|
EXC BACK LES SC 3 CM/>
|
Facility
|
IP
|
$1,817.00
|
|
|
Service Code
|
CPT 21931
|
| Hospital Charge Code |
9602193101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,344.76 |
| Max. Negotiated Rate |
$1,726.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,726.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,344.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,344.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,544.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,526.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,453.60
|
| Rate for Payer: Cash Price |
$908.50
|
| Rate for Payer: Cigna Commercial |
$1,453.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,453.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,453.60
|
| Rate for Payer: Multiplan Commercial |
$1,689.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,544.45
|
| Rate for Payer: United Healthcare Commercial |
$1,726.15
|
|
|
EXC BACK LES SC 3 CM/>
|
Facility
|
OP
|
$1,817.00
|
|
|
Service Code
|
CPT 21931
|
| Hospital Charge Code |
9602193101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$804.75 |
| Max. Negotiated Rate |
$1,726.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,726.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,627.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$804.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,627.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,093.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,544.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,471.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$817.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,444.52
|
| Rate for Payer: Cash Price |
$908.50
|
| Rate for Payer: Cigna Commercial |
$1,453.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,453.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,453.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$817.65
|
| Rate for Payer: Multiplan Commercial |
$1,689.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,544.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$817.65
|
| Rate for Payer: United Healthcare Commercial |
$1,726.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$817.65
|
| Rate for Payer: United Healthcare VA CCN |
$817.65
|
|
|
EXC BACK LES SC 3 CM/>
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
CPT 21931
|
| Hospital Charge Code |
9602193102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$389.75 |
| Max. Negotiated Rate |
$836.00 |
| Rate for Payer: Aetna of VT Commercial |
$836.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$788.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$389.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$788.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$529.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$748.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$712.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$396.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$699.60
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna Commercial |
$704.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$704.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$704.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$396.00
|
| Rate for Payer: Multiplan Commercial |
$818.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$748.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$396.00
|
| Rate for Payer: United Healthcare Commercial |
$836.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$396.00
|
| Rate for Payer: United Healthcare VA CCN |
$396.00
|
|
|
EXC BACK LES SC 3 CM/>
|
Professional
|
Both
|
$1,817.00
|
|
|
Service Code
|
CPT 21931
|
| Hospital Charge Code |
9602193101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$437.93 |
| Max. Negotiated Rate |
$1,707.98 |
| Rate for Payer: Aetna of VT Commercial |
$1,707.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,627.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$451.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,627.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$613.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$554.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$554.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$554.40
|
| Rate for Payer: Cash Price |
$908.50
|
| Rate for Payer: Cash Price |
$908.50
|
| Rate for Payer: Cigna Commercial |
$828.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$739.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$739.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$437.93
|
| Rate for Payer: Multiplan Commercial |
$1,689.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$621.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$437.93
|
| Rate for Payer: United Healthcare Commercial |
$673.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$437.93
|
| Rate for Payer: United Healthcare VA CCN |
$437.93
|
|
|
EXC BACK LES SC 3 CM/>
|
Professional
|
Both
|
$880.00
|
|
|
Service Code
|
CPT 21931
|
| Hospital Charge Code |
9602193102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$437.93 |
| Max. Negotiated Rate |
$828.91 |
| Rate for Payer: Aetna of VT Commercial |
$827.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$788.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$451.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$788.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$613.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$554.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$554.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$554.40
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna Commercial |
$828.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$739.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$739.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$437.93
|
| Rate for Payer: Multiplan Commercial |
$818.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$621.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$437.93
|
| Rate for Payer: United Healthcare Commercial |
$673.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$437.93
|
| Rate for Payer: United Healthcare VA CCN |
