|
ENCEPHALTIS WEST EQNE ANTBDY
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
3008665401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$755.25 |
| Rate for Payer: Aetna of VT Commercial |
$755.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$352.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$478.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$675.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$643.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$357.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$632.02
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$636.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$636.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$636.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$357.75
|
| Rate for Payer: Multiplan Commercial |
$739.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$675.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$357.75
|
| Rate for Payer: United Healthcare Commercial |
$755.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare VA CCN |
$357.75
|
|
|
ENCEPHALTIS WEST EQNE ANTBDY
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
3008665401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$588.38 |
| Max. Negotiated Rate |
$755.25 |
| Rate for Payer: Aetna of VT Commercial |
$755.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$588.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$588.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$675.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$667.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$636.00
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$636.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$636.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$636.00
|
| Rate for Payer: Multiplan Commercial |
$739.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$675.75
|
| Rate for Payer: United Healthcare Commercial |
$755.25
|
|
|
ENCEPHALTIS WEST EQNE ANTBDY
|
Professional
|
Both
|
$795.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
3008665401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$747.30 |
| Rate for Payer: Aetna of VT Commercial |
$747.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.55
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$15.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$739.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare Commercial |
$20.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare VA CCN |
$13.19
|
|
|
ENDOCERV CURETTAGE W/SCOPE
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
CPT 57456
|
| Hospital Charge Code |
5105745601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.64 |
| Max. Negotiated Rate |
$323.36 |
| Rate for Payer: Aetna of VT Commercial |
$323.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$95.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$129.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$239.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$239.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$106.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$239.47
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna Commercial |
$164.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$234.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$234.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.11
|
| Rate for Payer: Multiplan Commercial |
$319.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$92.64
|
| Rate for Payer: United Healthcare Commercial |
$142.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.64
|
| Rate for Payer: United Healthcare VA CCN |
$92.64
|
|
|
ENDOCERV CURETTAGE W/SCOPE
|
Facility
|
OP
|
$721.00
|
|
|
Service Code
|
CPT 57456
|
| Hospital Charge Code |
9605745601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$319.33 |
| Max. Negotiated Rate |
$684.95 |
| Rate for Payer: Aetna of VT Commercial |
$684.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$645.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$319.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$645.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$434.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$612.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$584.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$324.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$573.20
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: Cigna Commercial |
$576.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$576.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$576.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$324.45
|
| Rate for Payer: Multiplan Commercial |
$670.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$612.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$324.45
|
| Rate for Payer: United Healthcare Commercial |
$684.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.45
|
| Rate for Payer: United Healthcare VA CCN |
$324.45
|
|
|
ENDOCERV CURETTAGE W/SCOPE
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT 57456
|
| Hospital Charge Code |
5105745601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$152.36 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna of VT Commercial |
$326.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$152.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$207.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$292.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$154.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$273.48
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna Commercial |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$275.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$154.80
|
| Rate for Payer: Multiplan Commercial |
$319.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$292.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$154.80
|
| Rate for Payer: United Healthcare Commercial |
$326.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.80
|
| Rate for Payer: United Healthcare VA CCN |
$154.80
|
|
|
ENDOCERV CURETTAGE W/SCOPE
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 57456
|
| Hospital Charge Code |
9605745602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$167.42 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna of VT Commercial |
$359.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$167.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$227.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$321.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$306.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$300.51
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$302.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$302.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$302.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$170.10
|
| Rate for Payer: Multiplan Commercial |
$351.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$321.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$170.10
|
| Rate for Payer: United Healthcare Commercial |
$359.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$170.10
|
| Rate for Payer: United Healthcare VA CCN |
$170.10
|
|
|
ENDOCERV CURETTAGE W/SCOPE
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT 57456
|
| Hospital Charge Code |
5105745601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$254.59 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna of VT Commercial |
$326.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$254.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$254.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$292.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$288.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$275.20
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna Commercial |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$275.20
|
| Rate for Payer: Multiplan Commercial |
$319.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$292.40
|
| Rate for Payer: United Healthcare Commercial |
$326.80
|
|
|
ENDOCERV CURETTAGE W/SCOPE
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
CPT 57456
|
| Hospital Charge Code |
