|
EXCISION OF TONGUE FOLD
|
Facility
|
IP
|
$1,416.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
9604111502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,047.98 |
| Max. Negotiated Rate |
$1,345.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,345.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,047.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,047.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,203.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,189.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,132.80
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cigna Commercial |
$1,132.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,132.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,132.80
|
| Rate for Payer: Multiplan Commercial |
$1,316.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,203.60
|
| Rate for Payer: United Healthcare Commercial |
$1,345.20
|
|
|
EXCISION OF TONGUE FOLD
|
Facility
|
IP
|
$2,360.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
9604111501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,746.64 |
| Max. Negotiated Rate |
$2,242.00 |
| Rate for Payer: Aetna of VT Commercial |
$2,242.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,746.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,746.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,006.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,982.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,888.00
|
| Rate for Payer: Cash Price |
$1,180.00
|
| Rate for Payer: Cigna Commercial |
$1,888.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,888.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,888.00
|
| Rate for Payer: Multiplan Commercial |
$2,194.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,006.00
|
| Rate for Payer: United Healthcare Commercial |
$2,242.00
|
|
|
EXCISION OF TONGUE FOLD
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
5104111501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$418.10 |
| Max. Negotiated Rate |
$896.80 |
| Rate for Payer: Aetna of VT Commercial |
$896.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$845.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$418.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$845.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$568.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$802.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$764.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$424.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$750.48
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cigna Commercial |
$755.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$755.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$755.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$424.80
|
| Rate for Payer: Multiplan Commercial |
$877.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$802.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$424.80
|
| Rate for Payer: United Healthcare Commercial |
$896.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$424.80
|
| Rate for Payer: United Healthcare VA CCN |
$424.80
|
|
|
EXCISION OF TONGUE FOLD
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
9604111501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,045.24 |
| Max. Negotiated Rate |
$2,242.00 |
| Rate for Payer: Aetna of VT Commercial |
$2,242.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,114.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,045.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,114.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,420.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,006.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,911.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,062.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,876.20
|
| Rate for Payer: Cash Price |
$1,180.00
|
| Rate for Payer: Cigna Commercial |
$1,888.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,888.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,888.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,062.00
|
| Rate for Payer: Multiplan Commercial |
$2,194.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,006.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,062.00
|
| Rate for Payer: United Healthcare Commercial |
$2,242.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,062.00
|
| Rate for Payer: United Healthcare VA CCN |
$1,062.00
|
|
|
EXCISION OF TONGUE FOLD
|
Facility
|
OP
|
$1,416.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
9604111502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$627.15 |
| Max. Negotiated Rate |
$1,345.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,345.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,268.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$627.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,268.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$852.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,203.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,146.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$637.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,125.72
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cigna Commercial |
$1,132.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,132.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,132.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$637.20
|
| Rate for Payer: Multiplan Commercial |
$1,316.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,203.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$637.20
|
| Rate for Payer: United Healthcare Commercial |
$1,345.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$637.20
|
| Rate for Payer: United Healthcare VA CCN |
$637.20
|
|
|
EXCISION OF TONGUE FOLD
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
5104111501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$698.65 |
| Max. Negotiated Rate |
$896.80 |
| Rate for Payer: Aetna of VT Commercial |
$896.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$698.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$698.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$802.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$792.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$755.20
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cigna Commercial |
$755.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$755.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$755.20
|
| Rate for Payer: Multiplan Commercial |
$877.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$802.40
|
| Rate for Payer: United Healthcare Commercial |
$896.80
|
|
|
EXCISION PILONIDAL CYST/SINUS
|
Facility
|
IP
|
$824.00
|
|
|
Service Code
|
CPT 11770
|
| Hospital Charge Code |
9821177001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$609.84 |
| Max. Negotiated Rate |
$782.80 |
| Rate for Payer: Aetna of VT Commercial |
$782.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$609.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$609.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$700.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$692.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$659.20
