|
LAPAROSCOPY ASPIRATION
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
CPT 49322
|
| Hospital Charge Code |
9824932201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$637.78 |
| Max. Negotiated Rate |
$1,368.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,368.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,290.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$637.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,290.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$866.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,224.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,166.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$648.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,144.80
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$1,152.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,152.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,152.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$648.00
|
| Rate for Payer: Multiplan Commercial |
$1,339.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,224.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$648.00
|
| Rate for Payer: United Healthcare Commercial |
$1,368.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$648.00
|
| Rate for Payer: United Healthcare VA CCN |
$648.00
|
|
|
LAPAROSCOPY ASPIRATION
|
Professional
|
Both
|
$1,440.00
|
|
|
Service Code
|
CPT 49322
|
| Hospital Charge Code |
9824932201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$344.72 |
| Max. Negotiated Rate |
$1,353.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,353.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,290.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$355.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,290.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$482.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$715.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$715.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$396.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$715.26
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$631.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$583.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$583.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$344.72
|
| Rate for Payer: Multiplan Commercial |
$1,339.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$489.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$344.72
|
| Rate for Payer: United Healthcare Commercial |
$530.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$344.72
|
| Rate for Payer: United Healthcare VA CCN |
$344.72
|
|
|
LAPAROSCOPY ASPIRATION
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
CPT 49322
|
| Hospital Charge Code |
9824932201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,065.74 |
| Max. Negotiated Rate |
$1,368.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,368.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,065.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,065.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,224.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,209.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,152.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$1,152.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,152.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,152.00
|
| Rate for Payer: Multiplan Commercial |
$1,339.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare Commercial |
$1,368.00
|
|
|
LAPAROSCOPY BIOPSY
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
CPT 49321
|
| Hospital Charge Code |
9824932101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$318.29 |
| Max. Negotiated Rate |
$987.00 |
| Rate for Payer: Aetna of VT Commercial |
$987.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$940.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$327.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$940.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$445.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$691.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$691.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$366.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$691.87
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$582.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$537.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$537.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$318.29
|
| Rate for Payer: Multiplan Commercial |
$976.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$451.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$318.30
|
| Rate for Payer: United Healthcare Commercial |
$489.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$318.30
|
| Rate for Payer: United Healthcare VA CCN |
$318.30
|
|
|
LAPAROSCOPY BIOPSY
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
CPT 49321
|
| Hospital Charge Code |
9824932101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$465.05 |
| Max. Negotiated Rate |
$997.50 |
| Rate for Payer: Aetna of VT Commercial |
$997.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$940.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$465.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$940.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$632.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$892.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$850.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$472.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$834.75
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$840.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$840.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$840.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$472.50
|
| Rate for Payer: Multiplan Commercial |
$976.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$892.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$472.50
|
| Rate for Payer: United Healthcare Commercial |
$997.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$472.50
|
| Rate for Payer: United Healthcare VA CCN |
$472.50
|
|
|
LAPAROSCOPY BIOPSY
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
CPT 49321
|
| Hospital Charge Code |
9824932101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$777.11 |
| Max. Negotiated Rate |
$997.50 |
| Rate for Payer: Aetna of VT Commercial |
$997.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$777.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$777.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$892.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$882.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$840.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$840.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$840.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$840.00
|
| Rate for Payer: Multiplan Commercial |
$976.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$892.50
|
| Rate for Payer: United Healthcare Commercial |
$997.50
|
|
|
LAPAROSCOPY ENTEROLYSIS SP
|
Facility
|
IP
|
$2,542.00
|
|
|
Service Code
|
CPT 44180
|
| Hospital Charge Code |
9694418001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$1,881.33 |
| Max. Negotiated Rate |
$2,414.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,414.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,881.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,881.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,160.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,135.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,033.60
