|
EXC HAND TUM DEEP < 1.5 CM
|
Facility
|
OP
|
$1,604.00
|
|
|
Service Code
|
CPT 26116
|
| Hospital Charge Code |
9822611601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$710.41 |
| Max. Negotiated Rate |
$1,523.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,523.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,437.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$710.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,437.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$965.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,363.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,299.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$721.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,275.18
|
| Rate for Payer: Cash Price |
$802.00
|
| Rate for Payer: Cigna Commercial |
$1,283.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,283.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,283.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$721.80
|
| Rate for Payer: Multiplan Commercial |
$1,491.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,363.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$721.80
|
| Rate for Payer: United Healthcare Commercial |
$1,523.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$721.80
|
| Rate for Payer: United Healthcare VA CCN |
$721.80
|
|
|
EXC HAND TUM DEEP < 1.5 CM
|
Facility
|
IP
|
$1,604.00
|
|
|
Service Code
|
CPT 26116
|
| Hospital Charge Code |
9822611601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,187.12 |
| Max. Negotiated Rate |
$1,523.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,523.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,187.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,187.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,363.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,347.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,283.20
|
| Rate for Payer: Cash Price |
$802.00
|
| Rate for Payer: Cigna Commercial |
$1,283.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,283.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,283.20
|
| Rate for Payer: Multiplan Commercial |
$1,491.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,363.40
|
| Rate for Payer: United Healthcare Commercial |
$1,523.80
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Facility
|
IP
|
$201.11
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
4501142001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.84 |
| Max. Negotiated Rate |
$191.05 |
| Rate for Payer: Aetna of VT Commercial |
$191.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$148.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$148.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$168.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$160.89
|
| Rate for Payer: Cash Price |
$100.56
|
| Rate for Payer: Cigna Commercial |
$160.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$160.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$160.89
|
| Rate for Payer: Multiplan Commercial |
$187.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.94
|
| Rate for Payer: United Healthcare Commercial |
$191.05
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
9601142001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$210.38 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Aetna of VT Commercial |
$451.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$425.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$425.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$285.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$384.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$213.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$377.62
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$380.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$380.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$380.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$213.75
|
| Rate for Payer: Multiplan Commercial |
$441.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$403.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$213.75
|
| Rate for Payer: United Healthcare Commercial |
$451.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$213.75
|
| Rate for Payer: United Healthcare VA CCN |
$213.75
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
9811142002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$79.01 |
| Max. Negotiated Rate |
$257.56 |
| Rate for Payer: Aetna of VT Commercial |
$257.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$245.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$245.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$110.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$169.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$90.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.65
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$88.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$195.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$195.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.45
|
| Rate for Payer: Multiplan Commercial |
$254.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.01
|
| Rate for Payer: United Healthcare Commercial |
$121.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.01
|
| Rate for Payer: United Healthcare VA CCN |
$79.01
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
9601142002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$79.01 |
| Max. Negotiated Rate |
$257.56 |
| Rate for Payer: Aetna of VT Commercial |
$257.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$245.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$245.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$110.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$169.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$90.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.65
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$88.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$195.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$195.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.45
|
| Rate for Payer: Multiplan Commercial |
$254.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.01
|
| Rate for Payer: United Healthcare Commercial |
$121.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.01
|
| Rate for Payer: United Healthcare VA CCN |
$79.01
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
5101142001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.01 |
| Max. Negotiated Rate |
$195.43 |
| Rate for Payer: Aetna of VT Commercial |
$189.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$180.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$180.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$110.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$169.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$90.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.65
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna Commercial |
$88.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$195.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$195.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.45
|
| Rate for Payer: Multiplan Commercial |
$187.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.01
|
| Rate for Payer: United Healthcare Commercial |
$121.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.01
|
| Rate for Payer: United Healthcare VA CCN |
$79.01
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
5101142001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.47 |
| Max. Negotiated Rate |
$191.90 |
| Rate for Payer: Aetna of VT Commercial |
$191.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$180.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$89.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$180.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$121.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$171.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$163.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$90.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$160.59
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna Commercial |
$161.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$161.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$161.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$90.90
|
| Rate for Payer: Multiplan Commercial |
$187.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$171.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$90.90
|
| Rate for Payer: United Healthcare Commercial |
$191.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$90.90
|
| Rate for Payer: United Healthcare VA CCN |
