|
REMOVAL OF SKIN TAGS <W/15
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
9601120001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$73.80 |
| Max. Negotiated Rate |
$271.66 |
| Rate for Payer: Aetna of VT Commercial |
$271.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$103.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$117.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$117.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$84.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$117.51
|
| Rate for Payer: Cash Price |
$144.50
|
| Rate for Payer: Cash Price |
$144.50
|
| Rate for Payer: Cigna Commercial |
$82.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$88.57
|
| Rate for Payer: Multiplan Commercial |
$268.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$104.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$73.80
|
| Rate for Payer: United Healthcare Commercial |
$113.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.80
|
| Rate for Payer: United Healthcare VA CCN |
$73.80
|
|
|
REMOVAL OF SKIN TAGS <W/15
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
9811120002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$175.75 |
| Rate for Payer: Aetna of VT Commercial |
$175.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$165.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$165.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$111.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$157.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$83.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$147.07
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$148.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.25
|
| Rate for Payer: Multiplan Commercial |
$172.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$157.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.25
|
| Rate for Payer: United Healthcare Commercial |
$175.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.25
|
| Rate for Payer: United Healthcare VA CCN |
$83.25
|
|
|
REMOVAL OF SKIN TAGS <W/15
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
9601120002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$175.75 |
| Rate for Payer: Aetna of VT Commercial |
$175.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$165.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$165.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$111.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$157.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$83.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$147.07
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$148.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.25
|
| Rate for Payer: Multiplan Commercial |
$172.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$157.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.25
|
| Rate for Payer: United Healthcare Commercial |
$175.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.25
|
| Rate for Payer: United Healthcare VA CCN |
$83.25
|
|
|
REMOVAL OF SKIN TAGS <W/15
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
9601120002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$73.80 |
| Max. Negotiated Rate |
$173.90 |
| Rate for Payer: Aetna of VT Commercial |
$173.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$165.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$165.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$103.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$117.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$117.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$84.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$117.51
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$82.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$88.57
|
| Rate for Payer: Multiplan Commercial |
$172.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$104.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$73.80
|
| Rate for Payer: United Healthcare Commercial |
$113.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.80
|
| Rate for Payer: United Healthcare VA CCN |
$73.80
|
|
|
REMOVAL OF SKIN TAGS <W/15
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
9601120001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$128.00 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Aetna of VT Commercial |
$274.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$128.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$173.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$245.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$234.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$130.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$229.75
|
| Rate for Payer: Cash Price |
$144.50
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$231.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$231.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$130.05
|
| Rate for Payer: Multiplan Commercial |
$268.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$245.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$130.05
|
| Rate for Payer: United Healthcare Commercial |
$274.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.05
|
| Rate for Payer: United Healthcare VA CCN |
$130.05
|
|
|
REMOVAL OF SKIN TAGS <W/15
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
5101120001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.80 |
| Max. Negotiated Rate |
$143.49 |
| Rate for Payer: Aetna of VT Commercial |
$98.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$94.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$94.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$103.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$117.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$117.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$84.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$117.51
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$82.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$88.57
|
| Rate for Payer: Multiplan Commercial |
$97.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$104.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$73.80
|
| Rate for Payer: United Healthcare Commercial |
$113.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.80
|
| Rate for Payer: United Healthcare VA CCN |
$73.80
|
|
|
REMOVAL OF SKIN TAGS <W/15
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
9811120002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$136.92 |
| Max. Negotiated Rate |
$175.75 |
| Rate for Payer: Aetna of VT Commercial |
$175.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$157.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$155.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$148.00
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$148.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.00
|
| Rate for Payer: Multiplan Commercial |
$172.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$157.25
|
| Rate for Payer: United Healthcare Commercial |
$175.75
|
|
|
REMOVAL OF SMALL INTESTINE
|
Facility
|
IP
|
$3,272.00
|
|
|
Service Code
|
CPT 44120
|
| Hospital Charge Code |
9824412001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,421.61 |