9605745602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$92.64 |
| Max. Negotiated Rate |
$355.32 |
| Rate for Payer: Aetna of VT Commercial |
$355.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$95.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$129.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$239.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$239.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$106.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$239.47
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$164.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$234.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$234.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.11
|
| Rate for Payer: Multiplan Commercial |
$351.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$92.64
|
| Rate for Payer: United Healthcare Commercial |
$142.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.64
|
| Rate for Payer: United Healthcare VA CCN |
$92.64
|
|
|
ENDOCERV CURETTAGE W/SCOPE
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 57456
|
| Hospital Charge Code |
9605745602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$279.76 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna of VT Commercial |
$359.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$279.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$279.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$321.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$317.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$302.40
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$302.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$302.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$302.40
|
| Rate for Payer: Multiplan Commercial |
$351.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$321.30
|
| Rate for Payer: United Healthcare Commercial |
$359.10
|
|
|
ENDOCERV CURETTAGE W/SCOPE
|
Professional
|
Both
|
$721.00
|
|
|
Service Code
|
CPT 57456
|
| Hospital Charge Code |
9605745601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$92.64 |
| Max. Negotiated Rate |
$677.74 |
| Rate for Payer: Aetna of VT Commercial |
$677.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$645.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$95.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$645.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$129.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$239.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$239.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$106.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$239.47
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: Cigna Commercial |
$164.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$234.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$234.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.11
|
| Rate for Payer: Multiplan Commercial |
$670.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$92.64
|
| Rate for Payer: United Healthcare Commercial |
$142.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.64
|
| Rate for Payer: United Healthcare VA CCN |
$92.64
|
|
|
ENDOCERV CURETTAGE W/SCOPE
|
Facility
|
IP
|
$721.00
|
|
|
Service Code
|
CPT 57456
|
| Hospital Charge Code |
9605745601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$533.61 |
| Max. Negotiated Rate |
$684.95 |
| Rate for Payer: Aetna of VT Commercial |
$684.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$533.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$533.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$612.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$605.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$576.80
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: Cigna Commercial |
$576.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$576.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$576.80
|
| Rate for Payer: Multiplan Commercial |
$670.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$612.85
|
| Rate for Payer: United Healthcare Commercial |
$684.95
|
|
|
ENDOCERVICAL CURETTAGE
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
9605750502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$103.19 |
| Max. Negotiated Rate |
$236.07 |
| Rate for Payer: Aetna of VT Commercial |
$235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$223.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$106.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$223.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$144.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$192.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$192.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$192.43
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$183.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$144.63
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.19
|
| Rate for Payer: United Healthcare Commercial |
$158.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.19
|
| Rate for Payer: United Healthcare VA CCN |
$103.19
|
|
|
ENDOCERVICAL CURETTAGE
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
9825750501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$103.19 |
| Max. Negotiated Rate |
$236.07 |
| Rate for Payer: Aetna of VT Commercial |
$235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$223.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$106.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$223.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$144.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$192.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$192.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$192.43
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$183.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$144.63
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.19
|
| Rate for Payer: United Healthcare Commercial |
$158.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.19
|
| Rate for Payer: United Healthcare VA CCN |
$103.19
|
|
|
ENDOCERVICAL CURETTAGE
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
9605750502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$185.03 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Aetna of VT Commercial |
$237.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$185.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$185.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$212.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$200.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$200.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$200.00
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$212.50
|
| Rate for Payer: United Healthcare Commercial |
$237.50
|
|
|
ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
9605750502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$110.72 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Aetna of VT Commercial |
$237.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$223.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$110.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$223.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$150.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$212.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$202.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$198.75
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$200.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$200.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$112.50
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$212.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.50
|
| Rate for Payer: United Healthcare Commercial |
$237.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.50
|
| Rate for Payer: United Healthcare VA CCN |
$112.50
|
|
|
ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
9825750501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$110.72 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Aetna of VT Commercial |