|
| Rate for Payer: Cash Price |
$1,271.00
|
| Rate for Payer: Cigna Commercial |
$2,033.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,033.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,033.60
|
| Rate for Payer: Multiplan Commercial |
$2,364.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,160.70
|
| Rate for Payer: United Healthcare Commercial |
$2,414.90
|
|
|
LAPAROSCOPY ENTEROLYSIS SP
|
Professional
|
Both
|
$2,542.00
|
|
|
Service Code
|
CPT 44180
|
| Hospital Charge Code |
9694418001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$839.39 |
| Max. Negotiated Rate |
$2,389.48 |
| Rate for Payer: Aetna of VT Commercial |
$2,389.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,277.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$864.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,277.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,175.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,235.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,235.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$965.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,235.49
|
| Rate for Payer: Cash Price |
$1,271.00
|
| Rate for Payer: Cash Price |
$1,271.00
|
| Rate for Payer: Cigna Commercial |
$1,533.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,429.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,429.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$839.39
|
| Rate for Payer: Multiplan Commercial |
$2,364.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,191.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$839.39
|
| Rate for Payer: United Healthcare Commercial |
$1,291.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$839.39
|
| Rate for Payer: United Healthcare VA CCN |
$839.39
|
|
|
LAPAROSCOPY ENTEROLYSIS SP
|
Facility
|
OP
|
$2,542.00
|
|
|
Service Code
|
CPT 44180
|
| Hospital Charge Code |
9694418001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$1,125.85 |
| Max. Negotiated Rate |
$2,414.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,414.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,277.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,125.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,277.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,530.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,160.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,059.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,143.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,020.89
|
| Rate for Payer: Cash Price |
$1,271.00
|
| Rate for Payer: Cigna Commercial |
$2,033.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,033.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,033.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,143.90
|
| Rate for Payer: Multiplan Commercial |
$2,364.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,160.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,143.90
|
| Rate for Payer: United Healthcare Commercial |
$2,414.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,143.90
|
| Rate for Payer: United Healthcare VA CCN |
$1,143.90
|
|
|
LAPAROSCOPY EXCISE LESIONS
|
Facility
|
IP
|
$1,837.00
|
|
|
Service Code
|
CPT 58662
|
| Hospital Charge Code |
9825866201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,359.56 |
| Max. Negotiated Rate |
$1,745.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,745.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,359.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,359.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,561.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,543.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,469.60
|
| Rate for Payer: Cash Price |
$918.50
|
| Rate for Payer: Cigna Commercial |
$1,469.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,469.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,469.60
|
| Rate for Payer: Multiplan Commercial |
$1,708.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,561.45
|
| Rate for Payer: United Healthcare Commercial |
$1,745.15
|
|
|
LAPAROSCOPY EXCISE LESIONS
|
Professional
|
Both
|
$1,837.00
|
|
|
Service Code
|
CPT 58662
|
| Hospital Charge Code |
9825866201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$661.53 |
| Max. Negotiated Rate |
$1,726.78 |
| Rate for Payer: Aetna of VT Commercial |
$1,726.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,645.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$681.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,645.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$926.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,215.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,215.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$760.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,215.53
|
| Rate for Payer: Cash Price |
$918.50
|
| Rate for Payer: Cash Price |
$918.50
|
| Rate for Payer: Cigna Commercial |
$1,167.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,105.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,105.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$661.53
|
| Rate for Payer: Multiplan Commercial |
$1,708.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$939.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$661.53
|
| Rate for Payer: United Healthcare Commercial |
$1,017.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$661.53
|
| Rate for Payer: United Healthcare VA CCN |
$661.53
|
|
|
LAPAROSCOPY EXCISE LESIONS
|
Facility
|
OP
|
$1,837.00
|
|
|
Service Code
|
CPT 58662
|
| Hospital Charge Code |
9825866201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$813.61 |
| Max. Negotiated Rate |
$1,745.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,745.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,645.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$813.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,645.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,105.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,561.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,487.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$826.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,460.41
|
| Rate for Payer: Cash Price |
$918.50
|
| Rate for Payer: Cigna Commercial |
$1,469.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,469.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,469.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$826.65
|
| Rate for Payer: Multiplan Commercial |
$1,708.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,561.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$826.65
|
| Rate for Payer: United Healthcare Commercial |
$1,745.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$826.65
|
| Rate for Payer: United Healthcare VA CCN |
$826.65
|
|
|
LAPAROSCOPY LYSIS
|
Professional
|
Both
|
$1,914.00
|
|
|
Service Code
|
CPT 58660
|
| Hospital Charge Code |
9825866001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$632.94 |
| Max. Negotiated Rate |
$1,799.16 |
| Rate for Payer: Aetna of VT Commercial |
$1,799.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,714.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$651.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,714.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$886.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,145.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,145.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$727.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,145.96
|
| Rate for Payer: Cash Price |
$957.00
|
