|
EXC NECK LES SC 3 CM/>
|
Facility
|
OP
|
$6,297.00
|
|
|
Service Code
|
CPT 21552
|
| Hospital Charge Code |
5102155201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,788.94 |
| Max. Negotiated Rate |
$5,982.15 |
| Rate for Payer: Aetna of VT Commercial |
$5,982.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,641.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,788.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,641.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,790.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,352.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,100.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,833.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,006.11
|
| Rate for Payer: Cash Price |
$3,148.50
|
| Rate for Payer: Cigna Commercial |
$5,037.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,037.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,037.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,833.65
|
| Rate for Payer: Multiplan Commercial |
$5,856.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,352.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,833.65
|
| Rate for Payer: United Healthcare Commercial |
$5,982.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,833.65
|
| Rate for Payer: United Healthcare VA CCN |
$2,833.65
|
|
|
EXC NECK/THORX LES SUBQ < 3 CM
|
Facility
|
IP
|
$4,316.00
|
|
|
Service Code
|
CPT 21555
|
| Hospital Charge Code |
9602155501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,194.27 |
| Max. Negotiated Rate |
$4,100.20 |
| Rate for Payer: Aetna of VT Commercial |
$4,100.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,194.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,194.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,668.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,625.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,452.80
|
| Rate for Payer: Cash Price |
$2,158.00
|
| Rate for Payer: Cigna Commercial |
$3,452.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,452.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,452.80
|
| Rate for Payer: Multiplan Commercial |
$4,013.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,668.60
|
| Rate for Payer: United Healthcare Commercial |
$4,100.20
|
|
|
EXC NECK/THORX LES SUBQ < 3 CM
|
Facility
|
OP
|
$3,387.00
|
|
|
Service Code
|
CPT 21555
|
| Hospital Charge Code |
5102155501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,500.10 |
| Max. Negotiated Rate |
$3,217.65 |
| Rate for Payer: Aetna of VT Commercial |
$3,217.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,034.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,500.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,034.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,038.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,878.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,743.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,524.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,692.66
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cigna Commercial |
$2,709.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,709.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,709.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,524.15
|
| Rate for Payer: Multiplan Commercial |
$3,149.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,878.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,524.15
|
| Rate for Payer: United Healthcare Commercial |
$3,217.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,524.15
|
| Rate for Payer: United Healthcare VA CCN |
$1,524.15
|
|
|
EXC NECK/THORX LES SUBQ < 3 CM
|
Professional
|
Both
|
$930.00
|
|
|
Service Code
|
CPT 21555
|
| Hospital Charge Code |
9602155502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$291.02 |
| Max. Negotiated Rate |
$874.20 |
| Rate for Payer: Aetna of VT Commercial |
$874.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$833.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$299.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$833.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$407.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$530.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$530.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$334.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$530.12
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna Commercial |
$551.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$672.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$672.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$408.26
|
| Rate for Payer: Multiplan Commercial |
$864.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$413.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$291.02
|
| Rate for Payer: United Healthcare Commercial |
$447.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$291.02
|
| Rate for Payer: United Healthcare VA CCN |
$291.02
|
|
|
EXC NECK/THORX LES SUBQ < 3 CM
|
Professional
|
Both
|
$4,316.00
|
|
|
Service Code
|
CPT 21555
|
| Hospital Charge Code |
9602155501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$291.02 |
| Max. Negotiated Rate |
$4,057.04 |
| Rate for Payer: Aetna of VT Commercial |
$4,057.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,866.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$299.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,866.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$407.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$530.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$530.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$334.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$530.12
|
| Rate for Payer: Cash Price |
$2,158.00
|
| Rate for Payer: Cash Price |
$2,158.00
|
| Rate for Payer: Cigna Commercial |
$551.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$672.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$672.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$408.26
|
| Rate for Payer: Multiplan Commercial |
$4,013.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$413.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$291.02
