|
LAPARO-VAG HYST INCL T/O
|
Facility
|
IP
|
$2,487.00
|
|
|
Service Code
|
CPT 58552
|
| Hospital Charge Code |
9825855201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,840.63 |
| Max. Negotiated Rate |
$2,362.65 |
| Rate for Payer: Aetna of VT Commercial |
$2,362.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,840.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,840.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,113.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,089.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,989.60
|
| Rate for Payer: Cash Price |
$1,243.50
|
| Rate for Payer: Cigna Commercial |
$1,989.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,989.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,989.60
|
| Rate for Payer: Multiplan Commercial |
$2,312.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,113.95
|
| Rate for Payer: United Healthcare Commercial |
$2,362.65
|
|
|
LAPARO-VAG HYST INCL T/O
|
Facility
|
OP
|
$2,487.00
|
|
|
Service Code
|
CPT 58552
|
| Hospital Charge Code |
9825855201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,101.49 |
| Max. Negotiated Rate |
$2,362.65 |
| Rate for Payer: Aetna of VT Commercial |
$2,362.65
|
| 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 |
$1,101.49
|
| 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 |
$1,497.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,113.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,014.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,119.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,977.16
|
| Rate for Payer: Cash Price |
$1,243.50
|
| Rate for Payer: Cigna Commercial |
$1,989.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,989.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,989.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,119.15
|
| Rate for Payer: Multiplan Commercial |
$2,312.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,113.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,119.15
|
| Rate for Payer: United Healthcare Commercial |
$2,362.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,119.15
|
| Rate for Payer: United Healthcare VA CCN |
$1,119.15
|
|
|
LAPARO-VAG HYST W/T/O COMPL
|
Professional
|
Both
|
$3,268.00
|
|
|
Service Code
|
CPT 58554
|
| Hospital Charge Code |
9825855401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,205.48 |
| Max. Negotiated Rate |
$3,071.92 |
| Rate for Payer: Aetna of VT Commercial |
$3,071.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,927.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,241.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,927.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,687.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,228.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,228.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,386.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,228.66
|
| Rate for Payer: Cash Price |
$1,634.00
|
| Rate for Payer: Cash Price |
$1,634.00
|
| Rate for Payer: Cigna Commercial |
$2,129.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,015.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,015.56
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,205.48
|
| Rate for Payer: Multiplan Commercial |
$3,039.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,711.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,205.48
|
| Rate for Payer: United Healthcare Commercial |
$1,854.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,205.48
|
| Rate for Payer: United Healthcare VA CCN |
$1,205.48
|
|
|
LAPARO-VAG HYST W/T/O COMPL
|
Facility
|
OP
|
$3,268.00
|
|
|
Service Code
|
CPT 58554
|
| Hospital Charge Code |
9825855401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,447.40 |
| Max. Negotiated Rate |
$3,104.60 |
| Rate for Payer: Aetna of VT Commercial |
$3,104.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,927.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,447.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,927.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,967.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,777.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,647.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,470.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,598.06
|
| Rate for Payer: Cash Price |
$1,634.00
|
| Rate for Payer: Cigna Commercial |
$2,614.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,614.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,614.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,470.60
|
| Rate for Payer: Multiplan Commercial |
$3,039.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,777.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,470.60
|
| Rate for Payer: United Healthcare Commercial |
$3,104.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,470.60
|
| Rate for Payer: United Healthcare VA CCN |
$1,470.60
|
|
|
LAPARO-VAG HYST W/T/O COMPL
|
Facility
|
IP
|
$3,268.00
|
|
|
Service Code
|
CPT 58554
|
| Hospital Charge Code |
9825855401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,418.65 |
| Max. Negotiated Rate |
$3,104.60 |
| Rate for Payer: Aetna of VT Commercial |
$3,104.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,418.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,418.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,777.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,745.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,614.40
|
| Rate for Payer: Cash Price |
$1,634.00
|
| Rate for Payer: Cigna Commercial |
$2,614.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,614.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,614.40
|
| Rate for Payer: Multiplan Commercial |
$3,039.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,777.80
|
| Rate for Payer: United Healthcare Commercial |
$3,104.60
|
|
|
LAP ENTERECTOMY
|
Professional
|
Both
|
$4,453.00
|
|
|
Service Code
|
CPT 44202
|
| Hospital Charge Code |
9824420201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,260.82 |
| Max. Negotiated Rate |
$4,185.82 |
| Rate for Payer: Aetna of VT Commercial |
$4,185.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,989.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,298.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,989.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,765.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,162.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,162.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,449.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,162.09
|
| Rate for Payer: Cash Price |
$2,226.50
|
| Rate for Payer: Cash Price |
$2,226.50
|
| Rate for Payer: Cigna Commercial |
$2,307.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,145.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,145.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,260.82
|
| Rate for Payer: Multiplan Commercial |
$4,141.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,790.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,260.83
|
| Rate for Payer: United Healthcare Commercial |
$1,939.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,260.83