| Rate for Payer: Cash Price |
$957.00
|
| Rate for Payer: Cigna Commercial |
$1,114.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,064.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,064.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$632.94
|
| Rate for Payer: Multiplan Commercial |
$1,780.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$898.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$632.94
|
| Rate for Payer: United Healthcare Commercial |
$973.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$632.94
|
| Rate for Payer: United Healthcare VA CCN |
$632.94
|
|
|
LAPAROSCOPY LYSIS
|
Facility
|
OP
|
$1,914.00
|
|
|
Service Code
|
CPT 58660
|
| Hospital Charge Code |
9825866001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$847.71 |
| Max. Negotiated Rate |
$1,818.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,818.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,714.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$847.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,714.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,152.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,626.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,550.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$861.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,521.63
|
| Rate for Payer: Cash Price |
$957.00
|
| Rate for Payer: Cigna Commercial |
$1,531.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,531.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,531.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$861.30
|
| Rate for Payer: Multiplan Commercial |
$1,780.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,626.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$861.30
|
| Rate for Payer: United Healthcare Commercial |
$1,818.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$861.30
|
| Rate for Payer: United Healthcare VA CCN |
$861.30
|
|
|
LAPAROSCOPY LYSIS
|
Facility
|
IP
|
$1,914.00
|
|
|
Service Code
|
CPT 58660
|
| Hospital Charge Code |
9825866001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,416.55 |
| Max. Negotiated Rate |
$1,818.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,818.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,416.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,416.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,626.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,607.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,531.20
|
| Rate for Payer: Cash Price |
$957.00
|
| Rate for Payer: Cigna Commercial |
$1,531.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,531.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,531.20
|
| Rate for Payer: Multiplan Commercial |
$1,780.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Commercial |
$1,818.30
|
|
|
LAPAROSCOPY REMOVE ADNEXA
|
Facility
|
OP
|
$1,739.00
|
|
|
Service Code
|
CPT 58661
|
| Hospital Charge Code |
9825866101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$770.20 |
| Max. Negotiated Rate |
$1,652.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,652.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,557.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$770.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,557.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,046.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,478.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,408.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$782.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,382.51
|
| Rate for Payer: Cash Price |
$869.50
|
| Rate for Payer: Cigna Commercial |
$1,391.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,391.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,391.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$782.55
|
| Rate for Payer: Multiplan Commercial |
$1,617.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,478.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$782.55
|
| Rate for Payer: United Healthcare Commercial |
$1,652.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$782.55
|
| Rate for Payer: United Healthcare VA CCN |
$782.55
|
|
|
LAPAROSCOPY REMOVE ADNEXA
|
Professional
|
Both
|
$1,739.00
|
|
|
Service Code
|
CPT 58661
|
| Hospital Charge Code |
9825866101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$604.38 |
| Max. Negotiated Rate |
$1,634.66 |
| Rate for Payer: Aetna of VT Commercial |
$1,634.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,557.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$622.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,557.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$846.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,143.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,143.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$695.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,143.02
|
| Rate for Payer: Cash Price |
$869.50
|
| Rate for Payer: Cash Price |
$869.50
|
| Rate for Payer: Cigna Commercial |
$1,066.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,010.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,010.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$604.38
|
| Rate for Payer: Multiplan Commercial |
$1,617.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$858.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$604.38
|
| Rate for Payer: United Healthcare Commercial |
$929.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$604.38
|
| Rate for Payer: United Healthcare VA CCN |
$604.38
|
|
|
LAPAROSCOPY REMOVE ADNEXA
|
Facility
|
IP
|
$1,739.00
|
|
|
Service Code
|
CPT 58661
|
| Hospital Charge Code |
9825866101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,287.03 |
| Max. Negotiated Rate |
$1,652.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,652.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,287.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,287.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,478.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,460.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,391.20
|
| Rate for Payer: Cash Price |
$869.50
|
| Rate for Payer: Cigna Commercial |
$1,391.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,391.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,391.20
|
| Rate for Payer: Multiplan Commercial |
$1,617.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,478.15
|
| Rate for Payer: United Healthcare Commercial |
$1,652.05
|
|
|
LAPAROSCOPY TUBAL BLOCK
|
Professional
|
Both
|
$1,232.00
|
|
|
Service Code
|
CPT 58671
|
| Hospital Charge Code |
9825867101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$346.36 |
| Max. Negotiated Rate |
$1,158.08 |
| Rate for Payer: Aetna of VT Commercial |
$1,158.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,103.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$356.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,103.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$484.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$611.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$611.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$398.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$611.49
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cigna Commercial |
$612.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$577.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$577.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$346.36
|
| Rate for Payer: Multiplan Commercial |