| Max. Negotiated Rate |
$3,108.40 |
| Rate for Payer: Aetna of VT Commercial |
$3,108.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,421.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,421.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,781.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,748.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,617.60
|
| Rate for Payer: Cash Price |
$1,636.00
|
| Rate for Payer: Cigna Commercial |
$2,617.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,617.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,617.60
|
| Rate for Payer: Multiplan Commercial |
$3,042.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,781.20
|
| Rate for Payer: United Healthcare Commercial |
$3,108.40
|
|
|
REMOVAL OF SMALL INTESTINE
|
Facility
|
OP
|
$3,272.00
|
|
|
Service Code
|
CPT 44120
|
| Hospital Charge Code |
9824412001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,449.17 |
| Max. Negotiated Rate |
$3,108.40 |
| Rate for Payer: Aetna of VT Commercial |
$3,108.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,931.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,449.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,931.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,969.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,781.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,650.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,472.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,601.24
|
| Rate for Payer: Cash Price |
$1,636.00
|
| Rate for Payer: Cigna Commercial |
$2,617.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,617.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,617.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,472.40
|
| Rate for Payer: Multiplan Commercial |
$3,042.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,781.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,472.40
|
| Rate for Payer: United Healthcare Commercial |
$3,108.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,472.40
|
| Rate for Payer: United Healthcare VA CCN |
$1,472.40
|
|
|
REMOVAL OF SMALL INTESTINE
|
Professional
|
Both
|
$3,272.00
|
|
|
Service Code
|
CPT 44120
|
| Hospital Charge Code |
9824412001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,109.75 |
| Max. Negotiated Rate |
$3,075.68 |
| Rate for Payer: Aetna of VT Commercial |
$3,075.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,931.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,143.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,931.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,553.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,680.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,680.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,276.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,680.45
|
| Rate for Payer: Cash Price |
$1,636.00
|
| Rate for Payer: Cash Price |
$1,636.00
|
| Rate for Payer: Cigna Commercial |
$2,029.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,892.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,892.63
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,109.75
|
| Rate for Payer: Multiplan Commercial |
$3,042.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,575.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,109.76
|
| Rate for Payer: United Healthcare Commercial |
$1,707.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,109.76
|
| Rate for Payer: United Healthcare VA CCN |
$1,109.76
|
|
|
REMOVAL OF SPERM CORD LESION
|
Professional
|
Both
|
$1,011.00
|
|
|
Service Code
|
CPT 55520
|
| Hospital Charge Code |
9825552001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$426.45 |
| Max. Negotiated Rate |
$950.34 |
| Rate for Payer: Aetna of VT Commercial |
$950.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$905.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$439.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$905.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$597.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$640.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$640.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$490.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$640.73
|
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$720.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$720.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$426.45
|
| Rate for Payer: Multiplan Commercial |
$940.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$605.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$426.45
|
| Rate for Payer: United Healthcare Commercial |
$656.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$426.45
|
| Rate for Payer: United Healthcare VA CCN |
$426.45
|
|
|
REMOVAL OF SPERM CORD LESION
|
Facility
|
OP
|
$1,011.00
|
|
|
Service Code
|
CPT 55520
|
| Hospital Charge Code |
9825552001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$447.77 |
| Max. Negotiated Rate |
$960.45 |
| Rate for Payer: Aetna of VT Commercial |
$960.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$905.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$447.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$905.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$608.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$859.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$818.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$454.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$803.75
|
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Cigna Commercial |
$808.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$808.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$808.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$454.95
|
| Rate for Payer: Multiplan Commercial |
$940.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$859.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$454.95
|
| Rate for Payer: United Healthcare Commercial |
$960.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$454.95
|
| Rate for Payer: United Healthcare VA CCN |
$454.95
|
|
|
REMOVAL OF SPERM CORD LESION
|
Facility
|
IP
|
$1,011.00
|
|
|
Service Code
|
CPT 55520
|
| Hospital Charge Code |
9825552001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$748.24 |
| Max. Negotiated Rate |
$960.45 |
| Rate for Payer: Aetna of VT Commercial |
$960.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$748.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$748.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$859.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$849.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$808.80
|
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Cigna Commercial |
$808.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$808.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$808.80
|
| Rate for Payer: Multiplan Commercial |
$940.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$859.35
|
| Rate for Payer: United Healthcare Commercial |
$960.45
|
|
|
REMOVAL OF SPERM DUCT(S)
|
Professional
|
Both
|
$1,667.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
