|
HYALURONATE SODIUM
|
Professional
|
Both
|
$408.31
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
636J732301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$112.45 |
| Max. Negotiated Rate |
$383.81 |
| Rate for Payer: Aetna of VT Commercial |
$383.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$353.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$115.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$353.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$129.32
|
| Rate for Payer: Cash Price |
$204.16
|
| Rate for Payer: Cash Price |
$204.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$120.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$120.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$128.71
|
| Rate for Payer: Multiplan Commercial |
$379.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.45
|
| Rate for Payer: United Healthcare Commercial |
$172.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.45
|
| Rate for Payer: United Healthcare VA CCN |
$112.45
|
|
|
HYDROCORTISONE 1% CREAM
|
Professional
|
Both
|
$1.18
|
|
| Hospital Charge Code |
2500000079
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Aetna of VT Commercial |
$1.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.06
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.10
|
| Rate for Payer: United Healthcare Commercial |
$1.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.47
|
|
|
HYDROCORTISONE 1% CREAM
|
Professional
|
Both
|
$1.18
|
|
|
Service Code
|
NDC 536127780
|
| Hospital Charge Code |
2500000079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Aetna of VT Commercial |
$1.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.06
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.10
|
| Rate for Payer: United Healthcare Commercial |
$1.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.47
|
|
|
HYDROCORTISONE SODIUM SUCC I
|
Professional
|
Both
|
$116.84
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
636J172001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.58 |
| Max. Negotiated Rate |
$109.83 |
| Rate for Payer: Aetna of VT Commercial |
$109.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$56.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$56.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.51
|
| Rate for Payer: Cash Price |
$58.42
|
| Rate for Payer: Cash Price |
$58.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$20.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$20.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$20.58
|
| Rate for Payer: Multiplan Commercial |
$108.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.31
|
| Rate for Payer: United Healthcare Commercial |
$32.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.31
|
| Rate for Payer: United Healthcare VA CCN |
$21.31
|
|
|
HYDROCORTISONE SODIUM SUCC I
|
Facility
|
IP
|
$116.84
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
636J172001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.47 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Aetna of VT Commercial |
$111.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$99.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$98.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$93.47
|
| Rate for Payer: Cash Price |
$58.42
|
| Rate for Payer: Cigna Commercial |
$93.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$93.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$93.47
|
| Rate for Payer: Multiplan Commercial |
$108.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.31
|
| Rate for Payer: United Healthcare Commercial |
$111.00
|
|
|
HYDROCORTISONE SODIUM SUCC I
|
Facility
|
OP
|
$116.84
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
636J172001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.75 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Aetna of VT Commercial |
$111.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$56.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$51.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$56.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$70.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$99.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$52.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$92.89
|
| Rate for Payer: Cash Price |
$58.42
|
| Rate for Payer: Cash Price |
$58.42
|
| Rate for Payer: Cigna Commercial |
$93.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$93.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$93.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$52.58
|
| Rate for Payer: Multiplan Commercial |
$108.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.58
|
| Rate for Payer: United Healthcare Commercial |
$111.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.58
|
| Rate for Payer: United Healthcare VA CCN |
$52.58
|
|
|
HYDROGEN PEROXIDE SOLUTION
|
Professional
|
Both
|
$0.03
|
|
|
Service Code
|
NDC 4934817938
|
| Hospital Charge Code |
2500000133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
HYDROGEN PEROXIDE SOLUTION
|
Professional
|
Both
|
$0.03
|
|
| Hospital Charge Code |
2500000133
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
HYDROMORPHONE 2MG/1ML SYRINGE
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
636J117108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$31.35 |
| Rate for Payer: Aetna of VT Commercial |
$31.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$26.23
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$26.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$26.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$26.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.85
|
| Rate for Payer: Multiplan Commercial |
$30.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.85
|
| Rate for Payer: United Healthcare Commercial |
$31.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.85
|
| Rate for Payer: United Healthcare VA CCN |
$14.85
|
|
|
HYDROMORPHONE 2MG/1ML SYRINGE
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
636J117108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.42 |
| Max. Negotiated Rate |
$31.35 |
| Rate for Payer: Aetna of VT Commercial |
$31.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$24.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$24.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$27.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$26.40
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$26.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$26.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$30.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.05
|
| Rate for Payer: United Healthcare Commercial |
$31.35
|
|
|
HYSTERO 7FR CATH
|
Facility
|
IP
|
$280.88
|
|
| Hospital Charge Code |
2780056751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.88 |
| Max. Negotiated Rate |
$266.84 |
| Rate for Payer: Aetna of VT Commercial |
$266.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$207.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$207.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$238.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$235.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$224.70
|
| Rate for Payer: Cash Price |
$140.44
|
| Rate for Payer: Cigna Commercial |
$224.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$224.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$224.70
|
| Rate for Payer: Multiplan Commercial |
$261.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$238.75
|
| Rate for Payer: United Healthcare Commercial |
$266.84
|
|
|
HYSTERO 7FR CATH
|
Facility
|
OP
|
$280.88
|
|
| Hospital Charge Code |
2780056751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.40 |
| Max. Negotiated Rate |
$266.84 |
| Rate for Payer: Aetna of VT Commercial |
$266.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$251.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$124.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$251.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$169.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$238.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$227.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$126.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$223.30