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cigna Commercial |
$659.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$659.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$659.20
|
| Rate for Payer: Multiplan Commercial |
$766.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$700.40
|
| Rate for Payer: United Healthcare Commercial |
$782.80
|
|
|
EXCISION PILONIDAL CYST/SINUS
|
Facility
|
OP
|
$824.00
|
|
|
Service Code
|
CPT 11770
|
| Hospital Charge Code |
9821177001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$364.95 |
| Max. Negotiated Rate |
$782.80 |
| Rate for Payer: Aetna of VT Commercial |
$782.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$738.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$364.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$738.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$496.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$700.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$667.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$370.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$655.08
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cigna Commercial |
$659.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$659.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$659.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$370.80
|
| Rate for Payer: Multiplan Commercial |
$766.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$700.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$370.80
|
| Rate for Payer: United Healthcare Commercial |
$782.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$370.80
|
| Rate for Payer: United Healthcare VA CCN |
$370.80
|
|
|
EXCISION PILONIDAL CYST/SINUS
|
Professional
|
Both
|
$824.00
|
|
|
Service Code
|
CPT 11770
|
| Hospital Charge Code |
9821177001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$171.26 |
| Max. Negotiated Rate |
$774.56 |
| Rate for Payer: Aetna of VT Commercial |
$774.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$738.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$738.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$239.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$443.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$443.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$196.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$443.68
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cigna Commercial |
$315.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$536.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$536.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$326.39
|
| Rate for Payer: Multiplan Commercial |
$766.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$243.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$171.26
|
| Rate for Payer: United Healthcare Commercial |
$263.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.26
|
| Rate for Payer: United Healthcare VA CCN |
$171.26
|
|
|
EXCISION PREPATELLAR BURSA
|
Facility
|
OP
|
$1,298.00
|
|
|
Service Code
|
CPT 27340
|
| Hospital Charge Code |
9822734001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$574.88 |
| Max. Negotiated Rate |
$1,233.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,233.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,162.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$574.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,162.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$781.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,103.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,051.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$584.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,031.91
|
| Rate for Payer: Cash Price |
$649.00
|
| Rate for Payer: Cigna Commercial |
$1,038.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,038.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,038.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$584.10
|
| Rate for Payer: Multiplan Commercial |
$1,207.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,103.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$584.10
|
| Rate for Payer: United Healthcare Commercial |
$1,233.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$584.10
|
| Rate for Payer: United Healthcare VA CCN |
$584.10
|
|
|
EXCISION PREPATELLAR BURSA
|
Facility
|
IP
|
$1,298.00
|
|
|
Service Code
|
CPT 27340
|
| Hospital Charge Code |
9822734001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$960.65 |
| Max. Negotiated Rate |
$1,233.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,233.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$960.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$960.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,103.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,090.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,038.40
|
| Rate for Payer: Cash Price |
$649.00
|
| Rate for Payer: Cigna Commercial |
$1,038.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,038.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,038.40
|
| Rate for Payer: Multiplan Commercial |
$1,207.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,103.30
|
| Rate for Payer: United Healthcare Commercial |
$1,233.10
|
|
|
EXCISION PREPATELLAR BURSA
|
Professional
|
Both
|
$1,298.00
|
|
|
Service Code
|
CPT 27340
|
| Hospital Charge Code |
9822734001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$361.96 |
| Max. Negotiated Rate |
$1,220.12 |
| Rate for Payer: Aetna of VT Commercial |
$1,220.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,162.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$372.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,162.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$506.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$646.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$646.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$416.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$646.01
|
| Rate for Payer: Cash Price |
$649.00
|
| Rate for Payer: Cash Price |
$649.00
|
| Rate for Payer: Cigna Commercial |
$684.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$599.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$599.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$361.97
|
| Rate for Payer: Multiplan Commercial |
$1,207.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$513.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$361.96
|
| Rate for Payer: United Healthcare Commercial |
$556.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$361.96
|
| Rate for Payer: United Healthcare VA CCN |
$361.96
|
|
|
EXCISION VAGINAL CYST/TUMOR
|
Facility
|
IP
|
$6,645.00
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
5105713501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,917.96 |
| Max. Negotiated Rate |
$6,312.75 |
| Rate for Payer: Aetna of VT Commercial |
$6,312.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,917.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,917.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,648.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,581.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,316.00
|
| Rate for Payer: Cash Price |
