|
PULM FUNCT TST PLETHYSMOGRAP
|
Facility
|
IP
|
$350.53
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
9769472601
|
|
Hospital Revenue Code
|
976
|
| Min. Negotiated Rate |
$259.43 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Aetna of VT Commercial |
$333.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$259.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$259.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$297.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$294.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$280.42
|
| Rate for Payer: Cash Price |
$175.26
|
| Rate for Payer: Cigna Commercial |
$280.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$280.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$280.42
|
| Rate for Payer: Multiplan Commercial |
$325.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$297.95
|
| Rate for Payer: United Healthcare Commercial |
$333.00
|
|
|
PULM FUNCT TST PLETHYSMOGRAP
|
Facility
|
IP
|
$350.53
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
4609472601
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$259.43 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Aetna of VT Commercial |
$333.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$259.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$259.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$297.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$294.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$280.42
|
| Rate for Payer: Cash Price |
$175.26
|
| Rate for Payer: Cigna Commercial |
$280.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$280.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$280.42
|
| Rate for Payer: Multiplan Commercial |
$325.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$297.95
|
| Rate for Payer: United Healthcare Commercial |
$333.00
|
|
|
PULM FUNCT TST PLETHYSMOGRAP
|
Facility
|
OP
|
$350.53
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
4609472601
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$155.25 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Aetna of VT Commercial |
$333.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$314.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$155.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$314.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$211.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$297.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$157.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$278.67
|
| Rate for Payer: Cash Price |
$175.26
|
| Rate for Payer: Cigna Commercial |
$280.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$280.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$280.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$157.74
|
| Rate for Payer: Multiplan Commercial |
$325.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$297.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$157.74
|
| Rate for Payer: United Healthcare Commercial |
$333.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.74
|
| Rate for Payer: United Healthcare VA CCN |
$157.74
|
|
|
PULMONARY STRESS TESTING
|
Facility
|
IP
|
$773.43
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
4609461801
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$572.42 |
| Max. Negotiated Rate |
$734.76 |
| Rate for Payer: Aetna of VT Commercial |
$734.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$572.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$572.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$657.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$649.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$618.74
|
| Rate for Payer: Cash Price |
$386.71
|
| Rate for Payer: Cigna Commercial |
$618.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$618.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$618.74
|
| Rate for Payer: Multiplan Commercial |
$719.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$657.42
|
| Rate for Payer: United Healthcare Commercial |
$734.76
|
|
|
PULMONARY STRESS TESTING
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
4109461801
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
PULMONARY STRESS TESTING
|
Facility
|
OP
|
$773.43
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
4609461801
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$342.55 |
| Max. Negotiated Rate |
$734.76 |
| Rate for Payer: Aetna of VT Commercial |
$734.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$692.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$342.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$692.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$465.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$657.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$626.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$348.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$614.88
|
| Rate for Payer: Cash Price |
$386.71
|
| Rate for Payer: Cigna Commercial |
$618.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$618.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$618.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$348.04
|
| Rate for Payer: Multiplan Commercial |
$719.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$657.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$348.04
|
| Rate for Payer: United Healthcare Commercial |
$734.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$348.04
|
| Rate for Payer: United Healthcare VA CCN |
$348.04
|
|
|
PULMONARY STRESS TESTING
|
Professional
|
Both
|
$773.43
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
4609461801
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$32.73 |
| Max. Negotiated Rate |
$727.02 |
| Rate for Payer: Aetna of VT Commercial |
$727.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$692.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$33.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$692.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$45.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$48.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$48.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$48.61
|
| Rate for Payer: Cash Price |
$386.71
|
| Rate for Payer: Cash Price |
$386.71
|
| Rate for Payer: Cigna Commercial |
$48.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$52.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$52.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$32.73
|
| Rate for Payer: Multiplan Commercial |
$719.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.73
|
| Rate for Payer: United Healthcare Commercial |
$50.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.73
|
| Rate for Payer: United Healthcare VA CCN |
$32.73
|
|
|
PULMONARY STRESS TESTING
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
4109461801
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
|
|
PULMONARY STRESS TESTING
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
9769461801
|
|
Hospital Revenue Code
|
976
|
| Min. Negotiated Rate |
$291.60 |
| Max. Negotiated Rate |
$374.30 |
| Rate for Payer: Aetna of VT Commercial |
$374.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$291.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$291.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$334.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$330.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$315.20
|
| Rate for Payer: Cash Price |
$197.00
|
| Rate for Payer: Cigna Commercial |
$315.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$315.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$315.20
|
| Rate for Payer: Multiplan Commercial |
$366.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$334.90
|
| Rate for Payer: United Healthcare Commercial |
$374.30
|
|
|
PULMONARY STRESS TESTING