$437.93
|
|
|
EXC BACK LES SC 3 CM/>
|
Facility
|
OP
|
$937.00
|
|
|
Service Code
|
CPT 21931
|
| Hospital Charge Code |
5102193101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$415.00 |
| Max. Negotiated Rate |
$890.15 |
| Rate for Payer: Aetna of VT Commercial |
$890.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$839.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$415.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$839.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$564.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$796.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$758.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$421.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$744.91
|
| Rate for Payer: Cash Price |
$468.50
|
| Rate for Payer: Cigna Commercial |
$749.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$749.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$749.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$421.65
|
| Rate for Payer: Multiplan Commercial |
$871.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$796.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$421.65
|
| Rate for Payer: United Healthcare Commercial |
$890.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$421.65
|
| Rate for Payer: United Healthcare VA CCN |
$421.65
|
|
|
EXC BACK LES SC 3 CM/>
|
Professional
|
Both
|
$937.00
|
|
|
Service Code
|
CPT 21931
|
| Hospital Charge Code |
5102193101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$437.93 |
| Max. Negotiated Rate |
$880.78 |
| Rate for Payer: Aetna of VT Commercial |
$880.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$839.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$451.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$839.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$613.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$554.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$554.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$554.40
|
| Rate for Payer: Cash Price |
$468.50
|
| Rate for Payer: Cash Price |
$468.50
|
| Rate for Payer: Cigna Commercial |
$828.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$739.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$739.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$437.93
|
| Rate for Payer: Multiplan Commercial |
$871.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$621.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$437.93
|
| Rate for Payer: United Healthcare Commercial |
$673.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$437.93
|
| Rate for Payer: United Healthcare VA CCN |
$437.93
|
|
|
EXC BACK TUM DEEP < 5 CM
|
Professional
|
Both
|
$1,847.00
|
|
|
Service Code
|
CPT 21932
|
| Hospital Charge Code |
9822193201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$618.88 |
| Max. Negotiated Rate |
$1,736.18 |
| Rate for Payer: Aetna of VT Commercial |
$1,736.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,654.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$637.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,654.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$866.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$782.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$782.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$711.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$782.49
|
| Rate for Payer: Cash Price |
$923.50
|
| Rate for Payer: Cash Price |
$923.50
|
| Rate for Payer: Cigna Commercial |
$1,169.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,042.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,042.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$618.88
|
| Rate for Payer: Multiplan Commercial |
$1,717.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$878.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$618.88
|
| Rate for Payer: United Healthcare Commercial |
$952.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$618.88
|
| Rate for Payer: United Healthcare VA CCN |
$618.88
|
|
|
EXC BACK TUM DEEP < 5 CM
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
CPT 21932
|
| Hospital Charge Code |
9822193201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$818.04 |
| Max. Negotiated Rate |
$1,754.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,754.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,654.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$818.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,654.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,111.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,569.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,496.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$831.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,468.37
|
| Rate for Payer: Cash Price |
$923.50
|
| Rate for Payer: Cigna Commercial |
$1,477.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,477.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,477.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$831.15
|
| Rate for Payer: Multiplan Commercial |
$1,717.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,569.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$831.15
|
| Rate for Payer: United Healthcare Commercial |
$1,754.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$831.15
|
| Rate for Payer: United Healthcare VA CCN |
$831.15
|
|
|
EXC BACK TUM DEEP < 5 CM
|
Facility
|
IP
|
$1,847.00
|
|
|
Service Code
|
CPT 21932
|
| Hospital Charge Code |
9822193201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,366.96 |
| Max. Negotiated Rate |
$1,754.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,754.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,366.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,366.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,569.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,551.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,477.60
|
| Rate for Payer: Cash Price |
$923.50
|
| Rate for Payer: Cigna Commercial |
$1,477.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,477.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,477.60