$3,322.50
|
| Rate for Payer: Cigna Commercial |
$5,316.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,316.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,316.00
|
| Rate for Payer: Multiplan Commercial |
$6,179.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,648.25
|
| Rate for Payer: United Healthcare Commercial |
$6,312.75
|
|
|
EXCISION VAGINAL CYST/TUMOR
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
9605713502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$514.37 |
| Max. Negotiated Rate |
$660.25 |
| Rate for Payer: Aetna of VT Commercial |
$660.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$514.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$514.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$590.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$583.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$556.00
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cigna Commercial |
$556.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.00
|
| Rate for Payer: Multiplan Commercial |
$646.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$590.75
|
| Rate for Payer: United Healthcare Commercial |
$660.25
|
|
|
EXCISION VAGINAL CYST/TUMOR
|
Professional
|
Both
|
$7,339.00
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
9605713501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$176.15 |
| Max. Negotiated Rate |
$6,898.66 |
| Rate for Payer: Aetna of VT Commercial |
$6,898.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,575.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$181.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,575.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$246.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$337.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$337.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$202.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.40
|
| Rate for Payer: Cash Price |
$3,669.50
|
| Rate for Payer: Cash Price |
$3,669.50
|
| Rate for Payer: Cigna Commercial |
$311.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$381.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$381.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$231.72
|
| Rate for Payer: Multiplan Commercial |
$6,825.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$176.15
|
| Rate for Payer: United Healthcare Commercial |
$270.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$176.15
|
| Rate for Payer: United Healthcare VA CCN |
$176.15
|
|
|
EXCISION VAGINAL CYST/TUMOR
|
Facility
|
OP
|
$7,339.00
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
9605713501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,250.44 |
| Max. Negotiated Rate |
$6,972.05 |
| Rate for Payer: Aetna of VT Commercial |
$6,972.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,575.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,250.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,575.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,418.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,238.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,944.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,302.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,834.51
|
| Rate for Payer: Cash Price |
$3,669.50
|
| Rate for Payer: Cigna Commercial |
$5,871.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,871.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,871.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,302.55
|
| Rate for Payer: Multiplan Commercial |
$6,825.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,238.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,302.55
|
| Rate for Payer: United Healthcare Commercial |
$6,972.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,302.55
|
| Rate for Payer: United Healthcare VA CCN |
$3,302.55
|
|
|
EXCISION VAGINAL CYST/TUMOR
|
Professional
|
Both
|
$695.00
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
9825713501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$176.15 |
| Max. Negotiated Rate |
$653.30 |
| Rate for Payer: Aetna of VT Commercial |
$653.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$622.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$181.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$622.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$246.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$337.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$337.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$202.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.40
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cigna Commercial |
$311.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$381.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$381.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$231.72
|
| Rate for Payer: Multiplan Commercial |
$646.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$176.15
|
| Rate for Payer: United Healthcare Commercial |
$270.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$176.15
|
| Rate for Payer: United Healthcare VA CCN |
$176.15
|
|
|
EXCISION VAGINAL CYST/TUMOR
|
Facility
|
IP
|
$7,339.00
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
9605713501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$5,431.59 |
| Max. Negotiated Rate |
$6,972.05 |
| Rate for Payer: Aetna of VT Commercial |
$6,972.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,431.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,431.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,238.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,164.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,871.20
|
| Rate for Payer: Cash Price |
$3,669.50
|
| Rate for Payer: Cigna Commercial |
$5,871.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,871.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,871.20
|
| Rate for Payer: Multiplan Commercial |
$6,825.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,238.15
|
| Rate for Payer: United Healthcare Commercial |
$6,972.05
|
|
|
EXCISION VAGINAL CYST/TUMOR
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
9605713502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$307.82 |
| Max. Negotiated Rate |
$660.25 |
| Rate for Payer: Aetna of VT Commercial |
$660.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$622.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$307.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$622.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$590.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$562.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$312.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$552.52
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cigna Commercial |
$556.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$312.75
|
| Rate for Payer: Multiplan Commercial |
$646.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$590.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$312.75
|
| Rate for Payer: United Healthcare Commercial |
$660.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$312.75
|
| Rate for Payer: United Healthcare VA CCN |
$312.75
|
|
|
EXCISION VAGINAL CYST/TUMOR
