Hospital Charge Code |
9605306001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$155.12 |
| Max. Negotiated Rate |
$1,489.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,489.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,420.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$159.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,420.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$217.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$458.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$458.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$178.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$458.46
|
| Rate for Payer: Cash Price |
$792.50
|
| Rate for Payer: Cash Price |
$792.50
|
| Rate for Payer: Cigna Commercial |
$270.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$295.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$295.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$177.60
|
| Rate for Payer: Multiplan Commercial |
$1,474.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$155.12
|
| Rate for Payer: United Healthcare Commercial |
$238.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.12
|
| Rate for Payer: United Healthcare VA CCN |
$155.12
|
|
|
DRG OF SKENE'S GLAND ABSC/CYST
|
Facility
|
OP
|
$557.00
|
|
|
Service Code
|
CPT 53060
|
| Hospital Charge Code |
9605306002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$246.70 |
| Max. Negotiated Rate |
$529.15 |
| Rate for Payer: Aetna of VT Commercial |
$529.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$499.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$246.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$499.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$335.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$473.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$451.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$250.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$442.81
|
| Rate for Payer: Cash Price |
$278.50
|
| Rate for Payer: Cigna Commercial |
$445.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$445.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$445.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$250.65
|
| Rate for Payer: Multiplan Commercial |
$518.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$473.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$250.65
|
| Rate for Payer: United Healthcare Commercial |
$529.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$250.65
|
| Rate for Payer: United Healthcare VA CCN |
$250.65
|
|
|
DRG OF SKENE'S GLAND ABSC/CYST
|
Facility
|
IP
|
$1,585.00
|
|
|
Service Code
|
CPT 53060
|
| Hospital Charge Code |
9605306001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,173.06 |
| Max. Negotiated Rate |
$1,505.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,505.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,173.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,173.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,347.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,331.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,268.00
|
| Rate for Payer: Cash Price |
$792.50
|
| Rate for Payer: Cigna Commercial |
$1,268.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,268.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,268.00
|
| Rate for Payer: Multiplan Commercial |
$1,474.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,347.25
|
| Rate for Payer: United Healthcare Commercial |
$1,505.75
|
|
|
DRG OF SKENE'S GLAND ABSC/CYST
|
Facility
|
IP
|
$557.00
|
|
|
Service Code
|
CPT 53060
|
| Hospital Charge Code |
9825306001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$412.24 |
| Max. Negotiated Rate |
$529.15 |
| Rate for Payer: Aetna of VT Commercial |
$529.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$412.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$412.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$473.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$467.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$445.60
|
| Rate for Payer: Cash Price |
$278.50
|
| Rate for Payer: Cigna Commercial |
$445.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$445.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$445.60
|
| Rate for Payer: Multiplan Commercial |
$518.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$473.45
|
| Rate for Payer: United Healthcare Commercial |
$529.15
|
|
|
DRG OF SKENE'S GLAND ABSC/CYST
|
Facility
|
IP
|
$557.00
|
|
|
Service Code
|
CPT 53060
|
| Hospital Charge Code |
9605306002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$412.24 |
| Max. Negotiated Rate |
$529.15 |
| Rate for Payer: Aetna of VT Commercial |
$529.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$412.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$412.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$473.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$467.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$445.60
|
| Rate for Payer: Cash Price |
$278.50
|
| Rate for Payer: Cigna Commercial |
$445.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$445.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$445.60
|
| Rate for Payer: Multiplan Commercial |
$518.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$473.45
|
| Rate for Payer: United Healthcare Commercial |
$529.15
|
|
|
DRG OF SKENE'S GLAND ABSC/CYST
|
Facility
|
OP
|
$1,028.00
|
|
|
Service Code
|
CPT 53060
|
| Hospital Charge Code |
5105306001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$455.30 |
| Max. Negotiated Rate |
$976.60 |
| Rate for Payer: Aetna of VT Commercial |
$976.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$920.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$455.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$920.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$618.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$873.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$832.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$462.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$817.26
|
| Rate for Payer: Cash Price |
$514.00
|
| Rate for Payer: Cigna Commercial |
$822.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$822.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$822.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$462.60
|
| Rate for Payer: Multiplan Commercial |
$956.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$873.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$462.60
|
| Rate for Payer: United Healthcare Commercial |
$976.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$462.60
|
| Rate for Payer: United Healthcare VA CCN |
$462.60
|
|
|
DRG OF SKENE'S GLAND ABSC/CYST
|
Professional
|
Both
|
$1,028.00
|
|
|
Service Code
|
CPT 53060
|
| Hospital Charge Code |
5105306001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$155.12 |
| Max. Negotiated Rate |
$966.32 |
| Rate for Payer: Aetna of VT Commercial |
$966.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$920.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$159.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$920.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$217.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$458.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$458.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$178.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$458.46