|
| Rate for Payer: Multiplan Commercial |
$1,717.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,569.95
|
| Rate for Payer: United Healthcare Commercial |
$1,754.65
|
|
|
EXC BACK TUM DEEP 5 CM/>
|
Facility
|
OP
|
$2,734.00
|
|
|
Service Code
|
CPT 21933
|
| Hospital Charge Code |
9822193301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,210.89 |
| Max. Negotiated Rate |
$2,597.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,597.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,449.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,210.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,449.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,645.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,323.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,214.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,230.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,173.53
|
| Rate for Payer: Cash Price |
$1,367.00
|
| Rate for Payer: Cigna Commercial |
$2,187.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,187.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,187.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,230.30
|
| Rate for Payer: Multiplan Commercial |
$2,542.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,323.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,230.30
|
| Rate for Payer: United Healthcare Commercial |
$2,597.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,230.30
|
| Rate for Payer: United Healthcare VA CCN |
$1,230.30
|
|
|
EXC BACK TUM DEEP 5 CM/>
|
Facility
|
IP
|
$2,734.00
|
|
|
Service Code
|
CPT 21933
|
| Hospital Charge Code |
9822193301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,023.43 |
| Max. Negotiated Rate |
$2,597.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,597.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,023.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,023.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,323.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,296.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,187.20
|
| Rate for Payer: Cash Price |
$1,367.00
|
| Rate for Payer: Cigna Commercial |
$2,187.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,187.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,187.20
|
| Rate for Payer: Multiplan Commercial |
$2,542.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,323.90
|
| Rate for Payer: United Healthcare Commercial |
$2,597.30
|
|
|
EXC BACK TUM DEEP 5 CM/>
|
Professional
|
Both
|
$2,734.00
|
|
|
Service Code
|
CPT 21933
|
| Hospital Charge Code |
9822193301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$683.50 |
| Max. Negotiated Rate |
$2,569.96 |
| Rate for Payer: Aetna of VT Commercial |
$2,569.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,449.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$704.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,449.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$956.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$869.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$869.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$786.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$869.86
|
| Rate for Payer: Cash Price |
$1,367.00
|
| Rate for Payer: Cash Price |
$1,367.00
|
| Rate for Payer: Cigna Commercial |
$1,296.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,154.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,154.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$683.50
|
| Rate for Payer: Multiplan Commercial |
$2,542.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$970.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$683.50
|
| Rate for Payer: United Healthcare Commercial |
$1,051.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$683.50
|
| Rate for Payer: United Healthcare VA CCN |
$683.50
|
|
|
EXC BARTHOLINS GLAND/CYST
|
Professional
|
Both
|
$679.00
|
|
|
Service Code
|
CPT 56740
|
| Hospital Charge Code |
9825674001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$292.68 |
| Max. Negotiated Rate |
$638.26 |
| Rate for Payer: Aetna of VT Commercial |
$638.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$608.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$301.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$608.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$409.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$491.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$491.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$336.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$491.58
|
| Rate for Payer: Cash Price |
$339.50
|
| Rate for Payer: Cash Price |
$339.50
|
| Rate for Payer: Cigna Commercial |
$519.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$487.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$487.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$292.68
|
| Rate for Payer: Multiplan Commercial |
$631.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$415.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$292.68
|
| Rate for Payer: United Healthcare Commercial |
$450.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.68
|
| Rate for Payer: United Healthcare VA CCN |
$292.68
|
|
|
EXC BARTHOLINS GLAND/CYST
|
Facility
|
IP
|
$7,724.00
|
|
|
Service Code
|
CPT 56740
|
| Hospital Charge Code |
9605674001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$5,716.53 |
| Max. Negotiated Rate |
$7,337.80 |
| Rate for Payer: Aetna of VT Commercial |
$7,337.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,716.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,716.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,565.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,488.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,179.20
|
| Rate for Payer: Cash Price |
$3,862.00
|
| Rate for Payer: Cigna Commercial |
$6,179.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,179.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,179.20
|
| Rate for Payer: Multiplan Commercial |
$7,183.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,565.40
|
| Rate for Payer: United Healthcare Commercial |
