|
INCISION OF URETHRA
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
CPT 53020
|
| Hospital Charge Code |
9825302001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$331.56 |
| Max. Negotiated Rate |
$425.60 |
| Rate for Payer: Aetna of VT Commercial |
$425.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$331.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$331.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$380.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$376.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$358.40
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cigna Commercial |
$358.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$358.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$358.40
|
| Rate for Payer: Multiplan Commercial |
$416.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$380.80
|
| Rate for Payer: United Healthcare Commercial |
$425.60
|
|
|
INCISION OF WINDPIPE
|
Facility
|
OP
|
$1,633.72
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
4503160501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$723.57 |
| Max. Negotiated Rate |
$1,552.03 |
| Rate for Payer: Aetna of VT Commercial |
$1,552.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,463.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$723.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,463.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$983.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,388.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,323.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$735.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,298.81
|
| Rate for Payer: Cash Price |
$816.86
|
| Rate for Payer: Cigna Commercial |
$1,306.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,306.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,306.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$735.17
|
| Rate for Payer: Multiplan Commercial |
$1,519.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,388.66
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$735.17
|
| Rate for Payer: United Healthcare Commercial |
$1,552.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$735.17
|
| Rate for Payer: United Healthcare VA CCN |
$735.17
|
|
|
INCISION OF WINDPIPE
|
Facility
|
OP
|
$893.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
9813160502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$395.51 |
| Max. Negotiated Rate |
$848.35 |
| Rate for Payer: Aetna of VT Commercial |
$848.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$800.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$395.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$800.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$537.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$759.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$723.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$401.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$709.93
|
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: Cigna Commercial |
$714.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$714.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$714.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$401.85
|
| Rate for Payer: Multiplan Commercial |
$830.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$759.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$401.85
|
| Rate for Payer: United Healthcare Commercial |
$848.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$401.85
|
| Rate for Payer: United Healthcare VA CCN |
$401.85
|
|
|
INCISION OF WINDPIPE
|
Facility
|
IP
|
$1,633.72
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
4503160501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,209.12 |
| Max. Negotiated Rate |
$1,552.03 |
| Rate for Payer: Aetna of VT Commercial |
$1,552.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,209.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,209.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,388.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,372.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,306.98
|
| Rate for Payer: Cash Price |
$816.86
|
| Rate for Payer: Cigna Commercial |
$1,306.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,306.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,306.98
|
| Rate for Payer: Multiplan Commercial |
$1,519.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,388.66
|
| Rate for Payer: United Healthcare Commercial |
$1,552.03
|
|
|
INCISION OF WINDPIPE
|
Facility
|
OP
|
$893.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
9823160501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$395.51 |
| Max. Negotiated Rate |
$848.35 |
| Rate for Payer: Aetna of VT Commercial |
$848.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$800.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$395.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$800.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$537.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$759.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$723.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$401.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$709.93
|
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: Cigna Commercial |
$714.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$714.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$714.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$401.85
|
| Rate for Payer: Multiplan Commercial |
$830.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$759.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$401.85
|
| Rate for Payer: United Healthcare Commercial |
$848.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$401.85
|
| Rate for Payer: United Healthcare VA CCN |
$401.85
|
|
|
INCISION OF WINDPIPE
|
Facility
|
IP
|
$893.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
9813160502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$660.91 |
| Max. Negotiated Rate |
$848.35 |
| Rate for Payer: Aetna of VT Commercial |
$848.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$660.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$660.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$759.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$750.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$714.40
|
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: Cigna Commercial |
$714.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$714.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$714.40
|
| Rate for Payer: Multiplan Commercial |
$830.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$759.05
|
| Rate for Payer: United Healthcare Commercial |
$848.35
|
|
|
INCISION OF WINDPIPE
|
Facility
|
IP
|
$893.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
9823160501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$660.91 |
| Max. Negotiated Rate |
$848.35 |
| Rate for Payer: Aetna of VT Commercial |
$848.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$660.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$660.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$759.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$750.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$714.40
|
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: Cigna Commercial |
$714.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$714.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$714.40
|
| Rate for Payer: Multiplan Commercial |
$830.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$759.05
|
| Rate for Payer: United Healthcare Commercial |
$848.35
|
|
|
INCISION OF WINDPIPE
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
9813160502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$298.97 |
| Max. Negotiated Rate |
$839.42 |
| Rate for Payer: Aetna of VT Commercial |
$839.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$800.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$307.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$800.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$444.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$444.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$343.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$444.65
