|
EXC FACE-MM B9+MARG 1.1-2 CM
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
9821144201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$143.58 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Aetna of VT Commercial |
$184.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$143.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$143.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$164.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.20
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$155.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.20
|
| Rate for Payer: Multiplan Commercial |
$180.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.90
|
| Rate for Payer: United Healthcare Commercial |
$184.30
|
|
|
EXC FACE-MM B9+MARG 1.1-2 CM
|
Facility
|
OP
|
$1,482.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
9601144201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$656.38 |
| Max. Negotiated Rate |
$1,407.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,407.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,327.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$656.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,327.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$892.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,259.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,200.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$666.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,178.19
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cigna Commercial |
$1,185.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,185.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,185.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$666.90
|
| Rate for Payer: Multiplan Commercial |
$1,378.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,259.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$666.90
|
| Rate for Payer: United Healthcare Commercial |
$1,407.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$666.90
|
| Rate for Payer: United Healthcare VA CCN |
$666.90
|
|
|
EXC FACE-MM B9+MARG 1.1-2 CM
|
Professional
|
Both
|
$1,482.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
9601144201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$140.44 |
| Max. Negotiated Rate |
$1,393.08 |
| Rate for Payer: Aetna of VT Commercial |
$1,393.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,327.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$144.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,327.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$196.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$263.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$263.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$263.43
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cigna Commercial |
$157.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$298.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$298.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$183.48
|
| Rate for Payer: Multiplan Commercial |
$1,378.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$140.44
|
| Rate for Payer: United Healthcare Commercial |
$216.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.44
|
| Rate for Payer: United Healthcare VA CCN |
$140.44
|
|
|
EXC FACE-MM B9+MARG 1.1-2 CM
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
9821144201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$140.44 |
| Max. Negotiated Rate |
$298.80 |
| Rate for Payer: Aetna of VT Commercial |
$182.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$173.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$144.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$173.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$196.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$263.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$263.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$263.43
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$157.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$298.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$298.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$183.48
|
| Rate for Payer: Multiplan Commercial |
$180.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$140.44
|
| Rate for Payer: United Healthcare Commercial |
$216.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.44
|
| Rate for Payer: United Healthcare VA CCN |
$140.44
|
|
|
EXC FACE-MM B9+MARG 2.1-3 CM
|
Facility
|
IP
|
$1,216.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
9601144301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$899.96 |
| Max. Negotiated Rate |
$1,155.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,155.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$899.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$899.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,033.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,021.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$972.80
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cigna Commercial |
$972.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$972.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$972.80
|
| Rate for Payer: Multiplan Commercial |
$1,130.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,033.60
|
| Rate for Payer: United Healthcare Commercial |
$1,155.20
|
|
|
EXC FACE-MM B9+MARG 2.1-3 CM
|
Facility
|
OP
|
$1,216.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
9601144301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$538.57 |
| Max. Negotiated Rate |
$1,155.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,155.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,089.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$538.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,089.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$732.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,033.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$984.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$547.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$966.72
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cigna Commercial |
$972.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$972.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$972.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$547.20
|
| Rate for Payer: Multiplan Commercial |
$1,130.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,033.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$547.20
|
| Rate for Payer: United Healthcare Commercial |
$1,155.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$547.20
|
| Rate for Payer: United Healthcare VA CCN |
$547.20
|
|
|
EXC FACE-MM B9+MARG 2.1-3 CM
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
9601144302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$252.01 |
| Max. Negotiated Rate |
$540.55 |
| Rate for Payer: Aetna of VT Commercial |