|
| Rate for Payer: United Healthcare VA CCN |
$1,260.83
|
|
|
LAP ENTERECTOMY
|
Facility
|
OP
|
$4,453.00
|
|
|
Service Code
|
CPT 44202
|
| Hospital Charge Code |
9824420201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,972.23 |
| Max. Negotiated Rate |
$4,230.35 |
| Rate for Payer: Aetna of VT Commercial |
$4,230.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,989.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,972.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,989.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,680.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,785.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,606.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,003.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,540.14
|
| Rate for Payer: Cash Price |
$2,226.50
|
| Rate for Payer: Cigna Commercial |
$3,562.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,562.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,562.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,003.85
|
| Rate for Payer: Multiplan Commercial |
$4,141.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,785.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,003.85
|
| Rate for Payer: United Healthcare Commercial |
$4,230.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,003.85
|
| Rate for Payer: United Healthcare VA CCN |
$2,003.85
|
|
|
LAP ENTERECTOMY
|
Facility
|
IP
|
$4,453.00
|
|
|
Service Code
|
CPT 44202
|
| Hospital Charge Code |
9824420201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$3,295.67 |
| Max. Negotiated Rate |
$4,230.35 |
| Rate for Payer: Aetna of VT Commercial |
$4,230.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,295.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,295.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,785.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,740.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,562.40
|
| Rate for Payer: Cash Price |
$2,226.50
|
| Rate for Payer: Cigna Commercial |
$3,562.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,562.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,562.40
|
| Rate for Payer: Multiplan Commercial |
$4,141.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,785.05
|
| Rate for Payer: United Healthcare Commercial |
$4,230.35
|
|
|
LAP ING HERNIA REPAIR INIT
|
Facility
|
OP
|
$1,961.00
|
|
|
Service Code
|
CPT 49650
|
| Hospital Charge Code |
9824965001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$868.53 |
| Max. Negotiated Rate |
$1,862.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,862.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,756.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$868.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,756.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,180.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,666.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,588.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$882.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,558.99
|
| Rate for Payer: Cash Price |
$980.50
|
| Rate for Payer: Cigna Commercial |
$1,568.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,568.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,568.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$882.45
|
| Rate for Payer: Multiplan Commercial |
$1,823.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,666.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$882.45
|
| Rate for Payer: United Healthcare Commercial |
$1,862.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$882.45
|
| Rate for Payer: United Healthcare VA CCN |
$882.45
|
|
|
LAP ING HERNIA REPAIR INIT
|
Professional
|
Both
|
$1,961.00
|
|
|
Service Code
|
CPT 49650
|
| Hospital Charge Code |
9824965001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$401.64 |
| Max. Negotiated Rate |
$1,843.34 |
| Rate for Payer: Aetna of VT Commercial |
$1,843.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,756.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$413.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,756.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$562.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$701.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$701.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$461.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$701.94
|
| Rate for Payer: Cash Price |
$980.50
|
| Rate for Payer: Cash Price |
$980.50
|
| Rate for Payer: Cigna Commercial |
$732.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$679.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$679.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$401.64
|
| Rate for Payer: Multiplan Commercial |
$1,823.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$570.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$401.64
|
| Rate for Payer: United Healthcare Commercial |
$617.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$401.64
|
| Rate for Payer: United Healthcare VA CCN |
$401.64
|
|
|
LAP ING HERNIA REPAIR INIT
|
Facility
|
IP
|
$1,961.00
|
|
|
Service Code
|
CPT 49650
|
| Hospital Charge Code |
9824965001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,451.34 |
| Max. Negotiated Rate |
$1,862.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,862.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,451.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,451.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,666.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,647.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,568.80
|
| Rate for Payer: Cash Price |
$980.50
|
| Rate for Payer: Cigna Commercial |
$1,568.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,568.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,568.80
|
| Rate for Payer: Multiplan Commercial |
$1,823.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,666.85
|
| Rate for Payer: United Healthcare Commercial |
$1,862.95
|
|
|
LAP ING HERNIA REPAIR RECUR
|
Facility
|
IP
|
$1,782.00
|
|
|
Service Code
|
CPT 49651
|
| Hospital Charge Code |
9824965101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,318.86 |
| Max. Negotiated Rate |
$1,692.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,692.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,318.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,318.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,514.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,496.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,425.60
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Cigna Commercial |
$1,425.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,425.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,425.60
|
| Rate for Payer: Multiplan Commercial |
$1,657.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,514.70
|
| Rate for Payer: United Healthcare Commercial |
$1,692.90
|
|
|
LAP ING HERNIA REPAIR RECUR
|
Professional
|
Both
|
$1,782.00
|
|
|
Service Code
|
CPT 49651
|
| Hospital Charge Code |
9824965101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$523.07 |
| Max. Negotiated Rate |
$1,675.08 |