$90.90
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
9821142001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$202.79 |
| Max. Negotiated Rate |
$260.30 |
| Rate for Payer: Aetna of VT Commercial |
$260.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$202.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$202.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$232.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$230.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$219.20
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$219.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$219.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$219.20
|
| Rate for Payer: Multiplan Commercial |
$254.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$232.90
|
| Rate for Payer: United Healthcare Commercial |
$260.30
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
9601142001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$351.55 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Aetna of VT Commercial |
$451.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$351.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$351.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$399.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$380.00
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$380.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$380.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$380.00
|
| Rate for Payer: Multiplan Commercial |
$441.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$403.75
|
| Rate for Payer: United Healthcare Commercial |
$451.25
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
9811142001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$121.35 |
| Max. Negotiated Rate |
$260.30 |
| Rate for Payer: Aetna of VT Commercial |
$260.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$245.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$121.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$245.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$164.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$232.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$221.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$123.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$217.83
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$219.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$219.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$219.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$123.30
|
| Rate for Payer: Multiplan Commercial |
$254.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$232.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$123.30
|
| Rate for Payer: United Healthcare Commercial |
$260.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.30
|
| Rate for Payer: United Healthcare VA CCN |
$123.30
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
9811142002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$202.79 |
| Max. Negotiated Rate |
$260.30 |
| Rate for Payer: Aetna of VT Commercial |
$260.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$202.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$202.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$232.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$230.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$219.20
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$219.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$219.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$219.20
|
| Rate for Payer: Multiplan Commercial |
$254.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$232.90
|
| Rate for Payer: United Healthcare Commercial |
$260.30
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
9811142002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$121.35 |
| Max. Negotiated Rate |
$260.30 |
| Rate for Payer: Aetna of VT Commercial |
$260.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$245.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$121.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$245.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$164.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$232.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$221.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$123.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$217.83
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$219.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$219.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$219.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$123.30
|
| Rate for Payer: Multiplan Commercial |
$254.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$232.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$123.30
|
| Rate for Payer: United Healthcare Commercial |
$260.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.30
|
| Rate for Payer: United Healthcare VA CCN |
$123.30
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
9601142002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$202.79 |
| Max. Negotiated Rate |
$260.30 |
| Rate for Payer: Aetna of VT Commercial |
$260.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$202.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$202.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$232.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$230.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$219.20
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$219.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$219.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$219.20
|
| Rate for Payer: Multiplan Commercial |
$254.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$232.90
|
| Rate for Payer: United Healthcare Commercial |
$260.30
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
9601142001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$79.01 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Aetna of VT Commercial |
$446.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$425.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$425.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$110.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$169.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$90.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.65
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$88.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$195.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$195.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.45
|
| Rate for Payer: Multiplan Commercial |
$441.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.01
|
| Rate for Payer: United Healthcare Commercial |
$121.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.01
|
| Rate for Payer: United Healthcare VA CCN |
$79.01
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
9811142001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$79.01 |
| Max. Negotiated Rate |
$257.56 |
| Rate for Payer: Aetna of VT Commercial |
$257.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$245.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$245.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$110.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$169.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$90.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.65
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$88.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$195.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$195.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.45
|
| Rate for Payer: Multiplan Commercial |
$254.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.01
|
| Rate for Payer: United Healthcare Commercial |
$121.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.01
|
| Rate for Payer: United Healthcare VA CCN |
$79.01
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
9601142002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$121.35 |
| Max. Negotiated Rate |
$260.30 |
| Rate for Payer: Aetna of VT Commercial |
$260.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$245.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$121.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$245.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$164.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$232.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$221.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$123.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$217.83
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$219.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$219.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$219.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$123.30