$237.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$223.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$110.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$223.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$150.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$212.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$202.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$198.75
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$200.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$200.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$112.50
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$212.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.50
|
| Rate for Payer: United Healthcare Commercial |
$237.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.50
|
| Rate for Payer: United Healthcare VA CCN |
$112.50
|
|
|
ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
5105750501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Aetna of VT Commercial |
$105.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$66.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.25
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$88.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.95
|
| Rate for Payer: Multiplan Commercial |
$103.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.95
|
| Rate for Payer: United Healthcare Commercial |
$105.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.95
|
| Rate for Payer: United Healthcare VA CCN |
$49.95
|
|
|
ENDOCERVICAL CURETTAGE
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
9605750501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$103.19 |
| Max. Negotiated Rate |
$339.34 |
| Rate for Payer: Aetna of VT Commercial |
$339.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$323.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$106.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$323.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$144.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$192.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$192.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$192.43
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cigna Commercial |
$183.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$144.63
|
| Rate for Payer: Multiplan Commercial |
$335.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.19
|
| Rate for Payer: United Healthcare Commercial |
$158.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.19
|
| Rate for Payer: United Healthcare VA CCN |
$103.19
|
|
|
ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
9605750501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$159.89 |
| Max. Negotiated Rate |
$342.95 |
| Rate for Payer: Aetna of VT Commercial |
$342.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$323.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$159.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$323.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$217.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$306.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$292.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$162.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$287.00
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cigna Commercial |
$288.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$288.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$288.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$162.45
|
| Rate for Payer: Multiplan Commercial |
$335.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$162.45
|
| Rate for Payer: United Healthcare Commercial |
$342.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.45
|
| Rate for Payer: United Healthcare VA CCN |
$162.45
|
|
|
ENDOCERVICAL CURETTAGE
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
9605750501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$267.18 |
| Max. Negotiated Rate |
$342.95 |
| Rate for Payer: Aetna of VT Commercial |
$342.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$267.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$267.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$306.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$303.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$288.80
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cigna Commercial |
$288.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$288.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$288.80
|
| Rate for Payer: Multiplan Commercial |
$335.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.85
|
| Rate for Payer: United Healthcare Commercial |
$342.95
|
|
|
ENDOCERVICAL CURETTAGE
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
9825750501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$185.03 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Aetna of VT Commercial |
$237.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$185.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$185.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$212.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$200.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$200.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$200.00
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$212.50
|
| Rate for Payer: United Healthcare Commercial |
$237.50
|
|
|
ENDOCERVICAL CURETTAGE
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
5105750501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.44 |
| Max. Negotiated Rate |
$236.07 |
| Rate for Payer: Aetna of VT Commercial |
$104.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$106.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$144.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$192.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$192.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$192.43
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$183.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$144.63
|
| Rate for Payer: Multiplan Commercial |
$103.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.19
|
| Rate for Payer: United Healthcare Commercial |
$158.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.19
|
| Rate for Payer: United Healthcare VA CCN |
$103.19
|
|
|
ENDOCERVICAL CURETTAGE
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
5105750501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.15 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Aetna of VT Commercial |
$105.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$82.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$82.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$93.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.80
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$88.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.80
|
| Rate for Payer: Multiplan Commercial |
$103.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.35
|
| Rate for Payer: United Healthcare Commercial |
$105.45
|
|
|
ENDOMETR ABLATE THERMAL
|
Facility
|
OP
|
$2,067.00
|
|
|
Service Code
|
CPT 58353
|
| Hospital Charge Code |
9825835301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$915.47 |
| Max. Negotiated Rate |
$1,963.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,963.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,851.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$915.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,851.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,244.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,756.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,674.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$930.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,643.27
|
| Rate for Payer: Cash Price |
$1,033.50
|
| Rate for Payer: Cigna Commercial |
$1,653.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,653.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,653.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$930.15
|
| Rate for Payer: Multiplan Commercial |
$1,922.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,756.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$930.15
|
| Rate for Payer: United Healthcare Commercial |
$1,963.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$930.15
|
| Rate for Payer: United Healthcare VA CCN |
$930.15
|
|
