|
PELVIC EXAM W/ANES NOT LOCAL
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
9695741001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$98.56 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna of VT Commercial |
$231.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$220.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$101.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$220.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$137.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$254.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$254.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$113.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$254.60
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$173.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$164.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$164.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$98.56
|
| Rate for Payer: Multiplan Commercial |
$228.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$139.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$98.56
|
| Rate for Payer: United Healthcare Commercial |
$151.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.56
|
| Rate for Payer: United Healthcare VA CCN |
$98.56
|
|
|
PELVIC EXAM W/ANES NOT LOCAL
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
9695741001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$182.06 |
| Max. Negotiated Rate |
$233.70 |
| Rate for Payer: Aetna of VT Commercial |
$233.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$182.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$182.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$206.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.80
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$196.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.80
|
| Rate for Payer: Multiplan Commercial |
$228.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.10
|
| Rate for Payer: United Healthcare Commercial |
$233.70
|
|
|
PELVIC EXAM W/ANES NOT LOCAL
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
9695741001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$108.95 |
| Max. Negotiated Rate |
$233.70 |
| Rate for Payer: Aetna of VT Commercial |
$233.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$220.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$108.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$220.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$148.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$199.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$110.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$195.57
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$196.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$110.70
|
| Rate for Payer: Multiplan Commercial |
$228.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$110.70
|
| Rate for Payer: United Healthcare Commercial |
$233.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.70
|
| Rate for Payer: United Healthcare VA CCN |
$110.70
|
|
|
PENICILLIN G 1,200,000 UNIT
|
Professional
|
Both
|
$261.30
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
636J056102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.82 |
| Max. Negotiated Rate |
$245.62 |
| Rate for Payer: Aetna of VT Commercial |
$245.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$30.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$42.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$34.51
|
| Rate for Payer: Cash Price |
$130.65
|
| Rate for Payer: Cash Price |
$130.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$26.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$26.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.98
|
| Rate for Payer: Multiplan Commercial |
$243.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$30.01
|
| Rate for Payer: United Healthcare Commercial |
$46.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.01
|
| Rate for Payer: United Healthcare VA CCN |
$30.01
|
|
|
PENICILLIN G 1,200,000 UNIT
|
Facility
|
OP
|
$261.30
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
636J056102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$248.24 |
| Rate for Payer: Aetna of VT Commercial |
$248.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$115.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$222.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$211.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$117.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.73
|
| Rate for Payer: Cash Price |
$130.65
|
| Rate for Payer: Cash Price |
$130.65
|
| Rate for Payer: Cigna Commercial |
$209.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$209.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$209.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$117.58
|
| Rate for Payer: Multiplan Commercial |
$243.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$222.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$117.58
|
| Rate for Payer: United Healthcare Commercial |
$248.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$117.58
|
| Rate for Payer: United Healthcare VA CCN |
$117.58
|
|
|
PENICILLIN G 1,200,000 UNIT
|
Facility
|
IP
|
$261.30
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
636J056102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$193.39 |
| Max. Negotiated Rate |
$248.24 |
| Rate for Payer: Aetna of VT Commercial |
$248.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$193.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$193.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$222.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$219.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$209.04
|
| Rate for Payer: Cash Price |
$130.65
|
| Rate for Payer: Cigna Commercial |
$209.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$209.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$209.04
|
| Rate for Payer: Multiplan Commercial |
$243.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$222.10
|
| Rate for Payer: United Healthcare Commercial |
$248.24
|
|
|
PENILE INJECTION
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
9815423501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$77.95 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Aetna of VT Commercial |
$167.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$77.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$105.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$142.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$139.92
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$79.20
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$167.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.20
|
| Rate for Payer: United Healthcare VA CCN |
$79.20
|
|
|
PENILE INJECTION
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
9815423501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$69.76 |
| Max. Negotiated Rate |
$165.44 |
| Rate for Payer: Aetna of VT Commercial |
$165.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$71.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$97.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$145.64
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$120.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$142.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$142.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.78
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.76
|
| Rate for Payer: United Healthcare Commercial |
$107.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.76
|
| Rate for Payer: United Healthcare VA CCN |
$69.76
|
|
|
PENILE INJECTION
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
9605423502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$77.95 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Aetna of VT Commercial |
$167.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$77.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$105.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$142.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$139.92
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$79.20
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$167.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.20
|
| Rate for Payer: United Healthcare VA CCN |
$79.20
|
|
|
PENILE INJECTION
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
9605423501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$69.76 |
| Max. Negotiated Rate |
$309.26 |
| Rate for Payer: Aetna of VT Commercial |
$309.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$294.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$71.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$294.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$97.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$145.64
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cigna Commercial |
$120.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$142.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$142.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.78
|
| Rate for Payer: Multiplan Commercial |
$305.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.76
|
| Rate for Payer: United Healthcare Commercial |
$107.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.76
|
| Rate for Payer: United Healthcare VA CCN |
$69.76
|
|
|
PENILE INJECTION
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
9825423501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$77.95 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Aetna of VT Commercial |
$167.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$77.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$105.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$142.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$139.92
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$79.20
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$167.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.20
|
| Rate for Payer: United Healthcare VA CCN |
$79.20
|
|
|
PENILE INJECTION
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
5105423501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.98 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna of VT Commercial |
$146.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$123.20
