|
EVACUATE MOLE OF UTERUS
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
5105987001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$414.46 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna of VT Commercial |
$532.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$414.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$414.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$476.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$470.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$448.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$448.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$448.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$448.00
|
| Rate for Payer: Multiplan Commercial |
$520.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$476.00
|
| Rate for Payer: United Healthcare Commercial |
$532.00
|
|
|
EVACUATE MOLE OF UTERUS
|
Facility
|
OP
|
$1,388.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
9825987001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$614.75 |
| Max. Negotiated Rate |
$1,318.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,318.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,243.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$614.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,243.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$835.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,179.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,124.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$624.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,103.46
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cigna Commercial |
$1,110.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,110.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,110.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$624.60
|
| Rate for Payer: Multiplan Commercial |
$1,290.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,179.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$624.60
|
| Rate for Payer: United Healthcare Commercial |
$1,318.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$624.60
|
| Rate for Payer: United Healthcare VA CCN |
$624.60
|
|
|
EVACUATE MOLE OF UTERUS
|
Facility
|
IP
|
$1,388.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
9825987001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,027.26 |
| Max. Negotiated Rate |
$1,318.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,318.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,027.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,027.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,179.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,165.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,110.40
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cigna Commercial |
$1,110.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,110.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,110.40
|
| Rate for Payer: Multiplan Commercial |
$1,290.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,179.80
|
| Rate for Payer: United Healthcare Commercial |
$1,318.60
|
|
|
EVACUATE MOLE OF UTERUS
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
9825987001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$490.94 |
| Max. Negotiated Rate |
$1,304.72 |
| Rate for Payer: Aetna of VT Commercial |
$1,304.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,243.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$505.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,243.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$687.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$702.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$702.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$564.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$702.97
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cigna Commercial |
$542.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$832.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$832.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$490.94
|
| Rate for Payer: Multiplan Commercial |
$1,290.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$697.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$490.94
|
| Rate for Payer: United Healthcare Commercial |
$755.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$490.94
|
| Rate for Payer: United Healthcare VA CCN |
$490.94
|
|
|
EVACUATE MOLE OF UTERUS
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
5105987001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$248.02 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna of VT Commercial |
$532.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$501.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$248.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$501.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$337.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$476.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$453.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$252.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$445.20
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$448.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$448.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$448.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$252.00
|
| Rate for Payer: Multiplan Commercial |
$520.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$476.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$252.00
|
| Rate for Payer: United Healthcare Commercial |
$532.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.00
|
| Rate for Payer: United Healthcare VA CCN |
$252.00
|
|
|
EVACUATE MOLE OF UTERUS
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
5105987001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$490.94 |
| Max. Negotiated Rate |
$832.66 |
| Rate for Payer: Aetna of VT Commercial |
$526.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$501.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$505.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$501.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$687.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$702.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$702.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$564.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$702.97
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$542.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$832.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$832.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$490.94
|
| Rate for Payer: Multiplan Commercial |
$520.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$697.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$490.94
|
| Rate for Payer: United Healthcare Commercial |
$755.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$490.94
|
| Rate for Payer: United Healthcare VA CCN |
$490.94
|
|
|
EVACUATE MOLE OF UTERUS
|
Professional
|
Both
|
$1,948.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
9605987001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$490.94 |
| Max. Negotiated Rate |
$1,831.12 |
| Rate for Payer: Aetna of VT Commercial |
$1,831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,745.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$505.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,745.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$687.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$702.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$702.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$564.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$702.97
|
| Rate for Payer: Cash Price |
$974.00
|
| Rate for Payer: Cash Price |
$974.00
|
| Rate for Payer: Cigna Commercial |
$542.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$832.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$832.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$490.94
|
| Rate for Payer: Multiplan Commercial |
$1,811.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$697.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$490.94
|
| Rate for Payer: United Healthcare Commercial |
$755.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$490.94
|
| Rate for Payer: United Healthcare VA CCN |
$490.94
|
|
|
EVACUATE MOLE OF UTERUS
|
Facility
|
OP
|
$1,948.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
9605987001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$862.77 |
| Max. Negotiated Rate |
$1,850.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,850.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,745.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$862.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,745.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,172.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,655.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,577.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$876.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,548.66
|
| Rate for Payer: Cash Price |
$974.00
|
| Rate for Payer: Cigna Commercial |
$1,558.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,558.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,558.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$876.60
|
| Rate for Payer: Multiplan Commercial |
$1,811.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,655.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$876.60
|
| Rate for Payer: United Healthcare Commercial |
$1,850.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$876.60
|
| Rate for Payer: United Healthcare VA CCN |
$876.60
|
|
|
EVACUATE MOLE OF UTERUS
|
Facility
|
IP
|
$1,948.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
9605987001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,441.71 |
| Max. Negotiated Rate |
$1,850.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,850.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,441.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,441.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,655.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,636.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,558.40
|
| Rate for Payer: Cash Price |
$974.00
|
| Rate for Payer: Cigna Commercial |
$1,558.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,558.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,558.40
|
| Rate for Payer: Multiplan Commercial |
$1,811.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,655.80
|
| Rate for Payer: United Healthcare Commercial |
$1,850.60
|
|
|
EVACUATE MOLE OF UTERUS
|
Facility
|
IP
|
$1,388.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
9605987002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,027.26 |
| Max. Negotiated Rate |
$1,318.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,318.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,027.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,027.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,179.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,165.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,110.40