|
| Rate for Payer: Cash Price |
$140.44
|
| Rate for Payer: Cigna Commercial |
$224.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$224.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$224.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$126.40
|
| Rate for Payer: Multiplan Commercial |
$261.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$238.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$126.40
|
| Rate for Payer: United Healthcare Commercial |
$266.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.40
|
| Rate for Payer: United Healthcare VA CCN |
$126.40
|
|
|
HYSTEROSCOPY ABLATION
|
Facility
|
OP
|
$3,157.00
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
9825856301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,398.24 |
| Max. Negotiated Rate |
$2,999.15 |
| Rate for Payer: Aetna of VT Commercial |
$2,999.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,828.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,398.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,828.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,900.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,683.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,557.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,420.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,509.82
|
| Rate for Payer: Cash Price |
$1,578.50
|
| Rate for Payer: Cigna Commercial |
$2,525.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,525.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,525.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,420.65
|
| Rate for Payer: Multiplan Commercial |
$2,936.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,683.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,420.65
|
| Rate for Payer: United Healthcare Commercial |
$2,999.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,420.65
|
| Rate for Payer: United Healthcare VA CCN |
$1,420.65
|
|
|
HYSTEROSCOPY ABLATION
|
Facility
|
IP
|
$3,157.00
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
9825856301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,336.50 |
| Max. Negotiated Rate |
$2,999.15 |
| Rate for Payer: Aetna of VT Commercial |
$2,999.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,336.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,336.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,683.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,651.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,525.60
|
| Rate for Payer: Cash Price |
$1,578.50
|
| Rate for Payer: Cigna Commercial |
$2,525.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,525.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,525.60
|
| Rate for Payer: Multiplan Commercial |
$2,936.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,683.45
|
| Rate for Payer: United Healthcare Commercial |
$2,999.15
|
|
|
HYSTEROSCOPY ABLATION
|
Professional
|
Both
|
$3,157.00
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
9825856301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$226.05 |
| Max. Negotiated Rate |
$4,115.25 |
| Rate for Payer: Aetna of VT Commercial |
$2,967.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,828.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$232.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,828.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$316.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,115.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,115.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$259.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,115.25
|
| Rate for Payer: Cash Price |
$1,578.50
|
| Rate for Payer: Cash Price |
$1,578.50
|
| Rate for Payer: Cigna Commercial |
$398.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,035.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,035.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,885.69
|
| Rate for Payer: Multiplan Commercial |
$2,936.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$320.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$226.05
|
| Rate for Payer: United Healthcare Commercial |
$347.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$226.05
|
| Rate for Payer: United Healthcare VA CCN |
$226.05
|
|
|
HYSTEROSCOPY BIOPSY
|
Professional
|
Both
|
$946.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
9605855802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$212.95 |
| Max. Negotiated Rate |
$1,919.38 |
| Rate for Payer: Aetna of VT Commercial |
$889.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$847.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$219.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$847.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$298.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,784.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,784.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$244.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,784.99
|
| Rate for Payer: Cash Price |
$473.00
|
| Rate for Payer: Cash Price |
$473.00
|
| Rate for Payer: Cigna Commercial |
$374.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,919.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,919.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,188.76
|
| Rate for Payer: Multiplan Commercial |
$879.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$302.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$212.95
|
| Rate for Payer: United Healthcare Commercial |
$327.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.95
|
| Rate for Payer: United Healthcare VA CCN |
$212.95
|
|
|
HYSTEROSCOPY BIOPSY
|
Facility
|
IP
|
$6,271.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
9605855801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4,641.17 |
| Max. Negotiated Rate |
$5,957.45 |
| Rate for Payer: Aetna of VT Commercial |
$5,957.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,641.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,641.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,330.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,267.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,016.80
|
| Rate for Payer: Cash Price |
$3,135.50
|
| Rate for Payer: Cigna Commercial |
$5,016.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,016.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,016.80
|
| Rate for Payer: Multiplan Commercial |
$5,832.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,330.35
|
| Rate for Payer: United Healthcare Commercial |
$5,957.45
|
|
|
HYSTEROSCOPY BIOPSY
|
Facility
|
IP
|
$5,326.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
5105855801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,941.77 |
| Max. Negotiated Rate |
$5,059.70 |
| Rate for Payer: Aetna of VT Commercial |
$5,059.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,941.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,941.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,527.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,473.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,260.80
|
| Rate for Payer: Cash Price |
$2,663.00
|
| Rate for Payer: Cigna Commercial |
$4,260.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,260.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,260.80
|
| Rate for Payer: Multiplan Commercial |
$4,953.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,527.10
|
| Rate for Payer: United Healthcare Commercial |
$5,059.70
|
|
|
HYSTEROSCOPY BIOPSY
|
Facility
|
IP
|
$946.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
9605855802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$700.13 |
| Max. Negotiated Rate |
$898.70 |
| Rate for Payer: Aetna of VT Commercial |
$898.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$700.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$700.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$804.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$794.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$756.80