$7,337.80
|
|
|
EXC BARTHOLINS GLAND/CYST
|
Professional
|
Both
|
$7,046.00
|
|
|
Service Code
|
CPT 56740
|
| Hospital Charge Code |
5105674001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$292.68 |
| Max. Negotiated Rate |
$6,623.24 |
| Rate for Payer: Aetna of VT Commercial |
$6,623.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,312.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$301.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,312.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$409.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$491.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$491.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$336.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$491.58
|
| Rate for Payer: Cash Price |
$3,523.00
|
| Rate for Payer: Cash Price |
$3,523.00
|
| Rate for Payer: Cigna Commercial |
$519.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$487.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$487.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$292.68
|
| Rate for Payer: Multiplan Commercial |
$6,552.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$415.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$292.68
|
| Rate for Payer: United Healthcare Commercial |
$450.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.68
|
| Rate for Payer: United Healthcare VA CCN |
$292.68
|
|
|
EXC BARTHOLINS GLAND/CYST
|
Facility
|
OP
|
$7,046.00
|
|
|
Service Code
|
CPT 56740
|
| Hospital Charge Code |
5105674001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,120.67 |
| Max. Negotiated Rate |
$6,693.70 |
| Rate for Payer: Aetna of VT Commercial |
$6,693.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,312.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,120.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,312.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,241.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,989.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,707.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,170.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,601.57
|
| Rate for Payer: Cash Price |
$3,523.00
|
| Rate for Payer: Cigna Commercial |
$5,636.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,636.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,636.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,170.70
|
| Rate for Payer: Multiplan Commercial |
$6,552.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,989.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,170.70
|
| Rate for Payer: United Healthcare Commercial |
$6,693.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,170.70
|
| Rate for Payer: United Healthcare VA CCN |
$3,170.70
|
|
|
EXC BARTHOLINS GLAND/CYST
|
Facility
|
OP
|
$679.00
|
|
|
Service Code
|
CPT 56740
|
| Hospital Charge Code |
9825674001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$300.73 |
| Max. Negotiated Rate |
$645.05 |
| Rate for Payer: Aetna of VT Commercial |
$645.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$608.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$300.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$608.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$408.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$577.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$549.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$305.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$539.80
|
| Rate for Payer: Cash Price |
$339.50
|
| Rate for Payer: Cigna Commercial |
$543.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$543.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$543.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$305.55
|
| Rate for Payer: Multiplan Commercial |
$631.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$577.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$305.55
|
| Rate for Payer: United Healthcare Commercial |
$645.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$305.55
|
| Rate for Payer: United Healthcare VA CCN |
$305.55
|
|
|
EXC BARTHOLINS GLAND/CYST
|
Facility
|
IP
|
$679.00
|
|
|
Service Code
|
CPT 56740
|
| Hospital Charge Code |
9605674002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$502.53 |
| Max. Negotiated Rate |
$645.05 |
| Rate for Payer: Aetna of VT Commercial |
$645.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$502.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$502.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$577.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$570.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$543.20
|
| Rate for Payer: Cash Price |
$339.50
|
| Rate for Payer: Cigna Commercial |
$543.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$543.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$543.20
|
| Rate for Payer: Multiplan Commercial |
$631.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$577.15
|
| Rate for Payer: United Healthcare Commercial |
$645.05
|
|
|
EXC BARTHOLINS GLAND/CYST
|
Professional
|
Both
|
$7,724.00
|
|
|
Service Code
|
CPT 56740
|
| Hospital Charge Code |
9605674001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$292.68 |
| Max. Negotiated Rate |
$7,260.56 |
| Rate for Payer: Aetna of VT Commercial |
$7,260.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,919.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$301.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,919.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$409.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$491.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$491.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$336.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$491.58
|
| Rate for Payer: Cash Price |
$3,862.00
|
| Rate for Payer: Cash Price |
$3,862.00
|
| Rate for Payer: Cigna Commercial |
$519.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$487.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$487.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$292.68
|
| Rate for Payer: Multiplan Commercial |