|
| Rate for Payer: United Healthcare Commercial |
$447.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$291.02
|
| Rate for Payer: United Healthcare VA CCN |
$291.02
|
|
|
EXC NECK/THORX LES SUBQ < 3 CM
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT 21555
|
| Hospital Charge Code |
9602155502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$688.29 |
| Max. Negotiated Rate |
$883.50 |
| Rate for Payer: Aetna of VT Commercial |
$883.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$688.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$688.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$790.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$781.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$744.00
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna Commercial |
$744.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$744.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$744.00
|
| Rate for Payer: Multiplan Commercial |
$864.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$790.50
|
| Rate for Payer: United Healthcare Commercial |
$883.50
|
|
|
EXC NECK/THORX LES SUBQ < 3 CM
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
CPT 21555
|
| Hospital Charge Code |
9602155502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$411.90 |
| Max. Negotiated Rate |
$883.50 |
| Rate for Payer: Aetna of VT Commercial |
$883.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$833.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$411.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$833.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$559.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$790.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$753.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$418.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$739.35
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna Commercial |
$744.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$744.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$744.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$418.50
|
| Rate for Payer: Multiplan Commercial |
$864.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$790.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$418.50
|
| Rate for Payer: United Healthcare Commercial |
$883.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$418.50
|
| Rate for Payer: United Healthcare VA CCN |
$418.50
|
|
|
EXC NECK/THORX LES SUBQ < 3 CM
|
Professional
|
Both
|
$3,387.00
|
|
|
Service Code
|
CPT 21555
|
| Hospital Charge Code |
5102155501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$291.02 |
| Max. Negotiated Rate |
$3,183.78 |
| Rate for Payer: Aetna of VT Commercial |
$3,183.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,034.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$299.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,034.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$407.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$530.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$530.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$334.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$530.12
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cigna Commercial |
$551.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$672.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$672.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$408.26
|
| Rate for Payer: Multiplan Commercial |
$3,149.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$413.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$291.02
|
| Rate for Payer: United Healthcare Commercial |
$447.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$291.02
|
| Rate for Payer: United Healthcare VA CCN |
$291.02
|
|
|
EXC NECK/THORX LES SUBQ < 3 CM
|
Facility
|
IP
|
$3,387.00
|
|
|
Service Code
|
CPT 21555
|
| Hospital Charge Code |
5102155501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,506.72 |
| Max. Negotiated Rate |
$3,217.65 |
| Rate for Payer: Aetna of VT Commercial |
$3,217.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,506.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,506.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,878.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,845.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,709.60
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cigna Commercial |
$2,709.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,709.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,709.60
|
| Rate for Payer: Multiplan Commercial |
$3,149.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,878.95
|
| Rate for Payer: United Healthcare Commercial |
$3,217.65
|
|
|
EXC NECK/THORX LES SUBQ < 3 CM
|
Facility
|
OP
|
$4,316.00
|
|
|
Service Code
|
CPT 21555
|
| Hospital Charge Code |
9602155501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,911.56 |
| Max. Negotiated Rate |
$4,100.20 |
| Rate for Payer: Aetna of VT Commercial |
$4,100.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,866.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,911.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,866.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,598.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,668.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,495.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,942.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,431.22
|
| Rate for Payer: Cash Price |
$2,158.00
|
| Rate for Payer: Cigna Commercial |
$3,452.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,452.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,452.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,942.20
|
| Rate for Payer: Multiplan Commercial |
$4,013.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,668.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,942.20
|
| Rate for Payer: United Healthcare Commercial |
$4,100.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,942.20
|
| Rate for Payer: United Healthcare VA CCN |
$1,942.20
|
|
|
