|
KYLEENA (LEVONORGESTREL) IUD
|
Professional
|
Both
|
$4,858.52
|
|
|
Service Code
|
HCPCS J7296
|
| Hospital Charge Code |
636J729601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,104.00 |
| Max. Negotiated Rate |
$4,567.01 |
| Rate for Payer: Aetna of VT Commercial |
$4,567.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,340.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,340.23
|
| Rate for Payer: Cash Price |
$2,429.26
|
| Rate for Payer: Cash Price |
$2,429.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,179.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,179.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,384.68
|
| Rate for Payer: Multiplan Commercial |
$4,518.42
|
| Rate for Payer: United Healthcare Commercial |
$4,129.74
|
| Rate for Payer: United Healthcare VA CCN |
$1,104.00
|
|
|
KYLEENA (LEVONORGESTREL) IUD
|
Facility
|
OP
|
$3,340.23
|
|
|
Service Code
|
HCPCS J7296
|
| Hospital Charge Code |
636J729601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,340.23 |
| Max. Negotiated Rate |
$3,340.23 |
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,340.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,340.23
|
|
|
LACTATE DEHYDROGENASE LDH
|
Facility
|
IP
|
$107.76
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3008361501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.75 |
| Max. Negotiated Rate |
$102.37 |
| Rate for Payer: Aetna of VT Commercial |
$102.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$79.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$79.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$91.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$86.21
|
| Rate for Payer: Cash Price |
$53.88
|
| Rate for Payer: Cigna Commercial |
$86.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$86.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$86.21
|
| Rate for Payer: Multiplan Commercial |
$100.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.60
|
| Rate for Payer: United Healthcare Commercial |
$102.37
|
|
|
LACTATE DEHYDROGENASE LDH
|
Facility
|
OP
|
$107.76
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3008361501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$102.37 |
| Rate for Payer: Aetna of VT Commercial |
$102.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$47.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$64.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$91.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$48.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$85.67
|
| Rate for Payer: Cash Price |
$53.88
|
| Rate for Payer: Cash Price |
$53.88
|
| Rate for Payer: Cigna Commercial |
$86.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$86.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$86.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$48.49
|
| Rate for Payer: Multiplan Commercial |
$100.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$48.49
|
| Rate for Payer: United Healthcare Commercial |
$102.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.04
|
| Rate for Payer: United Healthcare VA CCN |
$48.49
|
|
|
LACTOFERRIN FECAL QUALITATIVE
|
Facility
|
OP
|
$155.55
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
3008363001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$147.77 |
| Rate for Payer: Aetna of VT Commercial |
$147.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$70.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$123.66
|
| Rate for Payer: Cash Price |
$77.78
|
| Rate for Payer: Cash Price |
$77.78
|
| Rate for Payer: Cigna Commercial |
$124.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$144.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.00
|
| Rate for Payer: United Healthcare Commercial |
$147.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.70
|
| Rate for Payer: United Healthcare VA CCN |
$70.00
|
|
|
LACTOFERRIN FECAL QUALITATIVE
|
Professional
|
Both
|
$155.55
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
3008363001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.42 |
| Max. Negotiated Rate |
$146.22 |
| Rate for Payer: Aetna of VT Commercial |
$146.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$33.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$33.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$22.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.68
|
| Rate for Payer: Cash Price |
$77.78
|
| Rate for Payer: Cash Price |
$77.78
|
| Rate for Payer: Cigna Commercial |
$23.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.42
|
| Rate for Payer: Multiplan Commercial |
$144.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.70
|
| Rate for Payer: United Healthcare Commercial |
$30.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.70
|
| Rate for Payer: United Healthcare VA CCN |
$19.70
|
|
|
LACTOFERRIN FECAL QUALITATIVE
|
Facility
|
IP
|
$155.55
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
3008363001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.12 |
| Max. Negotiated Rate |
$147.77 |
| Rate for Payer: Aetna of VT Commercial |
$147.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$115.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$115.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$130.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.44
|
| Rate for Payer: Cash Price |
$77.78
|
| Rate for Payer: Cigna Commercial |
$124.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.44
|
| Rate for Payer: Multiplan Commercial |
$144.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.22
|
| Rate for Payer: United Healthcare Commercial |
$147.77
|
|
|
LAPARO CHOLECYSTECTOMY/GRAPH
|
Facility
|
OP
|
$2,138.00
|
|
|
Service Code
|
CPT 47563
|
| Hospital Charge Code |
9824756301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$946.92 |
| Max. Negotiated Rate |
$2,031.10 |
| Rate for Payer: Aetna of VT Commercial |
$2,031.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,915.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$946.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,915.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,287.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,817.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,731.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$962.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,699.71
|
| Rate for Payer: Cash Price |
$1,069.00
|
| Rate for Payer: Cigna Commercial |
