|
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
|
$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 DX SEP PROC
|
Professional
|
Both
|
$1,158.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
9605855501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$140.17 |
| Max. Negotiated Rate |
$1,088.52 |
| Rate for Payer: Aetna of VT Commercial |
$1,088.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,037.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$144.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,037.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$196.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$454.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$454.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$454.40
|
| Rate for Payer: Cash Price |
$579.00
|
| Rate for Payer: Cash Price |
$579.00
|
| Rate for Payer: Cigna Commercial |
$245.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$523.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$523.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$320.04
|
| Rate for Payer: Multiplan Commercial |
$1,076.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$140.17
|
| Rate for Payer: United Healthcare Commercial |
$215.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.17
|
| Rate for Payer: United Healthcare VA CCN |
$140.17
|
|
|
HYSTEROSCOPY DX SEP PROC
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
5105855501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$203.53 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Aetna of VT Commercial |
$261.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$203.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$203.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$233.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$231.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$220.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$220.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$220.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$220.00
|
| Rate for Payer: Multiplan Commercial |
$255.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$233.75
|
| Rate for Payer: United Healthcare Commercial |
$261.25
|
|
|
HYSTEROSCOPY DX SEP PROC
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
9825855501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$391.52 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: Aetna of VT Commercial |
$839.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$791.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$391.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$791.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$532.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$751.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$716.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$397.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$702.78
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cigna Commercial |
$707.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$707.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$707.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$397.80
|
| Rate for Payer: Multiplan Commercial |
$822.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$751.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$397.80
|
| Rate for Payer: United Healthcare Commercial |
$839.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$397.80
|
| Rate for Payer: United Healthcare VA CCN |
$397.80
|
|
|
HYSTEROSCOPY DX SEP PROC
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
9825855501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$140.17 |
| Max. Negotiated Rate |
$830.96 |
| Rate for Payer: Aetna of VT Commercial |
$830.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$791.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$144.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$791.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$196.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$454.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$454.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$454.40
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cigna Commercial |
$245.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$523.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$523.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$320.04
|
| Rate for Payer: Multiplan Commercial |
$822.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$140.17
|
| Rate for Payer: United Healthcare Commercial |
$215.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.17
|
| Rate for Payer: United Healthcare VA CCN |
$140.17
|
|
|
HYSTEROSCOPY DX SEP PROC
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
9825855501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$654.25 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: Aetna of VT Commercial |
$839.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$654.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$654.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$751.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$742.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$707.20
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cigna Commercial |
$707.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$707.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$707.20
|
| Rate for Payer: Multiplan Commercial |
$822.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$751.40
|
| Rate for Payer: United Healthcare Commercial |
$839.80
|
|
|
HYSTEROSCOPY DX SEP PROC
|
Facility
|
OP
|
$1,158.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
9605855501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$512.88 |
| Max. Negotiated Rate |
$1,100.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,100.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,037.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$512.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,037.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$697.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$984.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$937.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$521.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$920.61
|
| Rate for Payer: Cash Price |
$579.00
|
| Rate for Payer: Cigna Commercial |
$926.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$926.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$926.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$521.10
|
| Rate for Payer: Multiplan Commercial |
$1,076.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$984.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$521.10
|
| Rate for Payer: United Healthcare Commercial |
$1,100.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$521.10
|
| Rate for Payer: United Healthcare VA CCN |
$521.10
|
|
|
HYSTEROSCOPY DX SEP PROC
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
9605855502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$140.17 |
| Max. Negotiated Rate |
$830.96 |
| Rate for Payer: Aetna of VT Commercial |
$830.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$791.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$144.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$791.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$196.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$454.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$454.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$454.40
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cigna Commercial |
$245.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$523.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$523.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$320.04
|
| Rate for Payer: Multiplan Commercial |
$822.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$140.17
|
| Rate for Payer: United Healthcare Commercial |
$215.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.17
|
| Rate for Payer: United Healthcare VA CCN |
$140.17
|
|
|
HYSTEROSCOPY DX SEP PROC
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
5105855501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.17 |
| Max. Negotiated Rate |
$523.05 |
| Rate for Payer: Aetna of VT Commercial |
$258.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$246.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$144.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$246.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$196.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$454.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$454.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$454.40