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$123.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$123.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$123.20
|
| Rate for Payer: Multiplan Commercial |
$143.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.90
|
| Rate for Payer: United Healthcare Commercial |
$146.30
|
|
|
PENILE INJECTION
|
Facility
|
IP
|
$153.03
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
4505423501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.26 |
| Max. Negotiated Rate |
$145.38 |
| Rate for Payer: Aetna of VT Commercial |
$145.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$128.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.42
|
| Rate for Payer: Cash Price |
$76.52
|
| Rate for Payer: Cigna Commercial |
$122.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$122.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$122.42
|
| Rate for Payer: Multiplan Commercial |
$142.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.08
|
| Rate for Payer: United Healthcare Commercial |
$145.38
|
|
|
PENILE INJECTION
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
5105423501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.76 |
| Max. Negotiated Rate |
$145.64 |
| Rate for Payer: Aetna of VT Commercial |
$144.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$71.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$97.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$145.64
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$120.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$142.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$142.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.78
|
| Rate for Payer: Multiplan Commercial |
$143.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.76
|
| Rate for Payer: United Healthcare Commercial |
$107.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.76
|
| Rate for Payer: United Healthcare VA CCN |
$69.76
|
|
|
PENILE INJECTION
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
9825423501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$69.76 |
| Max. Negotiated Rate |
$165.44 |
| Rate for Payer: Aetna of VT Commercial |
$165.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$71.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$97.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$145.64
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$120.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$142.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$142.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.78
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.76
|
| Rate for Payer: United Healthcare Commercial |
$107.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.76
|
| Rate for Payer: United Healthcare VA CCN |
$69.76
|
|
|
PENILE INJECTION
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
9815423502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$77.95 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Aetna of VT Commercial |
$167.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$77.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$105.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$142.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$139.92
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$79.20
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$167.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.20
|
| Rate for Payer: United Healthcare VA CCN |
$79.20
|
|
|
PENILE INJECTION
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
5105423501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.21 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna of VT Commercial |
$146.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.43
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$123.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$123.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$123.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.30
|
| Rate for Payer: Multiplan Commercial |
$143.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$146.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.30
|
| Rate for Payer: United Healthcare VA CCN |
$69.30
|
|
|
PENILE INJECTION
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
9605423501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$145.71 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Aetna of VT Commercial |
$312.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$294.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$145.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$294.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$198.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$279.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$266.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$148.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$261.56
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cigna Commercial |
$263.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$263.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$263.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$148.05
|
| Rate for Payer: Multiplan Commercial |
$305.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$279.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$148.05
|
| Rate for Payer: United Healthcare Commercial |
$312.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.05
|
| Rate for Payer: United Healthcare VA CCN |
$148.05
|
|
|
PENILE INJECTION
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
9815423502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$130.26 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Aetna of VT Commercial |
$167.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.80
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.80
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.60
|
| Rate for Payer: United Healthcare Commercial |
$167.20
|
|
|
PENILE INJECTION
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
9605423501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$243.49 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Aetna of VT Commercial |
$312.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$243.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$243.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$279.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$276.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$263.20
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cigna Commercial |
$263.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$263.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$263.20
|
| Rate for Payer: Multiplan Commercial |
$305.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$279.65
|
| Rate for Payer: United Healthcare Commercial |
$312.55
|
|
|
PENILE INJECTION
|
Facility
|
OP
|
$153.03
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
4505423501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$67.78 |
| Max. Negotiated Rate |
$145.38 |
| Rate for Payer: Aetna of VT Commercial |
$145.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$67.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$123.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$68.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$121.66
|
| Rate for Payer: Cash Price |
$76.52
|
| Rate for Payer: Cigna Commercial |
$122.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$122.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$122.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$68.86
|
| Rate for Payer: Multiplan Commercial |
$142.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$68.86
|
| Rate for Payer: United Healthcare Commercial |
$145.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.86
|
| Rate for Payer: United Healthcare VA CCN |
$68.86
|
|
|
PENILE INJECTION
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
9605423502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$69.76 |
| Max. Negotiated Rate |
$165.44 |
| Rate for Payer: Aetna of VT Commercial |
$165.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$71.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$97.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$145.64
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$120.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$142.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$142.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.78
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.76
|
| Rate for Payer: United Healthcare Commercial |
$107.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.76
|
| Rate for Payer: United Healthcare VA CCN |
$69.76
|
|
|
PENILE INJECTION
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
9815423501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$130.26 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Aetna of VT Commercial |
$167.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.80
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.80
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.60
|
| Rate for Payer: United Healthcare Commercial |
$167.20
|
|
|
PENILE INJECTION
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
9825423501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$130.26 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Aetna of VT Commercial |
$167.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.80
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.80
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.60
|
| Rate for Payer: United Healthcare Commercial |
$167.20
|
|
|
PENILE INJECTION
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
9815423502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$69.76 |
| Max. Negotiated Rate |
$165.44 |
| Rate for Payer: Aetna of VT Commercial |
$165.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$71.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$97.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$145.64
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$120.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$142.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$142.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.78
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.76
|
| Rate for Payer: United Healthcare Commercial |
$107.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.76
|
| Rate for Payer: United Healthcare VA CCN |
$69.76
|
|
