|
IMPLANT SPINAL CANAL CATH
|
Facility
|
OP
|
$1,967.00
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
9816235002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$871.18 |
| Max. Negotiated Rate |
$1,868.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,868.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,762.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$871.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,762.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,184.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,671.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,593.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$885.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,563.77
|
| Rate for Payer: Cash Price |
$983.50
|
| Rate for Payer: Cigna Commercial |
$1,573.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,573.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,573.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$885.15
|
| Rate for Payer: Multiplan Commercial |
$1,829.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,671.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$885.15
|
| Rate for Payer: United Healthcare Commercial |
$1,868.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$885.15
|
| Rate for Payer: United Healthcare VA CCN |
$885.15
|
|
|
IMPLANT SPINAL CANAL CATH
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
9816235001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
IMPLANT SPINAL CANAL CATH
|
Facility
|
IP
|
$1,967.00
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
9826235001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,455.78 |
| Max. Negotiated Rate |
$1,868.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,868.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,455.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,455.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,671.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,652.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,573.60
|
| Rate for Payer: Cash Price |
$983.50
|
| Rate for Payer: Cigna Commercial |
$1,573.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,573.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,573.60
|
| Rate for Payer: Multiplan Commercial |
$1,829.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,671.95
|
| Rate for Payer: United Healthcare Commercial |
$1,868.65
|
|
|
IMPLANT SPINAL CANAL CATH
|
Professional
|
Both
|
$1,967.00
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
9826235001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$372.41 |
| Max. Negotiated Rate |
$1,848.98 |
| Rate for Payer: Aetna of VT Commercial |
$1,848.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,762.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$383.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,762.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$521.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$659.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$659.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$428.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$659.10
|
| Rate for Payer: Cash Price |
$983.50
|
| Rate for Payer: Cash Price |
$983.50
|
| Rate for Payer: Cigna Commercial |
$518.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$624.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$624.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$372.41
|
| Rate for Payer: Multiplan Commercial |
$1,829.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$528.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$372.41
|
| Rate for Payer: United Healthcare Commercial |
$572.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$372.41
|
| Rate for Payer: United Healthcare VA CCN |
$372.41
|
|
|
IMPLANT SPINAL CANAL CATH
|
Professional
|
Both
|
$1,967.00
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
9816235002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$372.41 |
| Max. Negotiated Rate |
$1,848.98 |
| Rate for Payer: Aetna of VT Commercial |
$1,848.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,762.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$383.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,762.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$521.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$659.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$659.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$428.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$659.10
|
| Rate for Payer: Cash Price |
$983.50
|
| Rate for Payer: Cash Price |
$983.50
|
| Rate for Payer: Cigna Commercial |
$518.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$624.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$624.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$372.41
|
| Rate for Payer: Multiplan Commercial |
$1,829.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$528.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$372.41
|
| Rate for Payer: United Healthcare Commercial |
$572.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$372.41
|
| Rate for Payer: United Healthcare VA CCN |
$372.41
|
|
|
IMPLANT SPINAL CANAL CATH
|
Facility
|
OP
|
$9,204.32
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
4506235001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,076.59 |
| Max. Negotiated Rate |
$8,744.10 |
| Rate for Payer: Aetna of VT Commercial |
$8,744.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8,246.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4,076.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8,246.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5,541.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7,823.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7,455.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4,141.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,317.43
|
| Rate for Payer: Cash Price |
$4,602.16
|
| Rate for Payer: Cigna Commercial |
$7,363.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,363.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,363.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$4,141.94
|
| Rate for Payer: Multiplan Commercial |
$8,560.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,823.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4,141.94
|
| Rate for Payer: United Healthcare Commercial |
$8,744.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,141.94
|
| Rate for Payer: United Healthcare VA CCN |
$4,141.94
|
|
|
IMPLANT SPINAL CANAL CATH
|
Facility
|
IP
|
$9,204.32
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
4506235001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,812.12 |
| Max. Negotiated Rate |
$8,744.10 |
| Rate for Payer: Aetna of VT Commercial |
$8,744.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,812.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,812.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7,823.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7,731.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,363.46
|
| Rate for Payer: Cash Price |
$4,602.16
|
| Rate for Payer: Cigna Commercial |
$7,363.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,363.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,363.46
|
| Rate for Payer: Multiplan Commercial |
$8,560.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,823.67
|
| Rate for Payer: United Healthcare Commercial |
$8,744.10
|
|
|
IMPLANT SPINAL CANAL CATH
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
9816235001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
IMPLANT SPINAL CANAL CATH
|
Facility
|
OP
|
$1,967.00
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
9826235001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$871.18 |
| Max. Negotiated Rate |
$1,868.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,868.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,762.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$871.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,762.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,184.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,671.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,593.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$885.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,563.77
|
| Rate for Payer: Cash Price |
$983.50
|
| Rate for Payer: Cigna Commercial |