$1,710.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,710.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,710.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$962.10
|
| Rate for Payer: Multiplan Commercial |
$1,988.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,817.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$962.10
|
| Rate for Payer: United Healthcare Commercial |
$2,031.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$962.10
|
| Rate for Payer: United Healthcare VA CCN |
$962.10
|
|
|
LAPARO CHOLECYSTECTOMY/GRAPH
|
Professional
|
Both
|
$2,138.00
|
|
|
Service Code
|
CPT 47563
|
| Hospital Charge Code |
9824756301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$658.73 |
| Max. Negotiated Rate |
$2,009.72 |
| Rate for Payer: Aetna of VT Commercial |
$2,009.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,915.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$678.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,915.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$922.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,202.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,202.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$757.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,202.95
|
| Rate for Payer: Cash Price |
$1,069.00
|
| Rate for Payer: Cash Price |
$1,069.00
|
| Rate for Payer: Cigna Commercial |
$1,203.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,121.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,121.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$658.73
|
| Rate for Payer: Multiplan Commercial |
$1,988.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$935.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$658.73
|
| Rate for Payer: United Healthcare Commercial |
$1,013.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$658.73
|
| Rate for Payer: United Healthcare VA CCN |
$658.73
|
|
|
LAPARO CHOLECYSTECTOMY/GRAPH
|
Facility
|
IP
|
$2,138.00
|
|
|
Service Code
|
CPT 47563
|
| Hospital Charge Code |
9824756301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,582.33 |
| Max. Negotiated Rate |
$2,031.10 |
| Rate for Payer: Aetna of VT Commercial |
$2,031.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,582.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,582.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,817.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,795.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,710.40
|
| Rate for Payer: Cash Price |
$1,069.00
|
| Rate for Payer: Cigna Commercial |
$1,710.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,710.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,710.40
|
| Rate for Payer: Multiplan Commercial |
$1,988.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,817.30
|
| Rate for Payer: United Healthcare Commercial |
$2,031.10
|
|
|
LAPARO PARTIAL COLECTOMY
|
Facility
|
OP
|
$3,986.00
|
|
|
Service Code
|
CPT 44204
|
| Hospital Charge Code |
9824420401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,765.40 |
| Max. Negotiated Rate |
$3,786.70 |
| Rate for Payer: Aetna of VT Commercial |
$3,786.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,571.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,765.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,571.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,399.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,388.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,228.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,793.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,168.87
|
| Rate for Payer: Cash Price |
$1,993.00
|
| Rate for Payer: Cigna Commercial |
$3,188.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,188.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,188.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,793.70
|
| Rate for Payer: Multiplan Commercial |
$3,706.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,388.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,793.70
|
| Rate for Payer: United Healthcare Commercial |
$3,786.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,793.70
|
| Rate for Payer: United Healthcare VA CCN |
$1,793.70
|
|
|
LAPARO PARTIAL COLECTOMY
|
Professional
|
Both
|
$3,986.00
|
|
|
Service Code
|
CPT 44204
|
| Hospital Charge Code |
9824420401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,396.70 |
| Max. Negotiated Rate |
$3,746.84 |
| Rate for Payer: Aetna of VT Commercial |
$3,746.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,571.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,438.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,571.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,955.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,442.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,442.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,606.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,442.36
|
| Rate for Payer: Cash Price |
$1,993.00
|
| Rate for Payer: Cash Price |
$1,993.00
|
| Rate for Payer: Cigna Commercial |
$2,557.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,365.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,365.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,396.70
|
| Rate for Payer: Multiplan Commercial |
$3,706.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,983.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,396.70
|
| Rate for Payer: United Healthcare Commercial |
$2,148.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,396.70
|
| Rate for Payer: United Healthcare VA CCN |
$1,396.70
|
|
|
LAPARO PARTIAL COLECTOMY
|
Facility
|
IP
|
$3,986.00
|
|
|
Service Code
|
CPT 44204
|
| Hospital Charge Code |
9824420401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,950.04 |
| Max. Negotiated Rate |
$3,786.70 |
| Rate for Payer: Aetna of VT Commercial |
$3,786.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,950.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,950.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,388.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,348.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,188.80
|
| Rate for Payer: Cash Price |
$1,993.00
|
| Rate for Payer: Cigna Commercial |
$3,188.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,188.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,188.80
|
| Rate for Payer: Multiplan Commercial |
$3,706.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,388.10
|
| Rate for Payer: United Healthcare Commercial |
$3,786.70
|
|
|
LAPARO PROC ABDM/PER/OMENT
|
Facility
|
OP
|