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cigna Commercial |
$1,110.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,110.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,110.40
|
| Rate for Payer: Multiplan Commercial |
$1,290.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,179.80
|
| Rate for Payer: United Healthcare Commercial |
$1,318.60
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Professional
|
Both
|
$239.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
9601174001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$224.66 |
| Rate for Payer: Aetna of VT Commercial |
$224.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$214.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$214.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.03
|
| Rate for Payer: Cash Price |
$119.50
|
| Rate for Payer: Cash Price |
$119.50
|
| Rate for Payer: Cigna Commercial |
$56.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$55.19
|
| Rate for Payer: Multiplan Commercial |
$222.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.42
|
| Rate for Payer: United Healthcare Commercial |
$48.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.42
|
| Rate for Payer: United Healthcare VA CCN |
$31.42
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
9811174002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$71.05 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna of VT Commercial |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$81.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$80.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$76.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$89.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.60
|
| Rate for Payer: United Healthcare Commercial |
$91.20
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$143.73
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
4501174001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.37 |
| Max. Negotiated Rate |
$136.54 |
| Rate for Payer: Aetna of VT Commercial |
$136.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$120.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.98
|
| Rate for Payer: Cash Price |
$71.86
|
| Rate for Payer: Cigna Commercial |
$114.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$114.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$114.98
|
| Rate for Payer: Multiplan Commercial |
$133.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.17
|
| Rate for Payer: United Healthcare Commercial |
$136.54
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
5101174001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$106.57 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of VT Commercial |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$120.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$115.20
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.20
|
| Rate for Payer: Multiplan Commercial |
$133.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.40
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
9811174002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna of VT Commercial |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$42.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$57.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$81.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$77.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.32
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$76.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$89.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$43.20
|
| Rate for Payer: United Healthcare Commercial |
$91.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.20
|
| Rate for Payer: United Healthcare VA CCN |
$43.20
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
9601174001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$176.88 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Aetna of VT Commercial |
$227.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$176.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$176.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$203.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$200.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$191.20
|
| Rate for Payer: Cash Price |
$119.50
|
| Rate for Payer: Cigna Commercial |
$191.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$191.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$191.20
|
| Rate for Payer: Multiplan Commercial |
$222.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$203.15
|
| Rate for Payer: United Healthcare Commercial |
$227.05
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
9811174001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna of VT Commercial |
$90.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.03
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$56.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$55.19
|
| Rate for Payer: Multiplan Commercial |
$89.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.42
|
| Rate for Payer: United Healthcare Commercial |
$48.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.42
|
| Rate for Payer: United Healthcare VA CCN |
$31.42
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
9811174002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna of VT Commercial |
$90.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.03
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$56.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$55.19
|
| Rate for Payer: Multiplan Commercial |
$89.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.42
|
| Rate for Payer: United Healthcare Commercial |
$48.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.42
|
| Rate for Payer: United Healthcare VA CCN |
$31.42
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
9601174002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna of VT Commercial |
$90.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.03
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$56.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$55.19
|
| Rate for Payer: Multiplan Commercial |
$89.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.42
|
| Rate for Payer: United Healthcare Commercial |
$48.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.42
|
| Rate for Payer: United Healthcare VA CCN |
$31.42
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
9601174002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna of VT Commercial |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$42.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$57.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$81.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$77.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.32
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$76.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$89.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$43.20
|
| Rate for Payer: United Healthcare Commercial |
$91.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.20
|
| Rate for Payer: United Healthcare VA CCN |
$43.20
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
9601174002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$71.05 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna of VT Commercial |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$81.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$80.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$76.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$89.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.60
|
| Rate for Payer: United Healthcare Commercial |
$91.20
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
5101174001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.78 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of VT Commercial |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$129.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$63.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$129.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$86.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$116.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.48
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$133.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.80
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.80
|
| Rate for Payer: United Healthcare VA CCN |
$64.80
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
9811174001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$71.05 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna of VT Commercial |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$81.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$80.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$76.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$89.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.60
|
| Rate for Payer: United Healthcare Commercial |
$91.20
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
5101174001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna of VT Commercial |
$135.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$129.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$129.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.03
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$56.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$55.19
|
| Rate for Payer: Multiplan Commercial |
$133.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.42
|
| Rate for Payer: United Healthcare Commercial |
$48.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.42
|
| Rate for Payer: United Healthcare VA CCN |
$31.42
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$143.73
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
4501174001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$63.66 |
| Max. Negotiated Rate |
$136.54 |
| Rate for Payer: Aetna of VT Commercial |
$136.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$128.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$63.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$128.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$86.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$116.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.27
|
| Rate for Payer: Cash Price |
$71.86
|
| Rate for Payer: Cigna Commercial |
$114.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$114.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$114.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$64.68
|
| Rate for Payer: Multiplan Commercial |
$133.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.68
|
| Rate for Payer: United Healthcare Commercial |
$136.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.68
|
| Rate for Payer: United Healthcare VA CCN |
$64.68
|
|