$540.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$509.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$252.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$509.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$342.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$483.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$460.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$256.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$452.36
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Cigna Commercial |
$455.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$455.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$455.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$256.05
|
| Rate for Payer: Multiplan Commercial |
$529.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$483.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$256.05
|
| Rate for Payer: United Healthcare Commercial |
$540.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$256.05
|
| Rate for Payer: United Healthcare VA CCN |
$256.05
|
|
|
EXC FACE-MM B9+MARG 2.1-3 CM
|
Professional
|
Both
|
$1,216.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
9601144301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.51 |
| Max. Negotiated Rate |
$1,143.04 |
| Rate for Payer: Aetna of VT Commercial |
$1,143.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,089.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$175.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,089.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$238.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$323.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$196.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$323.61
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cigna Commercial |
$191.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$353.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$353.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$216.44
|
| Rate for Payer: Multiplan Commercial |
$1,130.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$242.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$170.51
|
| Rate for Payer: United Healthcare Commercial |
$262.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$170.51
|
| Rate for Payer: United Healthcare VA CCN |
$170.51
|
|
|
EXC FACE-MM B9+MARG 2.1-3 CM
|
Professional
|
Both
|
$648.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
5101144301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$170.51 |
| Max. Negotiated Rate |
$609.12 |
| Rate for Payer: Aetna of VT Commercial |
$609.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$175.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$238.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$323.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$196.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$323.61
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$191.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$353.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$353.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$216.44
|
| Rate for Payer: Multiplan Commercial |
$602.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$242.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$170.51
|
| Rate for Payer: United Healthcare Commercial |
$262.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$170.51
|
| Rate for Payer: United Healthcare VA CCN |
$170.51
|
|
|
EXC FACE-MM B9+MARG 2.1-3 CM
|
Professional
|
Both
|
$569.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
9601144302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.51 |
| Max. Negotiated Rate |
$534.86 |
| Rate for Payer: Aetna of VT Commercial |
$534.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$509.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$175.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$509.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$238.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$323.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$196.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$323.61
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Cigna Commercial |
$191.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$353.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$353.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$216.44
|
| Rate for Payer: Multiplan Commercial |
$529.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$242.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$170.51
|
| Rate for Payer: United Healthcare Commercial |
$262.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$170.51
|
| Rate for Payer: United Healthcare VA CCN |
$170.51
|
|
|
EXC FACE-MM B9+MARG 2.1-3 CM
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
9601144302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$421.12 |
| Max. Negotiated Rate |
$540.55 |
| Rate for Payer: Aetna of VT Commercial |
$540.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$421.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$421.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$483.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$477.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$455.20
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Cigna Commercial |
$455.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$455.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$455.20
|
| Rate for Payer: Multiplan Commercial |
$529.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$483.65
|
| Rate for Payer: United Healthcare Commercial |
$540.55
|
|
|
EXC FACE-MM B9+MARG 2.1-3 CM
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
5101144301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Aetna of VT Commercial |
$615.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$287.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$390.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$550.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$524.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$291.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$515.16
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$518.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$518.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$518.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$291.60
|
| Rate for Payer: Multiplan Commercial |
$602.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$550.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$291.60
|
| Rate for Payer: United Healthcare Commercial |
$615.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$291.60
|
| Rate for Payer: United Healthcare VA CCN |
$291.60
|
|
|
EXC FACE-MM B9+MARG 2.1-3 CM
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
5101144301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$479.58 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Aetna of VT Commercial |
$615.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$479.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$479.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$550.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$544.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$518.40