|
| Rate for Payer: Multiplan Commercial |
$254.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$232.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$123.30
|
| Rate for Payer: United Healthcare Commercial |
$260.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.30
|
| Rate for Payer: United Healthcare VA CCN |
$123.30
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
9811142001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$202.79 |
| Max. Negotiated Rate |
$260.30 |
| Rate for Payer: Aetna of VT Commercial |
$260.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$202.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$202.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$232.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$230.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$219.20
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$219.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$219.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$219.20
|
| Rate for Payer: Multiplan Commercial |
$254.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$232.90
|
| Rate for Payer: United Healthcare Commercial |
$260.30
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
9821142001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$79.01 |
| Max. Negotiated Rate |
$257.56 |
| Rate for Payer: Aetna of VT Commercial |
$257.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$245.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$245.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$110.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$169.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$90.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.65
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$88.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$195.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$195.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.45
|
| Rate for Payer: Multiplan Commercial |
$254.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.01
|
| Rate for Payer: United Healthcare Commercial |
$121.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.01
|
| Rate for Payer: United Healthcare VA CCN |
$79.01
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Facility
|
OP
|
$201.11
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
4501142001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.07 |
| Max. Negotiated Rate |
$191.05 |
| Rate for Payer: Aetna of VT Commercial |
$191.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$180.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$89.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$180.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$121.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$90.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.88
|
| Rate for Payer: Cash Price |
$100.56
|
| Rate for Payer: Cigna Commercial |
$160.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$160.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$160.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$90.50
|
| Rate for Payer: Multiplan Commercial |
$187.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$90.50
|
| Rate for Payer: United Healthcare Commercial |
$191.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$90.50
|
| Rate for Payer: United Healthcare VA CCN |
$90.50
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
5101142001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$191.90 |
| Rate for Payer: Aetna of VT Commercial |
$191.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$149.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$149.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$171.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$161.60
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna Commercial |
$161.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$161.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$161.60
|
| Rate for Payer: Multiplan Commercial |
$187.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$171.70
|
| Rate for Payer: United Healthcare Commercial |
$191.90
|
|
|
EXC H-F-NK-SP B9+MARG 0.5/<
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
9821142001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$121.35 |
| Max. Negotiated Rate |
$260.30 |
| Rate for Payer: Aetna of VT Commercial |
$260.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$245.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$121.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$245.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$164.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$232.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$221.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$123.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$217.83
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$219.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$219.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$219.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$123.30
|
| Rate for Payer: Multiplan Commercial |
$254.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$232.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$123.30
|
| Rate for Payer: United Healthcare Commercial |
$260.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.30
|
| Rate for Payer: United Healthcare VA CCN |
$123.30
|
|
|
EXC H-F-NK-SP B9+MARG 0.6-1
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
9601142102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$313.06 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna of VT Commercial |
$401.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$313.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$313.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$359.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$355.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$338.40
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cigna Commercial |
$338.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$338.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$338.40
|
| Rate for Payer: Multiplan Commercial |
$393.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$359.55
|
| Rate for Payer: United Healthcare Commercial |
$401.85
|
|
|
EXC H-F-NK-SP B9+MARG 0.6-1
|
Professional
|
Both
|
$1,003.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
9601142101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$104.19 |
| Max. Negotiated Rate |
$942.82 |
| Rate for Payer: Aetna of VT Commercial |
$942.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$898.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$107.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$898.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$145.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$219.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$219.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$119.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$219.90
|
| Rate for Payer: Cash Price |
$501.50
|
| Rate for Payer: Cash Price |
$501.50
|
| Rate for Payer: Cigna Commercial |
$117.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$245.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$245.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$151.41
|
| Rate for Payer: Multiplan Commercial |
$932.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$147.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$104.19
|
| Rate for Payer: United Healthcare Commercial |
$160.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$104.19
|
| Rate for Payer: United Healthcare VA CCN |
$104.19
|
|
|
EXC H-F-NK-SP B9+MARG 0.6-1
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
5101142101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$429.26 |
| Max. Negotiated Rate |
$551.00 |
| Rate for Payer: Aetna of VT Commercial |
$551.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$429.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$429.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$493.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$487.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$464.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cigna Commercial |
$464.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$464.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$464.00
|
| Rate for Payer: Multiplan Commercial |
$539.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$493.00
|
| Rate for Payer: United Healthcare Commercial |
$551.00
|
|