|
| Rate for Payer: Cash Price |
$473.00
|
| Rate for Payer: Cigna Commercial |
$756.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$756.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$756.80
|
| Rate for Payer: Multiplan Commercial |
$879.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$804.10
|
| Rate for Payer: United Healthcare Commercial |
$898.70
|
|
|
HYSTEROSCOPY BIOPSY
|
Facility
|
OP
|
$5,326.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
5105855801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,358.89 |
| Max. Negotiated Rate |
$5,059.70 |
| Rate for Payer: Aetna of VT Commercial |
$5,059.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,771.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,358.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,771.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,206.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,527.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,314.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,396.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,234.17
|
| Rate for Payer: Cash Price |
$2,663.00
|
| Rate for Payer: Cigna Commercial |
$4,260.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,260.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,260.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,396.70
|
| Rate for Payer: Multiplan Commercial |
$4,953.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,527.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,396.70
|
| Rate for Payer: United Healthcare Commercial |
$5,059.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,396.70
|
| Rate for Payer: United Healthcare VA CCN |
$2,396.70
|
|
|
HYSTEROSCOPY BIOPSY
|
Professional
|
Both
|
$3,656.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
9825855801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$212.95 |
| Max. Negotiated Rate |
$3,436.64 |
| Rate for Payer: Aetna of VT Commercial |
$3,436.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,275.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$219.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,275.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$298.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,784.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,784.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$244.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,784.99
|
| Rate for Payer: Cash Price |
$1,828.00
|
| Rate for Payer: Cash Price |
$1,828.00
|
| Rate for Payer: Cigna Commercial |
$374.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,919.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,919.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,188.76
|
| Rate for Payer: Multiplan Commercial |
$3,400.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$302.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$212.95
|
| Rate for Payer: United Healthcare Commercial |
$327.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.95
|
| Rate for Payer: United Healthcare VA CCN |
$212.95
|
|
|
HYSTEROSCOPY BIOPSY
|
Facility
|
OP
|
$6,271.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
9605855801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,777.43 |
| Max. Negotiated Rate |
$5,957.45 |
| Rate for Payer: Aetna of VT Commercial |
$5,957.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,618.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,777.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,618.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,775.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,330.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,079.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,821.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,985.44
|
| Rate for Payer: Cash Price |
$3,135.50
|
| Rate for Payer: Cigna Commercial |
$5,016.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,016.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,016.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,821.95
|
| Rate for Payer: Multiplan Commercial |
$5,832.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,330.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,821.95
|
| Rate for Payer: United Healthcare Commercial |
$5,957.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,821.95
|
| Rate for Payer: United Healthcare VA CCN |
$2,821.95
|
|
|
HYSTEROSCOPY BIOPSY
|
Facility
|
OP
|
$3,656.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
9825855801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,619.24 |
| Max. Negotiated Rate |
$3,473.20 |
| Rate for Payer: Aetna of VT Commercial |
$3,473.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,275.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,619.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,275.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,200.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,107.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,961.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,645.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,906.52
|
| Rate for Payer: Cash Price |
$1,828.00
|
| Rate for Payer: Cigna Commercial |
$2,924.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,924.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,924.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,645.20
|
| Rate for Payer: Multiplan Commercial |
$3,400.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,107.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,645.20
|
| Rate for Payer: United Healthcare Commercial |
$3,473.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,645.20
|
| Rate for Payer: United Healthcare VA CCN |
$1,645.20
|
|
|
HYSTEROSCOPY BIOPSY
|
Facility
|
IP
|
$3,656.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
9825855801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,705.81 |
| Max. Negotiated Rate |
$3,473.20 |
| Rate for Payer: Aetna of VT Commercial |
$3,473.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,705.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,705.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,107.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,071.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,924.80
|
| Rate for Payer: Cash Price |
$1,828.00
|
| Rate for Payer: Cigna Commercial |
$2,924.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,924.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,924.80
|
| Rate for Payer: Multiplan Commercial |
$3,400.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,107.60
|
| Rate for Payer: United Healthcare Commercial |
$3,473.20
|
|
|
HYSTEROSCOPY BIOPSY
|
Facility
|
OP
|
$946.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
9605855802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$418.98 |
| Max. Negotiated Rate |
$898.70 |
| Rate for Payer: Aetna of VT Commercial |
$898.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$847.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$418.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$847.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$569.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$804.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$766.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$425.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$752.07
|
| Rate for Payer: Cash Price |
$473.00
|
| Rate for Payer: Cigna Commercial |
$756.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$756.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$756.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$425.70
|
| Rate for Payer: Multiplan Commercial |
$879.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$804.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$425.70
|
| Rate for Payer: United Healthcare Commercial |
$898.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$425.70
|
| Rate for Payer: United Healthcare VA CCN |
$425.70
|
|