9605525002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$219.14 |
| Max. Negotiated Rate |
$1,566.98 |
| Rate for Payer: Aetna of VT Commercial |
$1,566.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,493.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$225.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,493.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$306.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$859.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$859.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$252.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$859.12
|
| Rate for Payer: Cash Price |
$833.50
|
| Rate for Payer: Cash Price |
$833.50
|
| Rate for Payer: Cigna Commercial |
$778.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$514.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$514.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$316.14
|
| Rate for Payer: Multiplan Commercial |
$1,550.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$311.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$219.14
|
| Rate for Payer: United Healthcare Commercial |
$337.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$219.14
|
| Rate for Payer: United Healthcare VA CCN |
$219.14
|
|
|
REMOVAL OF SPERM DUCT(S)
|
Facility
|
OP
|
$1,429.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
5105525001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$632.90 |
| Max. Negotiated Rate |
$1,357.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,357.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,280.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$632.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,280.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$860.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,214.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,157.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$643.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,136.06
|
| Rate for Payer: Cash Price |
$714.50
|
| Rate for Payer: Cigna Commercial |
$1,143.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,143.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,143.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$643.05
|
| Rate for Payer: Multiplan Commercial |
$1,328.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,214.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$643.05
|
| Rate for Payer: United Healthcare Commercial |
$1,357.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$643.05
|
| Rate for Payer: United Healthcare VA CCN |
$643.05
|
|
|
REMOVAL OF SPERM DUCT(S)
|
Facility
|
OP
|
$3,096.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
9605525001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,371.22 |
| Max. Negotiated Rate |
$2,941.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,941.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,773.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,371.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,773.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,863.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,631.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,507.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,393.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,461.32
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cigna Commercial |
$2,476.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,476.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,476.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,393.20
|
| Rate for Payer: Multiplan Commercial |
$2,879.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,631.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,393.20
|
| Rate for Payer: United Healthcare Commercial |
$2,941.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,393.20
|
| Rate for Payer: United Healthcare VA CCN |
$1,393.20
|
|
|
REMOVAL OF SPERM DUCT(S)
|
Facility
|
OP
|
$1,667.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
9825525001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$738.31 |
| Max. Negotiated Rate |
$1,583.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,583.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,493.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$738.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,493.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,003.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,416.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,350.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$750.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,325.27
|
| Rate for Payer: Cash Price |
$833.50
|
| Rate for Payer: Cigna Commercial |
$1,333.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,333.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,333.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$750.15
|
| Rate for Payer: Multiplan Commercial |
$1,550.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,416.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$750.15
|
| Rate for Payer: United Healthcare Commercial |
$1,583.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$750.15
|
| Rate for Payer: United Healthcare VA CCN |
$750.15
|
|
|
REMOVAL OF SPERM DUCT(S)
|
Facility
|
IP
|
$1,429.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
5105525001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,057.60 |
| Max. Negotiated Rate |
$1,357.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,357.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,057.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,057.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,214.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,200.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,143.20
|
| Rate for Payer: Cash Price |
$714.50
|
| Rate for Payer: Cigna Commercial |
$1,143.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,143.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,143.20
|
| Rate for Payer: Multiplan Commercial |
$1,328.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,214.65
|
| Rate for Payer: United Healthcare Commercial |
$1,357.55
|
|
|
REMOVAL OF SPERM DUCT(S)
|
Facility
|
IP
|
$3,096.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
9605525001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,291.35 |
| Max. Negotiated Rate |
$2,941.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,941.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,291.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,291.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,631.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,600.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,476.80
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cigna Commercial |
$2,476.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,476.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,476.80
|
| Rate for Payer: Multiplan Commercial |
$2,879.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,631.60
|
| Rate for Payer: United Healthcare Commercial |
$2,941.20
|
|
|
REMOVAL OF SPERM DUCT(S)
|
Facility
|
OP
|
$1,667.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