EXC NECK TUM DEEP < 5 CM
|
Professional
|
Both
|
$1,466.00
|
|
|
Service Code
|
CPT 21556
|
| Hospital Charge Code |
9822155601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$497.25 |
| Max. Negotiated Rate |
$1,378.04 |
| Rate for Payer: Aetna of VT Commercial |
$1,378.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,313.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$512.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,313.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$696.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$630.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$630.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$571.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$630.79
|
| Rate for Payer: Cash Price |
$733.00
|
| Rate for Payer: Cash Price |
$733.00
|
| Rate for Payer: Cigna Commercial |
$943.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$829.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$829.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$497.25
|
| Rate for Payer: Multiplan Commercial |
$1,363.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$706.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$497.25
|
| Rate for Payer: United Healthcare Commercial |
$764.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$497.25
|
| Rate for Payer: United Healthcare VA CCN |
$497.25
|
|
|
EXC NECK TUM DEEP < 5 CM
|
Facility
|
OP
|
$1,466.00
|
|
|
Service Code
|
CPT 21556
|
| Hospital Charge Code |
9822155601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$649.29 |
| Max. Negotiated Rate |
$1,392.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,392.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,313.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$649.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,313.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$882.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,246.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,187.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$659.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,165.47
|
| Rate for Payer: Cash Price |
$733.00
|
| Rate for Payer: Cigna Commercial |
$1,172.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,172.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,172.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$659.70
|
| Rate for Payer: Multiplan Commercial |
$1,363.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,246.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$659.70
|
| Rate for Payer: United Healthcare Commercial |
$1,392.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$659.70
|
| Rate for Payer: United Healthcare VA CCN |
$659.70
|
|
|
EXC NECK TUM DEEP < 5 CM
|
Facility
|
IP
|
$1,466.00
|
|
|
Service Code
|
CPT 21556
|
| Hospital Charge Code |
9822155601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,084.99 |
| Max. Negotiated Rate |
$1,392.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,392.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,084.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,084.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,246.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,231.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,172.80
|
| Rate for Payer: Cash Price |
$733.00
|
| Rate for Payer: Cigna Commercial |
$1,172.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,172.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,172.80
|
| Rate for Payer: Multiplan Commercial |
$1,363.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,246.10
|
| Rate for Payer: United Healthcare Commercial |
$1,392.70
|
|
|
EXC NECK TUM DEEP 5 CM/>
|
Facility
|
OP
|
$2,705.00
|
|
|
Service Code
|
CPT 21554
|
| Hospital Charge Code |
9822155401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,198.04 |
| Max. Negotiated Rate |
$2,569.75 |
| Rate for Payer: Aetna of VT Commercial |
$2,569.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,423.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,198.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,423.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,628.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,299.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,191.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,217.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,150.47
|
| Rate for Payer: Cash Price |
$1,352.50
|
| Rate for Payer: Cigna Commercial |
$2,164.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,164.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,164.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,217.25
|
| Rate for Payer: Multiplan Commercial |
$2,515.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,299.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,217.25
|
| Rate for Payer: United Healthcare Commercial |
$2,569.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,217.25
|
| Rate for Payer: United Healthcare VA CCN |
$1,217.25
|
|
|
EXC NECK TUM DEEP 5 CM/>
|
Professional
|
Both
|
$2,705.00
|
|
|
Service Code
|
CPT 21554
|
| Hospital Charge Code |
9822155401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$680.30 |
| Max. Negotiated Rate |
$2,542.70 |
| Rate for Payer: Aetna of VT Commercial |
$2,542.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,423.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$700.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,423.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$952.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$862.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$862.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$782.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$862.16
|
| Rate for Payer: Cash Price |
$1,352.50
|
| Rate for Payer: Cash Price |
$1,352.50
|
| Rate for Payer: Cigna Commercial |
$1,291.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,143.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,143.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$680.31
|
| Rate for Payer: Multiplan Commercial |