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$518.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$518.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$518.40
|
| Rate for Payer: Multiplan Commercial |
$602.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$550.80
|
| Rate for Payer: United Healthcare Commercial |
$615.60
|
|
|
EXC FACE TUM DEEP < 2 CM
|
Facility
|
OP
|
$1,463.00
|
|
|
Service Code
|
CPT 21013
|
| Hospital Charge Code |
9822101301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$647.96 |
| Max. Negotiated Rate |
$1,389.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,389.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,310.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$647.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,310.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$880.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,243.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,185.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$658.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,163.09
|
| Rate for Payer: Cash Price |
$731.50
|
| Rate for Payer: Cigna Commercial |
$1,170.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,170.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,170.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$658.35
|
| Rate for Payer: Multiplan Commercial |
$1,360.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,243.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$658.35
|
| Rate for Payer: United Healthcare Commercial |
$1,389.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$658.35
|
| Rate for Payer: United Healthcare VA CCN |
$658.35
|
|
|
EXC FACE TUM DEEP < 2 CM
|
Facility
|
IP
|
$1,463.00
|
|
|
Service Code
|
CPT 21013
|
| Hospital Charge Code |
9822101301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,082.77 |
| Max. Negotiated Rate |
$1,389.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,389.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,082.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,082.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,243.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,228.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,170.40
|
| Rate for Payer: Cash Price |
$731.50
|
| Rate for Payer: Cigna Commercial |
$1,170.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,170.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,170.40
|
| Rate for Payer: Multiplan Commercial |
$1,360.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,243.55
|
| Rate for Payer: United Healthcare Commercial |
$1,389.85
|
|
|
EXC FACE TUM DEEP < 2 CM
|
Professional
|
Both
|
$1,463.00
|
|
|
Service Code
|
CPT 21013
|
| Hospital Charge Code |
9822101301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$379.46 |
| Max. Negotiated Rate |
$1,375.22 |
| Rate for Payer: Aetna of VT Commercial |
$1,375.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,310.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$390.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,310.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$531.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$649.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$649.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$436.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$649.39
|
| Rate for Payer: Cash Price |
$731.50
|
| Rate for Payer: Cash Price |
$731.50
|
| Rate for Payer: Cigna Commercial |
$721.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$827.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$827.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$503.12
|
| Rate for Payer: Multiplan Commercial |
$1,360.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$538.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$379.46
|
| Rate for Payer: United Healthcare Commercial |
$583.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.46
|
| Rate for Payer: United Healthcare VA CCN |
$379.46
|
|
|
EXC FACE TUM DEEP 2 CM/>
|
Facility
|
OP
|
$1,445.00
|
|
|
Service Code
|
CPT 21014
|
| Hospital Charge Code |
9822101401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$639.99 |
| Max. Negotiated Rate |
$1,372.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,372.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,294.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$639.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,294.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$869.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,228.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,170.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$650.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,148.78
|
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Cigna Commercial |
$1,156.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,156.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,156.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$650.25
|
| Rate for Payer: Multiplan Commercial |
$1,343.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,228.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$650.25
|
| Rate for Payer: United Healthcare Commercial |
$1,372.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$650.25
|
| Rate for Payer: United Healthcare VA CCN |
$650.25
|
|
|
EXC FACE TUM DEEP 2 CM/>
|
Facility
|
IP
|
$1,445.00
|
|
|
Service Code
|
CPT 21014
|
| Hospital Charge Code |
9822101401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,069.44 |
| Max. Negotiated Rate |
$1,372.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,372.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,069.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,069.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,228.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,213.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,156.00
|
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Cigna Commercial |
$1,156.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,156.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,156.00
|
| Rate for Payer: Multiplan Commercial |
$1,343.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,228.25
|
| Rate for Payer: United Healthcare Commercial |
$1,372.75
|
|
|
EXC FACE TUM DEEP 2 CM/>
|
Professional
|
Both
|
$1,445.00
|
|
|
Service Code
|
CPT 21014
|
| Hospital Charge Code |
9822101401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$491.41 |
| Max. Negotiated Rate |
$1,358.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,358.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,294.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$506.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,294.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$687.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$619.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$619.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$565.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$619.36
|
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Cigna Commercial |