|
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: Cigna Commercial |
$473.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$507.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$507.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$298.97
|
| Rate for Payer: Multiplan Commercial |
$830.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$424.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$298.97
|
| Rate for Payer: United Healthcare Commercial |
$459.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$298.97
|
| Rate for Payer: United Healthcare VA CCN |
$298.97
|
|
|
INCISION OF WINDPIPE
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
9823160501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$298.97 |
| Max. Negotiated Rate |
$839.42 |
| Rate for Payer: Aetna of VT Commercial |
$839.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$800.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$307.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$800.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$444.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$444.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$343.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$444.65
|
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: Cigna Commercial |
$473.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$507.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$507.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$298.97
|
| Rate for Payer: Multiplan Commercial |
$830.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$424.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$298.97
|
| Rate for Payer: United Healthcare Commercial |
$459.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$298.97
|
| Rate for Payer: United Healthcare VA CCN |
$298.97
|
|
|
INCIS LINGUAL FRENUM FRENOTOMY
|
Facility
|
OP
|
$2,321.00
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
9824101001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,027.97 |
| Max. Negotiated Rate |
$2,204.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,204.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,079.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,027.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,079.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,397.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,972.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,880.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,044.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,845.19
|
| Rate for Payer: Cash Price |
$1,160.50
|
| Rate for Payer: Cigna Commercial |
$1,856.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,856.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,856.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,044.45
|
| Rate for Payer: Multiplan Commercial |
$2,158.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,972.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,044.45
|
| Rate for Payer: United Healthcare Commercial |
$2,204.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,044.45
|
| Rate for Payer: United Healthcare VA CCN |
$1,044.45
|
|
|
INCIS LINGUAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$2,321.00
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
9824101001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$104.43 |
| Max. Negotiated Rate |
$2,181.74 |
| Rate for Payer: Aetna of VT Commercial |
$2,181.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,079.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$107.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,079.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$146.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$302.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$302.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$120.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$302.78
|
| Rate for Payer: Cash Price |
$1,160.50
|
| Rate for Payer: Cash Price |
$1,160.50
|
| Rate for Payer: Cigna Commercial |
$167.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$327.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$327.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$202.07
|
| Rate for Payer: Multiplan Commercial |
$2,158.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$148.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$104.43
|
| Rate for Payer: United Healthcare Commercial |
$160.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$104.43
|
| Rate for Payer: United Healthcare VA CCN |
$104.43
|
|
|
INCIS LINGUAL FRENUM FRENOTOMY
|
Facility
|
IP
|
$2,321.00
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
9824101001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,717.77 |
| Max. Negotiated Rate |
$2,204.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,204.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,717.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,717.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,972.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,949.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,856.80
|
| Rate for Payer: Cash Price |
$1,160.50
|
| Rate for Payer: Cigna Commercial |
$1,856.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,856.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,856.80
|
| Rate for Payer: Multiplan Commercial |
$2,158.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,972.85
|
| Rate for Payer: United Healthcare Commercial |
$2,204.95
|
|
|
INCISN LABIAL FRENUM FRENOTOMY
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
9824080601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$128.00 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Aetna of VT Commercial |
$274.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$128.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$173.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$245.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$234.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$130.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$229.75
|
| Rate for Payer: Cash Price |
$144.50
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$231.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$231.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$130.05
|
| Rate for Payer: Multiplan Commercial |
$268.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$245.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$130.05
|
| Rate for Payer: United Healthcare Commercial |
$274.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.05
|
| Rate for Payer: United Healthcare VA CCN |
$130.05
|
|
|
INCISN LABIAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
9824080601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$271.66 |
| Rate for Payer: Aetna of VT Commercial |
$271.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$29.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$40.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$161.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$161.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$32.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$161.12
|
| Rate for Payer: Cash Price |
$144.50
|
| Rate for Payer: Cash Price |
$144.50
|
| Rate for Payer: Cigna Commercial |
$44.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$154.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$154.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$96.13
|
| Rate for Payer: Multiplan Commercial |
$268.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$28.68
|
| Rate for Payer: United Healthcare Commercial |
$44.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.68
|
| Rate for Payer: United Healthcare VA CCN |
$28.68
|
|
|
INCISN LABIAL FRENUM FRENOTOMY
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
9824080601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$213.89 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Aetna of VT Commercial |