$1,262.00
|
|
|
Service Code
|
CPT 49329
|
| Hospital Charge Code |
9824932901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$558.94 |
| Max. Negotiated Rate |
$1,198.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,198.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,130.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$558.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,130.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$759.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,072.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,022.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$567.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,003.29
|
| Rate for Payer: Cash Price |
$631.00
|
| Rate for Payer: Cigna Commercial |
$1,009.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,009.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,009.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$567.90
|
| Rate for Payer: Multiplan Commercial |
$1,173.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,072.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$567.90
|
| Rate for Payer: United Healthcare Commercial |
$1,198.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$567.90
|
| Rate for Payer: United Healthcare VA CCN |
$567.90
|
|
|
LAPARO PROC ABDM/PER/OMENT
|
Professional
|
Both
|
$1,262.00
|
|
|
Service Code
|
CPT 49329
|
| Hospital Charge Code |
9824932901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$504.80 |
| Max. Negotiated Rate |
$1,186.28 |
| Rate for Payer: Aetna of VT Commercial |
$1,186.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,130.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,130.63
|
| Rate for Payer: Cash Price |
$631.00
|
| Rate for Payer: Multiplan Commercial |
$1,173.66
|
| Rate for Payer: United Healthcare Commercial |
$1,072.70
|
| Rate for Payer: United Healthcare VA CCN |
$504.80
|
|
|
LAPARO PROC ABDM/PER/OMENT
|
Facility
|
IP
|
$1,262.00
|
|
|
Service Code
|
CPT 49329
|
| Hospital Charge Code |
9824932901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$934.01 |
| Max. Negotiated Rate |
$1,198.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,198.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$934.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$934.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,072.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,060.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,009.60
|
| Rate for Payer: Cash Price |
$631.00
|
| Rate for Payer: Cigna Commercial |
$1,009.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,009.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,009.60
|
| Rate for Payer: Multiplan Commercial |
$1,173.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,072.70
|
| Rate for Payer: United Healthcare Commercial |
$1,198.90
|
|
|
LAPAROSCOPIC APPENDECTOMY
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
CPT 44970
|
| Hospital Charge Code |
9824497001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,332.18 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,710.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,332.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,332.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,512.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,440.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,440.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,440.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,440.00
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,530.00
|
| Rate for Payer: United Healthcare Commercial |
$1,710.00
|
|
|
LAPAROSCOPIC APPENDECTOMY
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
CPT 44970
|
| Hospital Charge Code |
9824497001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$797.22 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,710.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,612.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$797.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,612.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,083.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,458.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$810.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,431.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,440.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,440.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,440.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$810.00
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,530.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$810.00
|
| Rate for Payer: United Healthcare Commercial |
$1,710.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$810.00
|
| Rate for Payer: United Healthcare VA CCN |
$810.00
|
|
|
LAPAROSCOPIC APPENDECTOMY
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
CPT 44970
|
| Hospital Charge Code |
9824497001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$554.12 |
| Max. Negotiated Rate |
$1,692.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,692.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,612.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$570.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,612.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$775.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$891.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$891.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$637.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$891.87
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,012.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$940.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$940.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$554.13
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$786.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$554.12
|
| Rate for Payer: United Healthcare Commercial |
$852.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$554.12
|
| Rate for Payer: United Healthcare VA CCN |
$554.12
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
CPT 47562
|
| Hospital Charge Code |
9824756201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$664.35 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,425.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,343.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$664.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,343.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$903.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,215.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$675.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,192.50