$1,145.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$491.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$346.36
|
| Rate for Payer: United Healthcare Commercial |
$532.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$346.36
|
| Rate for Payer: United Healthcare VA CCN |
$346.36
|
|
|
LAPAROSCOPY TUBAL BLOCK
|
Facility
|
IP
|
$1,232.00
|
|
|
Service Code
|
CPT 58671
|
| Hospital Charge Code |
9825867101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$911.80 |
| Max. Negotiated Rate |
$1,170.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,170.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$911.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$911.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,047.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,034.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$985.60
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cigna Commercial |
$985.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$985.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$985.60
|
| Rate for Payer: Multiplan Commercial |
$1,145.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,047.20
|
| Rate for Payer: United Healthcare Commercial |
$1,170.40
|
|
|
LAPAROSCOPY TUBAL BLOCK
|
Facility
|
OP
|
$1,232.00
|
|
|
Service Code
|
CPT 58671
|
| Hospital Charge Code |
9825867101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$545.65 |
| Max. Negotiated Rate |
$1,170.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,170.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,103.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$545.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,103.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$741.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,047.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$997.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$554.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$979.44
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cigna Commercial |
$985.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$985.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$985.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$554.40
|
| Rate for Payer: Multiplan Commercial |
$1,145.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,047.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$554.40
|
| Rate for Payer: United Healthcare Commercial |
$1,170.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$554.40
|
| Rate for Payer: United Healthcare VA CCN |
$554.40
|
|
|
LAPAROSCOPY TUBAL CAUTERY
|
Facility
|
OP
|
$1,345.00
|
|
|
Service Code
|
CPT 58670
|
| Hospital Charge Code |
9825867001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$595.70 |
| Max. Negotiated Rate |
$1,277.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,277.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,204.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$595.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,204.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$809.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,143.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,089.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$605.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,069.28
|
| Rate for Payer: Cash Price |
$672.50
|
| Rate for Payer: Cigna Commercial |
$1,076.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,076.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,076.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$605.25
|
| Rate for Payer: Multiplan Commercial |
$1,250.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,143.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$605.25
|
| Rate for Payer: United Healthcare Commercial |
$1,277.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$605.25
|
| Rate for Payer: United Healthcare VA CCN |
$605.25
|
|
|
LAPAROSCOPY TUBAL CAUTERY
|
Professional
|
Both
|
$1,345.00
|
|
|
Service Code
|
CPT 58670
|
| Hospital Charge Code |
9825867001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$346.36 |
| Max. Negotiated Rate |
$1,264.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,264.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,204.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$356.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,204.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$484.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$814.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$814.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$398.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$814.71
|
| Rate for Payer: Cash Price |
$672.50
|
| Rate for Payer: Cash Price |
$672.50
|
| Rate for Payer: Cigna Commercial |
$612.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$577.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$577.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$346.36
|
| Rate for Payer: Multiplan Commercial |
$1,250.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$491.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$346.36
|
| Rate for Payer: United Healthcare Commercial |
$532.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$346.36
|
| Rate for Payer: United Healthcare VA CCN |
$346.36
|
|
|
LAPAROSCOPY TUBAL CAUTERY
|
Facility
|
IP
|
$1,345.00
|
|
|
Service Code
|
CPT 58670
|
| Hospital Charge Code |
9825867001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$995.43 |
| Max. Negotiated Rate |
$1,277.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,277.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$995.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$995.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,143.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,129.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,076.00
|
| Rate for Payer: Cash Price |
$672.50
|
| Rate for Payer: Cigna Commercial |
$1,076.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,076.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,076.00
|
| Rate for Payer: Multiplan Commercial |
$1,250.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,143.25
|
| Rate for Payer: United Healthcare Commercial |
$1,277.75
|
|
|
LAPARO-VAG HYST INCL T/O
|
Professional
|
Both
|
$2,487.00
|
|
|
Service Code
|
CPT 58552
|
| Hospital Charge Code |
9825855201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$910.60 |
| Max. Negotiated Rate |
$2,337.78 |
| Rate for Payer: Aetna of VT Commercial |
$2,337.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,228.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$937.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,228.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,274.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,653.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,653.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,047.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,653.09
|
| Rate for Payer: Cash Price |
$1,243.50
|
| Rate for Payer: Cash Price |
$1,243.50
|
| Rate for Payer: Cigna Commercial |
$1,604.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,520.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,520.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$910.60
|
| Rate for Payer: Multiplan Commercial |
$2,312.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,293.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$910.60
|
| Rate for Payer: United Healthcare Commercial |
$1,400.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$910.60
|
| Rate for Payer: United Healthcare VA CCN |
$910.60
|
|