9605525002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$738.31 |
| Max. Negotiated Rate |
$1,583.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,583.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,493.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$738.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,493.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,003.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,416.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,350.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$750.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,325.27
|
| Rate for Payer: Cash Price |
$833.50
|
| Rate for Payer: Cigna Commercial |
$1,333.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,333.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,333.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$750.15
|
| Rate for Payer: Multiplan Commercial |
$1,550.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,416.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$750.15
|
| Rate for Payer: United Healthcare Commercial |
$1,583.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$750.15
|
| Rate for Payer: United Healthcare VA CCN |
$750.15
|
|
|
REMOVAL OF SPERM DUCT(S)
|
Facility
|
IP
|
$1,667.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
9605525002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,233.75 |
| Max. Negotiated Rate |
$1,583.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,583.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,233.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,233.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,416.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,400.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,333.60
|
| Rate for Payer: Cash Price |
$833.50
|
| Rate for Payer: Cigna Commercial |
$1,333.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,333.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,333.60
|
| Rate for Payer: Multiplan Commercial |
$1,550.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,416.95
|
| Rate for Payer: United Healthcare Commercial |
$1,583.65
|
|
|
REMOVAL OF SPERM DUCT(S)
|
Professional
|
Both
|
$3,096.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
9605525001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$219.14 |
| Max. Negotiated Rate |
$2,910.24 |
| Rate for Payer: Aetna of VT Commercial |
$2,910.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,773.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$225.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,773.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$306.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$859.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$859.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$252.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$859.12
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cigna Commercial |
$778.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$514.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$514.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$316.14
|
| Rate for Payer: Multiplan Commercial |
$2,879.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$311.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$219.14
|
| Rate for Payer: United Healthcare Commercial |
$337.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$219.14
|
| Rate for Payer: United Healthcare VA CCN |
$219.14
|
|
|
REMOVAL OF SPERM DUCT(S)
|
Professional
|
Both
|
$1,667.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
9825525001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$219.14 |
| Max. Negotiated Rate |
$1,566.98 |
| Rate for Payer: Aetna of VT Commercial |
$1,566.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,493.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$225.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,493.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$306.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$859.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$859.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$252.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$859.12
|
| Rate for Payer: Cash Price |
$833.50
|
| Rate for Payer: Cash Price |
$833.50
|
| Rate for Payer: Cigna Commercial |
$778.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$514.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$514.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$316.14
|
| Rate for Payer: Multiplan Commercial |
$1,550.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$311.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$219.14
|
| Rate for Payer: United Healthcare Commercial |
$337.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$219.14
|
| Rate for Payer: United Healthcare VA CCN |
$219.14
|
|
|
REMOVAL OF SPERM DUCT(S)
|
Facility
|
IP
|
$1,667.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
9825525001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,233.75 |
| Max. Negotiated Rate |
$1,583.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,583.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,233.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,233.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,416.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,400.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,333.60
|
| Rate for Payer: Cash Price |
$833.50
|
| Rate for Payer: Cigna Commercial |
$1,333.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,333.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,333.60
|
| Rate for Payer: Multiplan Commercial |
$1,550.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,416.95
|
| Rate for Payer: United Healthcare Commercial |
$1,583.65
|
|
|
REMOVAL OF SPERM DUCT(S)
|
Professional
|
Both
|
$1,429.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
5105525001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$219.14 |
| Max. Negotiated Rate |
$1,343.26 |
| Rate for Payer: Aetna of VT Commercial |
$1,343.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,280.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$225.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,280.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$306.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$859.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$859.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$252.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$859.12
|
| Rate for Payer: Cash Price |
$714.50
|
| Rate for Payer: Cash Price |
$714.50
|
| Rate for Payer: Cigna Commercial |
$778.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$514.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$514.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$316.14
|
| Rate for Payer: Multiplan Commercial |
$1,328.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$311.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$219.14
|
| Rate for Payer: United Healthcare Commercial |
$337.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$219.14
|
| Rate for Payer: United Healthcare VA CCN |
$219.14
|
|