| Rate for Payer: Aetna of VT Commercial |
$1,675.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,596.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$538.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,596.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$732.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$943.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$943.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$601.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$943.14
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Cigna Commercial |
$955.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$886.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$886.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$523.07
|
| Rate for Payer: Multiplan Commercial |
$1,657.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$742.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$523.07
|
| Rate for Payer: United Healthcare Commercial |
$804.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$523.07
|
| Rate for Payer: United Healthcare VA CCN |
$523.07
|
|
|
LAP ING HERNIA REPAIR RECUR
|
Facility
|
OP
|
$1,782.00
|
|
|
Service Code
|
CPT 49651
|
| Hospital Charge Code |
9824965101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$789.25 |
| Max. Negotiated Rate |
$1,692.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,692.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,596.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$789.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,596.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,072.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,514.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$801.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,416.69
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Cigna Commercial |
$1,425.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,425.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,425.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$801.90
|
| Rate for Payer: Multiplan Commercial |
$1,657.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,514.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$801.90
|
| Rate for Payer: United Healthcare Commercial |
$1,692.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$801.90
|
| Rate for Payer: United Healthcare VA CCN |
$801.90
|
|
|
LARYNGOSCOPY FLEX DIAGNOSTIC
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
9603157502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$234.61 |
| Max. Negotiated Rate |
$301.15 |
| Rate for Payer: Aetna of VT Commercial |
$301.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$234.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$234.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$269.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$266.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$253.60
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cigna Commercial |
$253.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$253.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$253.60
|
| Rate for Payer: Multiplan Commercial |
$294.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$269.45
|
| Rate for Payer: United Healthcare Commercial |
$301.15
|
|
|
LARYNGOSCOPY FLEX DIAGNOSTIC
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
9823157501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$234.61 |
| Max. Negotiated Rate |
$301.15 |
| Rate for Payer: Aetna of VT Commercial |
$301.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$234.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$234.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$269.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$266.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$253.60
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cigna Commercial |
$253.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$253.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$253.60
|
| Rate for Payer: Multiplan Commercial |
$294.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$269.45
|
| Rate for Payer: United Healthcare Commercial |
$301.15
|
|
|
LARYNGOSCOPY FLEX DIAGNOSTIC
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
9603157502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$301.15 |
| Rate for Payer: Aetna of VT Commercial |
$301.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$284.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$284.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$190.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$269.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$256.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$252.01
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cigna Commercial |
$253.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$253.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$253.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.65
|
| Rate for Payer: Multiplan Commercial |
$294.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$269.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$142.65
|
| Rate for Payer: United Healthcare Commercial |
$301.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.65
|
| Rate for Payer: United Healthcare VA CCN |
$142.65
|
|
|
LARYNGOSCOPY FLEX DIAGNOSTIC
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
9823157501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$301.15 |
| Rate for Payer: Aetna of VT Commercial |
$301.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$284.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$284.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$190.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$269.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$256.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$252.01
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cigna Commercial |
$253.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$253.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$253.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.65
|
| Rate for Payer: Multiplan Commercial |
$294.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$269.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$142.65
|
| Rate for Payer: United Healthcare Commercial |
$301.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.65
|
| Rate for Payer: United Healthcare VA CCN |
$142.65
|
|
|
LARYNGOSCOPY FLEX DIAGNOSTIC
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
5103157501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$147.93 |
| Max. Negotiated Rate |
$317.30 |
| Rate for Payer: Aetna of VT Commercial |
$317.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$299.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$147.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$299.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$201.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$283.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$270.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$150.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$265.53