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$245.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$523.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$523.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$320.04
|
| Rate for Payer: Multiplan Commercial |
$255.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$140.17
|
| Rate for Payer: United Healthcare Commercial |
$215.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.17
|
| Rate for Payer: United Healthcare VA CCN |
$140.17
|
|
|
HYSTEROSCOPY DX SEP PROC
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
5105855501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Aetna of VT Commercial |
$261.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$246.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$121.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$246.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$165.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$233.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$222.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$123.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$218.62
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$220.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$220.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$220.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$123.75
|
| Rate for Payer: Multiplan Commercial |
$255.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$233.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$123.75
|
| Rate for Payer: United Healthcare Commercial |
$261.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.75
|
| Rate for Payer: United Healthcare VA CCN |
$123.75
|
|
|
HYSTEROSCOPY DX SEP PROC
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
9605855502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$654.25 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: Aetna of VT Commercial |
$839.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$654.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$654.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$751.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$742.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$707.20
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cigna Commercial |
$707.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$707.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$707.20
|
| Rate for Payer: Multiplan Commercial |
$822.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$751.40
|
| Rate for Payer: United Healthcare Commercial |
$839.80
|
|
|
HYSTEROSCOPY DX SEP PROC
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
9605855502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$391.52 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: Aetna of VT Commercial |
$839.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$791.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$391.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$791.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$532.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$751.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$716.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$397.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$702.78
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cigna Commercial |
$707.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$707.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$707.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$397.80
|
| Rate for Payer: Multiplan Commercial |
$822.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$751.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$397.80
|
| Rate for Payer: United Healthcare Commercial |
$839.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$397.80
|
| Rate for Payer: United Healthcare VA CCN |
$397.80
|
|
|
HYSTEROSCOPY DX SEP PROC
|
Facility
|
IP
|
$1,158.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
9605855501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$857.04 |
| Max. Negotiated Rate |
$1,100.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,100.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$857.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$857.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$984.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$972.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$926.40
|
| Rate for Payer: Cash Price |
$579.00
|
| Rate for Payer: Cigna Commercial |
$926.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$926.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$926.40
|
| Rate for Payer: Multiplan Commercial |
$1,076.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$984.30
|
| Rate for Payer: United Healthcare Commercial |
$1,100.10
|
|
|
HYSTEROSCOPY LYSIS
|
Facility
|
OP
|
$1,527.00
|
|
|
Service Code
|
CPT 58559
|
| Hospital Charge Code |
9825855901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$676.31 |
| Max. Negotiated Rate |
$1,450.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,450.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,368.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$676.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,368.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$919.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,297.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,236.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$687.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,213.96
|
| Rate for Payer: Cash Price |
$763.50
|
| Rate for Payer: Cigna Commercial |
$1,221.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,221.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,221.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$687.15
|
| Rate for Payer: Multiplan Commercial |
$1,420.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,297.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$687.15
|
| Rate for Payer: United Healthcare Commercial |
$1,450.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$687.15
|
| Rate for Payer: United Healthcare VA CCN |
$687.15
|
|
|
HYSTEROSCOPY LYSIS
|
Facility
|
IP
|
$1,527.00
|
|
|
Service Code
|
CPT 58559
|
| Hospital Charge Code |
9825855901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,130.13 |
| Max. Negotiated Rate |
$1,450.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,450.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,130.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,130.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,297.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,282.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,221.60
|
| Rate for Payer: Cash Price |
$763.50
|
| Rate for Payer: Cigna Commercial |
$1,221.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,221.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,221.60
|
| Rate for Payer: Multiplan Commercial |
$1,420.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,297.95
|
| Rate for Payer: United Healthcare Commercial |
$1,450.65
|
|
|
HYSTEROSCOPY LYSIS
|
Professional
|
Both
|
$1,527.00
|
|
|
Service Code
|
CPT 58559
|
| Hospital Charge Code |
9825855901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$260.51 |
| Max. Negotiated Rate |
$1,435.38 |
| Rate for Payer: Aetna of VT Commercial |
$1,435.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,368.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$268.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,368.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$364.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$616.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$616.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$299.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$616.40
|
| Rate for Payer: Cash Price |
$763.50
|
| Rate for Payer: Cash Price |
$763.50
|
| Rate for Payer: Cigna Commercial |
$459.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$436.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$436.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$260.51
|
| Rate for Payer: Multiplan Commercial |
$1,420.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$369.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$260.51
|
| Rate for Payer: United Healthcare Commercial |
$400.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$260.51
|
| Rate for Payer: United Healthcare VA CCN |
$260.51
|
|
|
HYSTEROSCOPY REMOVE FB
|
Professional
|
Both
|
$1,150.00
|
|
|
Service Code
|
CPT 58562
|
| Hospital Charge Code |
9825856201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$203.72 |
| Max. Negotiated Rate |