$274.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$213.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$213.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$245.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$242.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$231.20
|
| Rate for Payer: Cash Price |
$144.50
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$231.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$231.20
|
| Rate for Payer: Multiplan Commercial |
$268.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$245.65
|
| Rate for Payer: United Healthcare Commercial |
$274.55
|
|
|
INFLIXIMAB 100 MG V5
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
636J174501
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$83.93 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
INFLIXIMAB 100 MG V5
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
636J174501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
INFLIXIMAB-AXXQ (AVSOLA)
|
Facility
|
IP
|
$2,094.75
|
|
|
Service Code
|
HCPCS Q5121
|
| Hospital Charge Code |
636Q512101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,550.32 |
| Max. Negotiated Rate |
$1,990.01 |
| Rate for Payer: Aetna of VT Commercial |
$1,990.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,550.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,550.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,780.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,759.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,675.80
|
| Rate for Payer: Cash Price |
$1,047.38
|
| Rate for Payer: Cigna Commercial |
$1,675.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,675.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,675.80
|
| Rate for Payer: Multiplan Commercial |
$1,948.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,780.54
|
| Rate for Payer: United Healthcare Commercial |
$1,990.01
|
|
|
INFLIXIMAB-AXXQ (AVSOLA)
|
Facility
|
OP
|
$2,094.75
|
|
|
Service Code
|
HCPCS Q5121
|
| Hospital Charge Code |
636Q512101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.31 |
| Max. Negotiated Rate |
$1,990.01 |
| Rate for Payer: Aetna of VT Commercial |
$1,990.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$927.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,261.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,780.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,696.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$942.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,665.33
|
| Rate for Payer: Cash Price |
$1,047.38
|
| Rate for Payer: Cash Price |
$1,047.38
|
| Rate for Payer: Cigna Commercial |
$1,675.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,675.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,675.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$942.64
|
| Rate for Payer: Multiplan Commercial |
$1,948.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,780.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$942.64
|
| Rate for Payer: United Healthcare Commercial |
$1,990.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$942.64
|
| Rate for Payer: United Healthcare VA CCN |
$942.64
|
|
|
INFLIXIMAB-AXXQ (AVSOLA)*340B*
|
Facility
|
IP
|
$2,094.75
|
|
|
Service Code
|
HCPCS Q5121
|
| Hospital Charge Code |
636Q512102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,550.32 |
| Max. Negotiated Rate |
$1,990.01 |
| Rate for Payer: Aetna of VT Commercial |
$1,990.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,550.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,550.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,780.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,759.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,675.80
|
| Rate for Payer: Cash Price |
$1,047.38
|
| Rate for Payer: Cigna Commercial |
$1,675.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,675.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,675.80
|
| Rate for Payer: Multiplan Commercial |
$1,948.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,780.54
|
| Rate for Payer: United Healthcare Commercial |
$1,990.01
|
|
|
INFLIXIMAB-AXXQ (AVSOLA)*340B*
|
Facility
|
OP
|
$2,094.75
|
|
|
Service Code
|
HCPCS Q5121 TB
|
| Hospital Charge Code |
636Q512102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.31 |
| Max. Negotiated Rate |
$1,990.01 |
| Rate for Payer: Aetna of VT Commercial |
$1,990.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$927.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,261.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,780.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,696.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$942.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,665.33
|
| Rate for Payer: Cash Price |
$1,047.38
|
| Rate for Payer: Cash Price |
$1,047.38
|
| Rate for Payer: Cigna Commercial |
$1,675.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,675.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,675.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$942.64
|
| Rate for Payer: Multiplan Commercial |
$1,948.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,780.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$942.64
|
| Rate for Payer: United Healthcare Commercial |
$1,990.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$942.64
|
| Rate for Payer: United Healthcare VA CCN |
$942.64
|
|
|
INFLIXIMAB-AXXQ (AVSOLA)*340B*
|
Facility
|
OP
|
$2,094.75
|
|
|
Service Code
|
HCPCS Q5121
|
| Hospital Charge Code |
636Q512102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.31 |
| Max. Negotiated Rate |
$1,990.01 |
| Rate for Payer: Aetna of VT Commercial |
$1,990.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$927.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,261.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,780.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,696.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$942.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,665.33
|
| Rate for Payer: Cash Price |
$1,047.38
|
| Rate for Payer: Cash Price |
$1,047.38
|
| Rate for Payer: Cigna Commercial |
$1,675.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,675.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,675.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$942.64
|
| Rate for Payer: Multiplan Commercial |
$1,948.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,780.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$942.64
|
| Rate for Payer: United Healthcare Commercial |
$1,990.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$942.64
|
| Rate for Payer: United Healthcare VA CCN |
$942.64
|
|
|
INFLIXIMAB-AXXQ (AVSOLA)*340B*
|
Facility
|
IP
|
$2,094.75
|
|
|
Service Code
|
HCPCS Q5121 TB
|
| Hospital Charge Code |
636Q512102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,550.32 |
| Max. Negotiated Rate |
$1,990.01 |
| Rate for Payer: Aetna of VT Commercial |
$1,990.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,550.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,550.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,780.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,759.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,675.80
|
| Rate for Payer: Cash Price |
$1,047.38
|
| Rate for Payer: Cigna Commercial |
$1,675.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,675.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,675.80
|
| Rate for Payer: Multiplan Commercial |
$1,948.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,780.54
|
| Rate for Payer: United Healthcare Commercial |
$1,990.01
|
|
|
INFLIXIMAB-DYYB
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
636Q510301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
INFLIXIMAB-DYYB
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
636Q510301
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$43.75 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$43.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$43.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