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
9769461801
|
|
Hospital Revenue Code
|
976
|
| Min. Negotiated Rate |
$174.50 |
| Max. Negotiated Rate |
$374.30 |
| Rate for Payer: Aetna of VT Commercial |
$374.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$352.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$174.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$352.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$237.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$334.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$319.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$177.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$313.23
|
| Rate for Payer: Cash Price |
$197.00
|
| Rate for Payer: Cigna Commercial |
$315.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$315.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$315.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$177.30
|
| Rate for Payer: Multiplan Commercial |
$366.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$334.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$177.30
|
| Rate for Payer: United Healthcare Commercial |
$374.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.30
|
| Rate for Payer: United Healthcare VA CCN |
$177.30
|
|
|
PUNCH BX SKIN EA SEP/ADDL
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
9601110502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$122.86 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Aetna of VT Commercial |
$157.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$122.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$122.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$141.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$139.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$132.80
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.80
|
| Rate for Payer: Multiplan Commercial |
$154.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.10
|
| Rate for Payer: United Healthcare Commercial |
$157.70
|
|
|
PUNCH BX SKIN EA SEP/ADDL
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
5101110501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.95 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Aetna of VT Commercial |
$124.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$96.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$96.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$111.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.80
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$104.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$104.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$104.80
|
| Rate for Payer: Multiplan Commercial |
$121.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$111.35
|
| Rate for Payer: United Healthcare Commercial |
$124.45
|
|
|
PUNCH BX SKIN EA SEP/ADDL
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
5101110501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.02 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Aetna of VT Commercial |
$124.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$117.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$117.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$78.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$111.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$58.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.14
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$104.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$104.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$104.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$58.95
|
| Rate for Payer: Multiplan Commercial |
$121.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$111.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$58.95
|
| Rate for Payer: United Healthcare Commercial |
$124.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.95
|
| Rate for Payer: United Healthcare VA CCN |
$58.95
|
|
|
PUNCH BX SKIN EA SEP/ADDL
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
9601110501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$131.10 |
| Max. Negotiated Rate |
$281.20 |
| Rate for Payer: Aetna of VT Commercial |
$281.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$265.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$131.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$265.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$178.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$251.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$239.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$133.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$235.32
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$236.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$133.20
|
| Rate for Payer: Multiplan Commercial |
$275.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$251.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$133.20
|
| Rate for Payer: United Healthcare Commercial |
$281.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$133.20
|
| Rate for Payer: United Healthcare VA CCN |
$133.20
|
|
|
PUNCH BX SKIN EA SEP/ADDL
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
9601110502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$156.04 |
| Rate for Payer: Aetna of VT Commercial |
$156.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$148.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$148.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$33.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$27.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.89
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$26.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.36
|
| Rate for Payer: Multiplan Commercial |
$154.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.59
|
| Rate for Payer: United Healthcare Commercial |
$36.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.59
|
| Rate for Payer: United Healthcare VA CCN |
$23.59
|
|
|
PUNCH BX SKIN EA SEP/ADDL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
5101110501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$123.14 |
| Rate for Payer: Aetna of VT Commercial |
$123.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$117.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$117.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$33.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$27.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.89
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$26.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.36
|
| Rate for Payer: Multiplan Commercial |
$121.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.59
|
| Rate for Payer: United Healthcare Commercial |
$36.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.59
|
| Rate for Payer: United Healthcare VA CCN |
$23.59
|
|
|
PUNCH BX SKIN EA SEP/ADDL
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
9601110501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$278.24 |
| Rate for Payer: Aetna of VT Commercial |
$278.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$265.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$265.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$33.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$27.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.89
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$26.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.36
|
| Rate for Payer: Multiplan Commercial |
$275.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.59
|
| Rate for Payer: United Healthcare Commercial |
$36.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.59
|
| Rate for Payer: United Healthcare VA CCN |
$23.59
|
|
|
PUNCH BX SKIN EA SEP/ADDL
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