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,200.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,200.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,200.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$675.00
|
| Rate for Payer: Multiplan Commercial |
$1,395.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,275.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$675.00
|
| Rate for Payer: United Healthcare Commercial |
$1,425.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$675.00
|
| Rate for Payer: United Healthcare VA CCN |
$675.00
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
CPT 47562
|
| Hospital Charge Code |
9824756201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,110.15 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,425.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,110.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,110.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,260.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,200.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,200.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,200.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,200.00
|
| Rate for Payer: Multiplan Commercial |
$1,395.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,275.00
|
| Rate for Payer: United Healthcare Commercial |
$1,425.00
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
CPT 47562
|
| Hospital Charge Code |
9824756201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$606.44 |
| Max. Negotiated Rate |
$1,410.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,410.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,343.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$624.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,343.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$849.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,121.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,121.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$697.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,121.90
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,107.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,031.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,031.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$606.44
|
| Rate for Payer: Multiplan Commercial |
$1,395.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$861.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$606.44
|
| Rate for Payer: United Healthcare Commercial |
$932.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$606.44
|
| Rate for Payer: United Healthcare VA CCN |
$606.44
|
|
|
LAPAROSCOPIC MYOMECTOMY
|
Facility
|
OP
|
$3,153.00
|
|
|
Service Code
|
CPT 58545
|
| Hospital Charge Code |
9825854501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,396.46 |
| Max. Negotiated Rate |
$2,995.35 |
| Rate for Payer: Aetna of VT Commercial |
$2,995.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,824.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,396.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,824.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,898.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,680.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,553.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,418.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,506.64
|
| Rate for Payer: Cash Price |
$1,576.50
|
| Rate for Payer: Cigna Commercial |
$2,522.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,522.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,522.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,418.85
|
| Rate for Payer: Multiplan Commercial |
$2,932.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,680.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,418.85
|
| Rate for Payer: United Healthcare Commercial |
$2,995.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,418.85
|
| Rate for Payer: United Healthcare VA CCN |
$1,418.85
|
|
|
LAPAROSCOPIC MYOMECTOMY
|
Facility
|
IP
|
$3,153.00
|
|
|
Service Code
|
CPT 58545
|
| Hospital Charge Code |
9825854501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,333.54 |
| Max. Negotiated Rate |
$2,995.35 |
| Rate for Payer: Aetna of VT Commercial |
$2,995.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,333.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,333.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,680.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,648.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,522.40
|
| Rate for Payer: Cash Price |
$1,576.50
|
| Rate for Payer: Cigna Commercial |
$2,522.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,522.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,522.40
|
| Rate for Payer: Multiplan Commercial |
$2,932.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,680.05
|
| Rate for Payer: United Healthcare Commercial |
$2,995.35
|
|
|
LAPAROSCOPIC MYOMECTOMY
|
Professional
|
Both
|
$3,153.00
|
|
|
Service Code
|
CPT 58545
|
| Hospital Charge Code |
9825854501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$834.86 |
| Max. Negotiated Rate |
$2,963.82 |
| Rate for Payer: Aetna of VT Commercial |
$2,963.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,824.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$859.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,824.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,168.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,507.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,507.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$960.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,507.05
|
| Rate for Payer: Cash Price |
$1,576.50
|
| Rate for Payer: Cash Price |
$1,576.50
|
| Rate for Payer: Cigna Commercial |
$1,474.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,396.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,396.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$834.87
|
| Rate for Payer: Multiplan Commercial |
$2,932.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,185.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$834.86
|
| Rate for Payer: United Healthcare Commercial |
$1,284.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$834.86
|
| Rate for Payer: United Healthcare VA CCN |
$834.86
|
|