$932.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$817.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$817.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$491.42
|
| Rate for Payer: Multiplan Commercial |
$1,343.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$697.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$491.41
|
| Rate for Payer: United Healthcare Commercial |
$755.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$491.41
|
| Rate for Payer: United Healthcare VA CCN |
$491.41
|
|
|
EXC F/E/E/N/L MAL+MRG 0.5CM<
|
Facility
|
IP
|
$1,993.00
|
|
|
Service Code
|
CPT 11640
|
| Hospital Charge Code |
9601164001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,475.02 |
| Max. Negotiated Rate |
$1,893.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,893.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,475.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,475.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,694.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,674.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,594.40
|
| Rate for Payer: Cash Price |
$996.50
|
| Rate for Payer: Cigna Commercial |
$1,594.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,594.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,594.40
|
| Rate for Payer: Multiplan Commercial |
$1,853.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,694.05
|
| Rate for Payer: United Healthcare Commercial |
$1,893.35
|
|
|
EXC F/E/E/N/L MAL+MRG 0.5CM<
|
Facility
|
OP
|
$1,560.00
|
|
|
Service Code
|
CPT 11640
|
| Hospital Charge Code |
5101164001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$690.92 |
| Max. Negotiated Rate |
$1,482.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,482.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,397.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$690.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,397.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$939.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,326.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,263.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$702.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,240.20
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cigna Commercial |
$1,248.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,248.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,248.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$702.00
|
| Rate for Payer: Multiplan Commercial |
$1,450.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,326.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$702.00
|
| Rate for Payer: United Healthcare Commercial |
$1,482.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$702.00
|
| Rate for Payer: United Healthcare VA CCN |
$702.00
|
|
|
EXC F/E/E/N/L MAL+MRG 0.5CM<
|
Facility
|
IP
|
$1,560.00
|
|
|
Service Code
|
CPT 11640
|
| Hospital Charge Code |
5101164001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,154.56 |
| Max. Negotiated Rate |
$1,482.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,482.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,154.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,154.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,326.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,310.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,248.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cigna Commercial |
$1,248.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,248.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,248.00
|
| Rate for Payer: Multiplan Commercial |
$1,450.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,326.00
|
| Rate for Payer: United Healthcare Commercial |
$1,482.00
|
|
|
EXC F/E/E/N/L MAL+MRG 0.5CM<
|
Facility
|
IP
|
$433.00
|
|
|
Service Code
|
CPT 11640
|
| Hospital Charge Code |
9601164002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$320.46 |
| Max. Negotiated Rate |
$411.35 |
| Rate for Payer: Aetna of VT Commercial |
$411.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$320.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$320.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$368.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$363.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$346.40
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cigna Commercial |
$346.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$346.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$346.40
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$368.05
|
| Rate for Payer: United Healthcare Commercial |
$411.35
|
|
|
EXC F/E/E/N/L MAL+MRG 0.5CM<
|
Facility
|
OP
|
$433.00
|
|
|
Service Code
|
CPT 11640
|
| Hospital Charge Code |
9601164002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$191.78 |
| Max. Negotiated Rate |
$411.35 |
| Rate for Payer: Aetna of VT Commercial |
$411.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$387.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$191.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$387.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$260.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$368.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$350.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$194.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$344.24
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cigna Commercial |
$346.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$346.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$346.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$194.85
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$368.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$194.85
|
| Rate for Payer: United Healthcare Commercial |
$411.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$194.85
|
| Rate for Payer: United Healthcare VA CCN |
$194.85
|
|
|
EXC F/E/E/N/L MAL+MRG 0.5CM<
|
Professional
|
Both
|
$433.00
|
|
|
Service Code
|
CPT 11640
|
| Hospital Charge Code |
9601164002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$120.17 |
| Max. Negotiated Rate |
$407.02 |
| Rate for Payer: Aetna of VT Commercial |
$407.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$387.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$123.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$387.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$168.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$248.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$248.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$138.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$248.82
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cigna Commercial |
$135.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$313.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$313.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$192.76
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$120.17
|
| Rate for Payer: United Healthcare Commercial |
$184.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.17
|
| Rate for Payer: United Healthcare VA CCN |
$120.17
|
|