$2,515.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$966.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$680.30
|
| Rate for Payer: United Healthcare Commercial |
$1,046.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$680.30
|
| Rate for Payer: United Healthcare VA CCN |
$680.30
|
|
|
EXC NECK TUM DEEP 5 CM/>
|
Facility
|
IP
|
$2,705.00
|
|
|
Service Code
|
CPT 21554
|
| Hospital Charge Code |
9822155401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,001.97 |
| Max. Negotiated Rate |
$2,569.75 |
| Rate for Payer: Aetna of VT Commercial |
$2,569.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,001.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,001.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,299.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,272.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,164.00
|
| Rate for Payer: Cash Price |
$1,352.50
|
| Rate for Payer: Cigna Commercial |
$2,164.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,164.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,164.00
|
| Rate for Payer: Multiplan Commercial |
$2,515.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,299.25
|
| Rate for Payer: United Healthcare Commercial |
$2,569.75
|
|
|
EXC RECT TUM TRANSANAL PART
|
Facility
|
IP
|
$1,686.00
|
|
|
Service Code
|
CPT 45171
|
| Hospital Charge Code |
9824517101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,247.81 |
| Max. Negotiated Rate |
$1,601.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,601.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,247.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,247.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,433.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,416.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,348.80
|
| Rate for Payer: Cash Price |
$843.00
|
| Rate for Payer: Cigna Commercial |
$1,348.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,348.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,348.80
|
| Rate for Payer: Multiplan Commercial |
$1,567.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,433.10
|
| Rate for Payer: United Healthcare Commercial |
$1,601.70
|
|
|
EXC RECT TUM TRANSANAL PART
|
Facility
|
OP
|
$1,686.00
|
|
|
Service Code
|
CPT 45171
|
| Hospital Charge Code |
9824517101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$746.73 |
| Max. Negotiated Rate |
$1,601.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,601.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,510.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$746.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,510.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,014.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,433.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,365.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$758.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,340.37
|
| Rate for Payer: Cash Price |
$843.00
|
| Rate for Payer: Cigna Commercial |
$1,348.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,348.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,348.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$758.70
|
| Rate for Payer: Multiplan Commercial |
$1,567.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,433.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$758.70
|
| Rate for Payer: United Healthcare Commercial |
$1,601.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$758.70
|
| Rate for Payer: United Healthcare VA CCN |
$758.70
|
|
|
EXC RECT TUM TRANSANAL PART
|
Professional
|
Both
|
$1,686.00
|
|
|
Service Code
|
CPT 45171
|
| Hospital Charge Code |
9824517101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$579.14 |
| Max. Negotiated Rate |
$1,584.84 |
| Rate for Payer: Aetna of VT Commercial |
$1,584.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,510.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$596.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,510.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$810.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$740.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$740.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$666.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$740.77
|
| Rate for Payer: Cash Price |
$843.00
|
| Rate for Payer: Cash Price |
$843.00
|
| Rate for Payer: Cigna Commercial |
$1,058.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$962.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$962.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$579.14
|
| Rate for Payer: Multiplan Commercial |
$1,567.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$822.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$579.15
|
| Rate for Payer: United Healthcare Commercial |
$890.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$579.15
|
| Rate for Payer: United Healthcare VA CCN |
$579.15
|
|
|
EXC SHOULDER LES SC 3 CM/>
|
Facility
|
IP
|
$5,001.00
|
|
|
Service Code
|
CPT 23071
|
| Hospital Charge Code |
5102307101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,701.24 |
| Max. Negotiated Rate |
$4,750.95 |
| Rate for Payer: Aetna of VT Commercial |
$4,750.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,701.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,701.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,250.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,200.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,000.80
|
| Rate for Payer: Cash Price |
$2,500.50
|
| Rate for Payer: Cigna Commercial |
$4,000.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,000.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,000.80
|
| Rate for Payer: Multiplan Commercial |
$4,650.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,250.85
|
| Rate for Payer: United Healthcare Commercial |
$4,750.95
|
|
|
EXC SHOULDER LES SC 3 CM/>
|
Professional
|
Both
|
$6,073.00
|
|
|
Service Code
|
CPT 23071
|
| Hospital Charge Code |
9602307101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$393.99 |
| Max. Negotiated Rate |
$5,708.62 |
| Rate for Payer: Aetna of VT Commercial |