9601110502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$73.52 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Aetna of VT Commercial |
$157.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$148.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$73.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$148.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$99.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$141.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$134.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$74.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$131.97
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$74.70
|
| Rate for Payer: Multiplan Commercial |
$154.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.70
|
| Rate for Payer: United Healthcare Commercial |
$157.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.70
|
| Rate for Payer: United Healthcare VA CCN |
$74.70
|
|
|
PUNCH BX SKIN EA SEP/ADDL
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
9601110501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$219.07 |
| Max. Negotiated Rate |
$281.20 |
| Rate for Payer: Aetna of VT Commercial |
$281.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$219.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$219.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$251.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$248.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$236.80
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$236.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.80
|
| Rate for Payer: Multiplan Commercial |
$275.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$251.60
|
| Rate for Payer: United Healthcare Commercial |
$281.20
|
|
|
PUNCH BX SKIN SINGLE LESION
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
9601110402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$43.62 |
| Max. Negotiated Rate |
$216.20 |
| Rate for Payer: Aetna of VT Commercial |
$216.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$206.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$44.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$206.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$61.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$179.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$50.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$179.15
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$49.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$189.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$189.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$117.18
|
| Rate for Payer: Multiplan Commercial |
$213.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$43.62
|
| Rate for Payer: United Healthcare Commercial |
$67.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.62
|
| Rate for Payer: United Healthcare VA CCN |
$43.62
|
|
|
PUNCH BX SKIN SINGLE LESION
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
9601110402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.22 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Aetna of VT Commercial |
$218.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$170.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$170.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$193.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$184.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$184.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$184.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$184.00
|
| Rate for Payer: Multiplan Commercial |
$213.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.50
|
| Rate for Payer: United Healthcare Commercial |
$218.50
|
|
|
PUNCH BX SKIN SINGLE LESION
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
5101110401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.62 |
| Max. Negotiated Rate |
$256.62 |
| Rate for Payer: Aetna of VT Commercial |
$256.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$244.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$44.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$244.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$61.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$179.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$50.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$179.15
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cigna Commercial |
$49.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$189.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$189.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$117.18
|
| Rate for Payer: Multiplan Commercial |
$253.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$43.62
|
| Rate for Payer: United Healthcare Commercial |
$67.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.62
|
| Rate for Payer: United Healthcare VA CCN |
$43.62
|
|
|
PUNCH BX SKIN SINGLE LESION
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
5101110401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.91 |
| Max. Negotiated Rate |
$259.35 |
| Rate for Payer: Aetna of VT Commercial |
$259.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$244.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$120.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$244.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$164.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$232.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$221.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$122.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$217.03
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cigna Commercial |
$218.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$218.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$218.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$122.85
|
| Rate for Payer: Multiplan Commercial |
$253.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$232.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$122.85
|
| Rate for Payer: United Healthcare Commercial |
$259.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.85
|
| Rate for Payer: United Healthcare VA CCN |
$122.85
|
|
|
PUNCH BX SKIN SINGLE LESION
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
5101110401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$202.05 |
| Max. Negotiated Rate |
$259.35 |
| Rate for Payer: Aetna of VT Commercial |
$259.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$202.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$202.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$232.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$229.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$218.40
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cigna Commercial |
$218.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$218.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$253.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$232.05
|
| Rate for Payer: United Healthcare Commercial |
$259.35
|
|
|
PUNCH BX SKIN SINGLE LESION
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
9601110401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$372.27 |
| Max. Negotiated Rate |
$477.85 |
| Rate for Payer: Aetna of VT Commercial |
$477.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$372.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$372.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$427.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$422.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$402.40
|
| Rate for Payer: Cash Price |
$251.50
|
| Rate for Payer: Cigna Commercial |
$402.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$402.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$402.40
|
| Rate for Payer: Multiplan Commercial |
$467.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$427.55
|
| Rate for Payer: United Healthcare Commercial |
$477.85
|
|