|
| Rate for Payer: Cash Price |
$514.00
|
| Rate for Payer: Cash Price |
$514.00
|
| Rate for Payer: Cigna Commercial |
$270.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$295.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$295.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$177.60
|
| Rate for Payer: Multiplan Commercial |
$956.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$155.12
|
| Rate for Payer: United Healthcare Commercial |
$238.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.12
|
| Rate for Payer: United Healthcare VA CCN |
$155.12
|
|
|
DRG OF SKENE'S GLAND ABSC/CYST
|
Professional
|
Both
|
$557.00
|
|
|
Service Code
|
CPT 53060
|
| Hospital Charge Code |
9825306001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$155.12 |
| Max. Negotiated Rate |
$523.58 |
| Rate for Payer: Aetna of VT Commercial |
$523.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$499.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$159.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$499.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$217.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$458.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$458.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$178.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$458.46
|
| Rate for Payer: Cash Price |
$278.50
|
| Rate for Payer: Cash Price |
$278.50
|
| Rate for Payer: Cigna Commercial |
$270.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$295.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$295.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$177.60
|
| Rate for Payer: Multiplan Commercial |
$518.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$155.12
|
| Rate for Payer: United Healthcare Commercial |
$238.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.12
|
| Rate for Payer: United Healthcare VA CCN |
$155.12
|
|
|
DRG OF SKENE'S GLAND ABSC/CYST
|
Facility
|
IP
|
$1,028.00
|
|
|
Service Code
|
CPT 53060
|
| Hospital Charge Code |
5105306001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$760.82 |
| Max. Negotiated Rate |
$976.60 |
| Rate for Payer: Aetna of VT Commercial |
$976.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$760.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$760.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$873.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$863.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$822.40
|
| Rate for Payer: Cash Price |
$514.00
|
| Rate for Payer: Cigna Commercial |
$822.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$822.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$822.40
|
| Rate for Payer: Multiplan Commercial |
$956.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$873.80
|
| Rate for Payer: United Healthcare Commercial |
$976.60
|
|
|
DRG OF SKENE'S GLAND ABSC/CYST
|
Facility
|
OP
|
$557.00
|
|
|
Service Code
|
CPT 53060
|
| Hospital Charge Code |
9825306001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$246.70 |
| Max. Negotiated Rate |
$529.15 |
| Rate for Payer: Aetna of VT Commercial |
$529.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$499.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$246.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$499.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$335.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$473.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$451.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$250.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$442.81
|
| Rate for Payer: Cash Price |
$278.50
|
| Rate for Payer: Cigna Commercial |
$445.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$445.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$445.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$250.65
|
| Rate for Payer: Multiplan Commercial |
$518.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$473.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$250.65
|
| Rate for Payer: United Healthcare Commercial |
$529.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$250.65
|
| Rate for Payer: United Healthcare VA CCN |
$250.65
|
|
|
DRG OF SKENE'S GLAND ABSC/CYST
|
Facility
|
OP
|
$1,585.00
|
|
|
Service Code
|
CPT 53060
|
| Hospital Charge Code |
9605306001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$1,505.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,505.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,420.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$702.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,420.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$954.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,347.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,283.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$713.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,260.08
|
| Rate for Payer: Cash Price |
$792.50
|
| Rate for Payer: Cigna Commercial |
$1,268.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,268.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,268.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$713.25
|
| Rate for Payer: Multiplan Commercial |
$1,474.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,347.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$713.25
|
| Rate for Payer: United Healthcare Commercial |
$1,505.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$713.25
|
| Rate for Payer: United Healthcare VA CCN |
$713.25
|
|
|
DRG OF SKENE'S GLAND ABSC/CYST
|
Professional
|
Both
|
$557.00
|
|
|
Service Code
|
CPT 53060
|
| Hospital Charge Code |
9605306002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$155.12 |
| Max. Negotiated Rate |
$523.58 |
| Rate for Payer: Aetna of VT Commercial |
$523.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$499.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$159.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$499.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$217.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$458.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$458.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$178.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$458.46
|
| Rate for Payer: Cash Price |
$278.50
|
| Rate for Payer: Cash Price |
$278.50
|
| Rate for Payer: Cigna Commercial |
$270.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$295.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$295.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$177.60
|
| Rate for Payer: Multiplan Commercial |
$518.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$155.12
|
| Rate for Payer: United Healthcare Commercial |
$238.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.12
|
| Rate for Payer: United Healthcare VA CCN |
$155.12
|
|
|
DRILL, 1.3X100MM, SLD, AO
|
Facility
|
IP
|
$259.00
|
|
| Hospital Charge Code |
2720077181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.69 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Aetna of VT Commercial |
$246.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.20
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.20
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.15
|
| Rate for Payer: United Healthcare Commercial |
$246.05
|
|