$5,708.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,440.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$405.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,440.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$551.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$497.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$497.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$453.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$497.32
|
| Rate for Payer: Cash Price |
$3,036.50
|
| Rate for Payer: Cash Price |
$3,036.50
|
| Rate for Payer: Cigna Commercial |
$745.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$662.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$662.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$393.99
|
| Rate for Payer: Multiplan Commercial |
$5,647.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$559.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$394.00
|
| Rate for Payer: United Healthcare Commercial |
$606.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.00
|
| Rate for Payer: United Healthcare VA CCN |
$394.00
|
|
|
EXC SHOULDER LES SC 3 CM/>
|
Facility
|
OP
|
$6,073.00
|
|
|
Service Code
|
CPT 23071
|
| Hospital Charge Code |
9602307101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,689.73 |
| Max. Negotiated Rate |
$5,769.35 |
| Rate for Payer: Aetna of VT Commercial |
$5,769.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,440.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,689.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,440.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,655.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,162.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,919.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,732.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,828.03
|
| Rate for Payer: Cash Price |
$3,036.50
|
| Rate for Payer: Cigna Commercial |
$4,858.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,858.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,858.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,732.85
|
| Rate for Payer: Multiplan Commercial |
$5,647.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,162.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,732.85
|
| Rate for Payer: United Healthcare Commercial |
$5,769.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,732.85
|
| Rate for Payer: United Healthcare VA CCN |
$2,732.85
|
|
|
EXC SHOULDER LES SC 3 CM/>
|
Facility
|
OP
|
$1,073.00
|
|
|
Service Code
|
CPT 23071
|
| Hospital Charge Code |
9602307102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$475.23 |
| Max. Negotiated Rate |
$1,019.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,019.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$961.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$475.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$961.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$645.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$912.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$869.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$482.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$853.03
|
| Rate for Payer: Cash Price |
$536.50
|
| Rate for Payer: Cigna Commercial |
$858.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$858.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$858.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$482.85
|
| Rate for Payer: Multiplan Commercial |
$997.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$912.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$482.85
|
| Rate for Payer: United Healthcare Commercial |
$1,019.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$482.85
|
| Rate for Payer: United Healthcare VA CCN |
$482.85
|
|
|
EXC SHOULDER LES SC 3 CM/>
|
Facility
|
IP
|
$1,073.00
|
|
|
Service Code
|
CPT 23071
|
| Hospital Charge Code |
9602307102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$794.13 |
| Max. Negotiated Rate |
$1,019.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,019.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$794.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$794.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$912.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$901.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$858.40
|
| Rate for Payer: Cash Price |
$536.50
|
| Rate for Payer: Cigna Commercial |
$858.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$858.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$858.40
|
| Rate for Payer: Multiplan Commercial |
$997.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$912.05
|
| Rate for Payer: United Healthcare Commercial |
$1,019.35
|
|
|
EXC SHOULDER LES SC 3 CM/>
|
Professional
|
Both
|
$5,001.00
|
|
|
Service Code
|
CPT 23071
|
| Hospital Charge Code |
5102307101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$393.99 |
| Max. Negotiated Rate |
$4,700.94 |
| Rate for Payer: Aetna of VT Commercial |
$4,700.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,480.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$405.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,480.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$551.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$497.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$497.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$453.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$497.32
|
| Rate for Payer: Cash Price |
$2,500.50
|
| Rate for Payer: Cash Price |
$2,500.50
|
| Rate for Payer: Cigna Commercial |
$745.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$662.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$662.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$393.99
|
| Rate for Payer: Multiplan Commercial |
$4,650.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$559.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$394.00
|
| Rate for Payer: United Healthcare Commercial |
$606.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.00
|
| Rate for Payer: United Healthcare VA CCN |
$394.00
|
|