$1,573.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,573.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,573.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$885.15
|
| Rate for Payer: Multiplan Commercial |
$1,829.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,671.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$885.15
|
| Rate for Payer: United Healthcare Commercial |
$1,868.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$885.15
|
| Rate for Payer: United Healthcare VA CCN |
$885.15
|
|
|
In111 WBC (Indium)
|
Facility
|
OP
|
$1,877.23
|
|
|
Service Code
|
HCPCS A9547
|
| Hospital Charge Code |
343A954701
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$831.43 |
| Max. Negotiated Rate |
$1,783.37 |
| Rate for Payer: Aetna of VT Commercial |
$1,783.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,681.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$831.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,681.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,130.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,595.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,520.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$844.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,492.40
|
| Rate for Payer: Cash Price |
$938.62
|
| Rate for Payer: Cigna Commercial |
$1,501.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,501.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,501.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$844.75
|
| Rate for Payer: Multiplan Commercial |
$1,745.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,595.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$844.75
|
| Rate for Payer: United Healthcare Commercial |
$1,783.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$844.75
|
| Rate for Payer: United Healthcare VA CCN |
$844.75
|
|
|
In111 WBC (Indium)
|
Facility
|
IP
|
$1,877.23
|
|
|
Service Code
|
HCPCS A9547
|
| Hospital Charge Code |
343A954701
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,389.34 |
| Max. Negotiated Rate |
$1,783.37 |
| Rate for Payer: Aetna of VT Commercial |
$1,783.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,389.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,389.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,595.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,576.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,501.78
|
| Rate for Payer: Cash Price |
$938.62
|
| Rate for Payer: Cigna Commercial |
$1,501.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,501.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,501.78
|
| Rate for Payer: Multiplan Commercial |
$1,745.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,595.65
|
| Rate for Payer: United Healthcare Commercial |
$1,783.37
|
|
|
INCAL BX SKN SINGLE LES
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
9601110602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$175.83 |
| Max. Negotiated Rate |
$377.15 |
| Rate for Payer: Aetna of VT Commercial |
$377.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$355.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$175.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$355.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$238.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$337.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$321.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$178.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$315.62
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cigna Commercial |
$317.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$317.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$317.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$178.65
|
| Rate for Payer: Multiplan Commercial |
$369.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$337.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$178.65
|
| Rate for Payer: United Healthcare Commercial |
$377.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$178.65
|
| Rate for Payer: United Healthcare VA CCN |
$178.65
|
|
|
INCAL BX SKN SINGLE LES
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
5101110601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.86 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of VT Commercial |
$152.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$143.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$70.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$143.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$96.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$136.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$127.20
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$128.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$128.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$128.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$136.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$72.00
|
| Rate for Payer: United Healthcare Commercial |
$152.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.00
|
| Rate for Payer: United Healthcare VA CCN |
$72.00
|
|
|
INCAL BX SKN SINGLE LES
|
Professional
|
Both
|
$397.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
9821110601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$52.51 |
| Max. Negotiated Rate |
$373.18 |
| Rate for Payer: Aetna of VT Commercial |
$373.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$355.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$355.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$216.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$216.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.65
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cigna Commercial |
$59.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$145.66
|
| Rate for Payer: Multiplan Commercial |
$369.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.51
|
| Rate for Payer: United Healthcare Commercial |
$80.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.51
|
| Rate for Payer: United Healthcare VA CCN |
$52.51
|
|
|
INCAL BX SKN SINGLE LES
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
5101110601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$118.42 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of VT Commercial |
$152.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$118.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$118.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$136.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$134.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$128.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$128.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$128.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$128.00
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$136.00
|
| Rate for Payer: United Healthcare Commercial |
$152.00
|
|
|
INCAL BX SKN SINGLE LES
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
9601110601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$411.50 |
| Max. Negotiated Rate |
$528.20 |
| Rate for Payer: Aetna of VT Commercial |
$528.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$411.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$411.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$472.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$467.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$444.80
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cigna Commercial |
$444.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$444.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$444.80
|
| Rate for Payer: Multiplan Commercial |
$517.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$472.60
|
| Rate for Payer: United Healthcare Commercial |
$528.20
|
|
|
INCAL BX SKN SINGLE LES
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
9821110601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$175.83 |
| Max. Negotiated Rate |
$377.15 |
| Rate for Payer: Aetna of VT Commercial |
$377.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$355.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$175.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$355.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$238.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$337.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$321.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$178.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$315.62
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cigna Commercial |