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
9825713501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$514.37 |
| Max. Negotiated Rate |
$660.25 |
| Rate for Payer: Aetna of VT Commercial |
$660.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$514.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$514.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$590.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$583.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$556.00
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cigna Commercial |
$556.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.00
|
| Rate for Payer: Multiplan Commercial |
$646.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$590.75
|
| Rate for Payer: United Healthcare Commercial |
$660.25
|
|
|
EXCISION VAGINAL CYST/TUMOR
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
9825713501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$307.82 |
| Max. Negotiated Rate |
$660.25 |
| Rate for Payer: Aetna of VT Commercial |
$660.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$622.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$307.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$622.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$590.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$562.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$312.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$552.52
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cigna Commercial |
$556.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$312.75
|
| Rate for Payer: Multiplan Commercial |
$646.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$590.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$312.75
|
| Rate for Payer: United Healthcare Commercial |
$660.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$312.75
|
| Rate for Payer: United Healthcare VA CCN |
$312.75
|
|
|
EXCISION VAGINAL CYST/TUMOR
|
Facility
|
OP
|
$6,645.00
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
5105713501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,943.07 |
| Max. Negotiated Rate |
$6,312.75 |
| Rate for Payer: Aetna of VT Commercial |
$6,312.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,953.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,943.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,953.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,000.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,648.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,382.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,990.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,282.77
|
| Rate for Payer: Cash Price |
$3,322.50
|
| Rate for Payer: Cigna Commercial |
$5,316.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,316.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,316.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,990.25
|
| Rate for Payer: Multiplan Commercial |
$6,179.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,648.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,990.25
|
| Rate for Payer: United Healthcare Commercial |
$6,312.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,990.25
|
| Rate for Payer: United Healthcare VA CCN |
$2,990.25
|
|
|
EXCISION VAGINAL CYST/TUMOR
|
Professional
|
Both
|
$6,645.00
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
5105713501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$176.15 |
| Max. Negotiated Rate |
$6,246.30 |
| Rate for Payer: Aetna of VT Commercial |
$6,246.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,953.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$181.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,953.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$246.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$337.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$337.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$202.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.40
|
| Rate for Payer: Cash Price |
$3,322.50
|
| Rate for Payer: Cash Price |
$3,322.50
|
| Rate for Payer: Cigna Commercial |
$311.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$381.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$381.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$231.72
|
| Rate for Payer: Multiplan Commercial |
$6,179.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$176.15
|
| Rate for Payer: United Healthcare Commercial |
$270.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$176.15
|
| Rate for Payer: United Healthcare VA CCN |
$176.15
|
|
|
EXCISION VAGINAL CYST/TUMOR
|
Professional
|
Both
|
$695.00
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
9605713502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$176.15 |
| Max. Negotiated Rate |
$653.30 |
| Rate for Payer: Aetna of VT Commercial |
$653.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$622.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$181.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$622.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$246.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$337.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$337.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$202.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.40
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cigna Commercial |
$311.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$381.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$381.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$231.72
|
| Rate for Payer: Multiplan Commercial |
$646.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$176.15
|
| Rate for Payer: United Healthcare Commercial |
$270.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$176.15
|
| Rate for Payer: United Healthcare VA CCN |
$176.15
|
|
|
EXC LEG/ANKLE LES SC 3 CM/>
|
Professional
|
Both
|
$1,471.00
|
|
|
Service Code
|
CPT 27632
|
| Hospital Charge Code |
9822763201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$384.58 |
| Max. Negotiated Rate |
$1,382.74 |
| Rate for Payer: Aetna of VT Commercial |
$1,382.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,317.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$396.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,317.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$538.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$487.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$487.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$442.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$487.76
|
| Rate for Payer: Cash Price |
$735.50
|
| Rate for Payer: Cash Price |
$735.50
|
| Rate for Payer: Cigna Commercial |
$726.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$643.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$643.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$384.58
|
| Rate for Payer: Multiplan Commercial |
$1,368.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$546.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$384.58
|
| Rate for Payer: United Healthcare Commercial |
$591.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$384.58
|
| Rate for Payer: United Healthcare VA CCN |
$384.58
|
|