$7,183.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$415.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$292.68
|
| Rate for Payer: United Healthcare Commercial |
$450.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.68
|
| Rate for Payer: United Healthcare VA CCN |
$292.68
|
|
|
EXC BARTHOLINS GLAND/CYST
|
Facility
|
OP
|
$7,724.00
|
|
|
Service Code
|
CPT 56740
|
| Hospital Charge Code |
9605674001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,420.96 |
| Max. Negotiated Rate |
$7,337.80 |
| Rate for Payer: Aetna of VT Commercial |
$7,337.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,919.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,420.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,919.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,649.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,565.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,256.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,475.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,140.58
|
| Rate for Payer: Cash Price |
$3,862.00
|
| Rate for Payer: Cigna Commercial |
$6,179.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,179.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,179.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,475.80
|
| Rate for Payer: Multiplan Commercial |
$7,183.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,565.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,475.80
|
| Rate for Payer: United Healthcare Commercial |
$7,337.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,475.80
|
| Rate for Payer: United Healthcare VA CCN |
$3,475.80
|
|
|
EXC BARTHOLINS GLAND/CYST
|
Facility
|
OP
|
$679.00
|
|
|
Service Code
|
CPT 56740
|
| Hospital Charge Code |
9605674002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$300.73 |
| Max. Negotiated Rate |
$645.05 |
| Rate for Payer: Aetna of VT Commercial |
$645.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$608.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$300.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$608.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$408.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$577.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$549.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$305.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$539.80
|
| Rate for Payer: Cash Price |
$339.50
|
| Rate for Payer: Cigna Commercial |
$543.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$543.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$543.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$305.55
|
| Rate for Payer: Multiplan Commercial |
$631.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$577.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$305.55
|
| Rate for Payer: United Healthcare Commercial |
$645.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$305.55
|
| Rate for Payer: United Healthcare VA CCN |
$305.55
|
|
|
EXC BARTHOLINS GLAND/CYST
|
Facility
|
IP
|
$679.00
|
|
|
Service Code
|
CPT 56740
|
| Hospital Charge Code |
9825674001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$502.53 |
| Max. Negotiated Rate |
$645.05 |
| Rate for Payer: Aetna of VT Commercial |
$645.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$502.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$502.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$577.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$570.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$543.20
|
| Rate for Payer: Cash Price |
$339.50
|
| Rate for Payer: Cigna Commercial |
$543.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$543.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$543.20
|
| Rate for Payer: Multiplan Commercial |
$631.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$577.15
|
| Rate for Payer: United Healthcare Commercial |
$645.05
|
|
|
EXC BARTHOLINS GLAND/CYST
|
Professional
|
Both
|
$679.00
|
|
|
Service Code
|
CPT 56740
|
| Hospital Charge Code |
9605674002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$292.68 |
| Max. Negotiated Rate |
$638.26 |
| Rate for Payer: Aetna of VT Commercial |
$638.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$608.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$301.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$608.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$409.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$491.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$491.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$336.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$491.58
|
| Rate for Payer: Cash Price |
$339.50
|
| Rate for Payer: Cash Price |
$339.50
|
| Rate for Payer: Cigna Commercial |
$519.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$487.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$487.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$292.68
|
| Rate for Payer: Multiplan Commercial |
$631.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$415.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$292.68
|
| Rate for Payer: United Healthcare Commercial |
$450.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.68
|
| Rate for Payer: United Healthcare VA CCN |
$292.68
|
|
|
EXC BARTHOLINS GLAND/CYST
|
Facility
|
IP
|
$7,046.00
|
|
|
Service Code
|
CPT 56740
|
| Hospital Charge Code |
5105674001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,214.74 |
| Max. Negotiated Rate |
$6,693.70 |
| Rate for Payer: Aetna of VT Commercial |
$6,693.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,214.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,214.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,989.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,918.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,636.80
|
| Rate for Payer: Cash Price |
$3,523.00
|
| Rate for Payer: Cigna Commercial |
$5,636.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,636.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,636.80
|
| Rate for Payer: Multiplan Commercial |
$6,552.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,989.10
|
| Rate for Payer: United Healthcare Commercial |
$6,693.70
|
|