$317.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$317.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$317.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$178.65
|
| Rate for Payer: Multiplan Commercial |
$369.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$337.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$178.65
|
| Rate for Payer: United Healthcare Commercial |
$377.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$178.65
|
| Rate for Payer: United Healthcare VA CCN |
$178.65
|
|
|
INCAL BX SKN SINGLE LES
|
Professional
|
Both
|
$397.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
9601110602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$52.51 |
| Max. Negotiated Rate |
$373.18 |
| Rate for Payer: Aetna of VT Commercial |
$373.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$355.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$355.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$216.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$216.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.65
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cigna Commercial |
$59.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$145.66
|
| Rate for Payer: Multiplan Commercial |
$369.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.51
|
| Rate for Payer: United Healthcare Commercial |
$80.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.51
|
| Rate for Payer: United Healthcare VA CCN |
$52.51
|
|
|
INCAL BX SKN SINGLE LES
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
9821110601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$293.82 |
| Max. Negotiated Rate |
$377.15 |
| Rate for Payer: Aetna of VT Commercial |
$377.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$293.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$293.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$337.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$333.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$317.60
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cigna Commercial |
$317.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$317.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$317.60
|
| Rate for Payer: Multiplan Commercial |
$369.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$337.45
|
| Rate for Payer: United Healthcare Commercial |
$377.15
|
|
|
INCAL BX SKN SINGLE LES
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
9601110601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$246.25 |
| Max. Negotiated Rate |
$528.20 |
| Rate for Payer: Aetna of VT Commercial |
$528.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$498.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$246.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$498.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$334.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$472.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$450.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$250.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$442.02
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cigna Commercial |
$444.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$444.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$444.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$250.20
|
| Rate for Payer: Multiplan Commercial |
$517.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$472.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$250.20
|
| Rate for Payer: United Healthcare Commercial |
$528.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$250.20
|
| Rate for Payer: United Healthcare VA CCN |
$250.20
|
|
|
INCAL BX SKN SINGLE LES
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
9601110601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$52.51 |
| Max. Negotiated Rate |
$522.64 |
| Rate for Payer: Aetna of VT Commercial |
$522.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$498.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$498.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$216.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$216.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.65
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cigna Commercial |
$59.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$145.66
|
| Rate for Payer: Multiplan Commercial |
$517.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.51
|
| Rate for Payer: United Healthcare Commercial |
$80.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.51
|
| Rate for Payer: United Healthcare VA CCN |
$52.51
|
|
|
INCAL BX SKN SINGLE LES
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
9601110602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$293.82 |
| Max. Negotiated Rate |
$377.15 |
| Rate for Payer: Aetna of VT Commercial |
$377.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$293.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$293.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$337.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$333.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$317.60
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cigna Commercial |
$317.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$317.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$317.60
|
| Rate for Payer: Multiplan Commercial |
$369.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$337.45
|
| Rate for Payer: United Healthcare Commercial |
$377.15
|
|
|
INCAL BX SKN SINGLE LES
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
5101110601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.51 |
| Max. Negotiated Rate |
$236.07 |
| Rate for Payer: Aetna of VT Commercial |
$150.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$143.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$143.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$216.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$216.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.65
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$59.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$145.66
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.51
|
| Rate for Payer: United Healthcare Commercial |
$80.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.51
|
| Rate for Payer: United Healthcare VA CCN |
$52.51
|
|
|
INCISE EXTERNAL HEMORRHOID
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
9814608302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$356.73 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Aetna of VT Commercial |
$457.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$356.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$356.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$409.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$404.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$385.60
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna Commercial |
$385.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$385.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$385.60
|
| Rate for Payer: Multiplan Commercial |
$448.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$409.70
|
| Rate for Payer: United Healthcare Commercial |
$457.90
|
|
|
INCISE EXTERNAL HEMORRHOID
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
9604608301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$103.95 |
| Max. Negotiated Rate |
$810.28 |
| Rate for Payer: Aetna of VT Commercial |
$810.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$772.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$107.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$772.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$145.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$296.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$296.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$119.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$296.65
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cigna Commercial |
$189.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$318.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$318.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$195.17
|
| Rate for Payer: Multiplan Commercial |
$801.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$147.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.95
|
| Rate for Payer: United Healthcare Commercial |
$159.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.95
|
| Rate for Payer: United Healthcare VA CCN |
$103.95
|
|