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$267.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$267.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$267.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$150.30
|
| Rate for Payer: Multiplan Commercial |
$310.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$283.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$150.30
|
| Rate for Payer: United Healthcare Commercial |
$317.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.30
|
| Rate for Payer: United Healthcare VA CCN |
$150.30
|
|
|
LARYNGOSCOPY FLEX DIAGNOSTIC
|
Facility
|
IP
|
$333.98
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
4503157501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$247.18 |
| Max. Negotiated Rate |
$317.28 |
| Rate for Payer: Aetna of VT Commercial |
$317.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$247.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$247.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$283.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$280.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$267.18
|
| Rate for Payer: Cash Price |
$166.99
|
| Rate for Payer: Cigna Commercial |
$267.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$267.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$267.18
|
| Rate for Payer: Multiplan Commercial |
$310.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$283.88
|
| Rate for Payer: United Healthcare Commercial |
$317.28
|
|
|
LARYNGOSCOPY FLEX DIAGNOSTIC
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
9603157502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$65.04 |
| Max. Negotiated Rate |
$297.98 |
| Rate for Payer: Aetna of VT Commercial |
$297.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$284.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$66.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$284.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$91.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$194.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$194.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$74.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$194.28
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cigna Commercial |
$102.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.93
|
| Rate for Payer: Multiplan Commercial |
$294.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$92.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.04
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.04
|
| Rate for Payer: United Healthcare VA CCN |
$65.04
|
|
|
LARYNGOSCOPY FLEX DIAGNOSTIC
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
9813157501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$65.04 |
| Max. Negotiated Rate |
$297.98 |
| Rate for Payer: Aetna of VT Commercial |
$297.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$284.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$66.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$284.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$91.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$194.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$194.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$74.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$194.28
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cigna Commercial |
$102.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.93
|
| Rate for Payer: Multiplan Commercial |
$294.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$92.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.04
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.04
|
| Rate for Payer: United Healthcare VA CCN |
$65.04
|
|
|
LARYNGOSCOPY FLEX DIAGNOSTIC
|
Facility
|
OP
|
$651.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
9603157501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$288.33 |
| Max. Negotiated Rate |
$618.45 |
| Rate for Payer: Aetna of VT Commercial |
$618.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$583.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$288.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$583.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$391.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$553.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$527.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$292.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$517.54
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna Commercial |
$520.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$520.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$520.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$292.95
|
| Rate for Payer: Multiplan Commercial |
$605.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$553.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$292.95
|
| Rate for Payer: United Healthcare Commercial |
$618.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.95
|
| Rate for Payer: United Healthcare VA CCN |
$292.95
|
|
|
LARYNGOSCOPY FLEX DIAGNOSTIC
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
9823157501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$65.04 |
| Max. Negotiated Rate |
$297.98 |
| Rate for Payer: Aetna of VT Commercial |
$297.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$284.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$66.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$284.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$91.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$194.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$194.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$74.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$194.28
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cigna Commercial |
$102.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.93
|
| Rate for Payer: Multiplan Commercial |
$294.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$92.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.04
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.04
|
| Rate for Payer: United Healthcare VA CCN |
$65.04
|
|
|
LARYNGOSCOPY FLEX DIAGNOSTIC
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
9813157501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$301.15 |
| Rate for Payer: Aetna of VT Commercial |
$301.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$284.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$284.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$190.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$269.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$256.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$252.01
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cigna Commercial |
$253.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$253.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$253.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.65
|
| Rate for Payer: Multiplan Commercial |
$294.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$269.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$142.65
|
| Rate for Payer: United Healthcare Commercial |
$301.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.65
|
| Rate for Payer: United Healthcare VA CCN |
$142.65
|
|