$1,081.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,081.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,030.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$209.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,030.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$285.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$537.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$537.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$234.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$537.21
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$359.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$629.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$629.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$383.60
|
| Rate for Payer: Multiplan Commercial |
$1,069.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$289.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$203.72
|
| Rate for Payer: United Healthcare Commercial |
$313.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$203.72
|
| Rate for Payer: United Healthcare VA CCN |
$203.72
|
|
|
HYSTEROSCOPY REMOVE FB
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
CPT 58562
|
| Hospital Charge Code |
9825856201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$851.12 |
| Max. Negotiated Rate |
$1,092.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,092.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$851.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$851.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$977.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$966.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$920.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$920.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$920.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$920.00
|
| Rate for Payer: Multiplan Commercial |
$1,069.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$977.50
|
| Rate for Payer: United Healthcare Commercial |
$1,092.50
|
|
|
HYSTEROSCOPY REMOVE FB
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT 58562
|
| Hospital Charge Code |
9825856201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$509.33 |
| Max. Negotiated Rate |
$1,092.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,092.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,030.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$509.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,030.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$692.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$977.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$931.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$517.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$914.25
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$920.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$920.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$920.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$517.50
|
| Rate for Payer: Multiplan Commercial |
$1,069.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$977.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$517.50
|
| Rate for Payer: United Healthcare Commercial |
$1,092.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$517.50
|
| Rate for Payer: United Healthcare VA CCN |
$517.50
|
|
|
HYSTEROSCOPY REMOVE MYOMA
|
Facility
|
OP
|
$2,046.00
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
9825856101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$906.17 |
| Max. Negotiated Rate |
$1,943.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,943.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,833.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$906.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,833.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,231.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,739.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,657.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$920.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,626.57
|
| Rate for Payer: Cash Price |
$1,023.00
|
| Rate for Payer: Cigna Commercial |
$1,636.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,636.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,636.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$920.70
|
| Rate for Payer: Multiplan Commercial |
$1,902.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,739.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$920.70
|
| Rate for Payer: United Healthcare Commercial |
$1,943.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$920.70
|
| Rate for Payer: United Healthcare VA CCN |
$920.70
|
|
|
HYSTEROSCOPY REMOVE MYOMA
|
Professional
|
Both
|
$2,046.00
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
9825856101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$328.12 |
| Max. Negotiated Rate |
$1,923.24 |
| Rate for Payer: Aetna of VT Commercial |
$1,923.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,833.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$337.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,833.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$459.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$865.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$865.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$377.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$865.24
|
| Rate for Payer: Cash Price |
$1,023.00
|
| Rate for Payer: Cash Price |
$1,023.00
|
| Rate for Payer: Cigna Commercial |
$578.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$550.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$550.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$328.13
|
| Rate for Payer: Multiplan Commercial |
$1,902.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$465.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$328.12
|
| Rate for Payer: United Healthcare Commercial |
$504.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$328.12
|
| Rate for Payer: United Healthcare VA CCN |
$328.12
|
|
|
HYSTEROSCOPY REMOVE MYOMA
|
Facility
|
IP
|
$2,046.00
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
9825856101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,514.24 |
| Max. Negotiated Rate |
$1,943.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,943.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,514.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,514.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,739.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,718.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,636.80
|
| Rate for Payer: Cash Price |
$1,023.00
|
| Rate for Payer: Cigna Commercial |
$1,636.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,636.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,636.80
|
| Rate for Payer: Multiplan Commercial |
$1,902.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,739.10
|
| Rate for Payer: United Healthcare Commercial |
$1,943.70
|
|
|
IAADIADOO NOT OTHERWISE SPECIF
|
Facility
|
IP
|
$183.34
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
3008789901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.69 |
| Max. Negotiated Rate |
$174.17 |
| Rate for Payer: Aetna of VT Commercial |
$174.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$135.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$135.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$154.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$146.67
|
| Rate for Payer: Cash Price |
$91.67
|
| Rate for Payer: Cigna Commercial |
$146.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$146.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$146.67
|
| Rate for Payer: Multiplan Commercial |
$170.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.84
|
| Rate for Payer: United Healthcare Commercial |
$174.17
|
|
|
IAADIADOO NOT OTHERWISE SPECIF
|
Facility
|
OP
|
$183.34
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
3008789901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$174.17 |
| Rate for Payer: Aetna of VT Commercial |
$174.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$79.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$79.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$110.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$148.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$82.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$145.76
|
| Rate for Payer: Cash Price |
$91.67
|
| Rate for Payer: Cash Price |
$91.67
|
| Rate for Payer: Cigna Commercial |
$146.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$146.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$146.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$82.50
|
| Rate for Payer: Multiplan Commercial |
$170.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$174.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.07
|
| Rate for Payer: United Healthcare VA CCN |
$82.50
|
|
