|
REMOVAL/REVISION OF CAST
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
9602970001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$162.99 |
| Max. Negotiated Rate |
$349.60 |
| Rate for Payer: Aetna of VT Commercial |
$349.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$329.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$162.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$329.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$221.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$298.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$292.56
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$294.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$294.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$294.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$342.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$165.60
|
| Rate for Payer: United Healthcare Commercial |
$349.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.60
|
| Rate for Payer: United Healthcare VA CCN |
$165.60
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
OP
|
$610.06
|
|
|
Service Code
|
CPT 29710
|
| Hospital Charge Code |
4502971001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$270.20 |
| Max. Negotiated Rate |
$579.56 |
| Rate for Payer: Aetna of VT Commercial |
$579.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$546.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$270.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$546.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$367.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$518.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$494.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$274.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$485.00
|
| Rate for Payer: Cash Price |
$305.03
|
| Rate for Payer: Cigna Commercial |
$488.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$274.53
|
| Rate for Payer: Multiplan Commercial |
$567.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$518.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$274.53
|
| Rate for Payer: United Healthcare Commercial |
$579.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$274.53
|
| Rate for Payer: United Healthcare VA CCN |
$274.53
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
9812970501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
REMOVAL/REVISION OF CAST
|
Professional
|
Both
|
$368.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
9602970001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$30.71 |
| Max. Negotiated Rate |
$345.92 |
| Rate for Payer: Aetna of VT Commercial |
$345.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$329.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$329.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$42.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$81.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$81.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$81.34
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$58.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$103.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$103.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.16
|
| Rate for Payer: Multiplan Commercial |
$342.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$43.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$30.71
|
| Rate for Payer: United Healthcare Commercial |
$47.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.71
|
| Rate for Payer: United Healthcare VA CCN |
$30.71
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
IP
|
$30,721.00
|
|
|
Service Code
|
CPT 29710
|
| Hospital Charge Code |
9812971001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$22,736.61 |
| Max. Negotiated Rate |
$29,184.95 |
| Rate for Payer: Aetna of VT Commercial |
$29,184.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$22,736.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$22,736.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26,112.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$25,805.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24,576.80
|
| Rate for Payer: Cash Price |
$15,360.50
|
| Rate for Payer: Cigna Commercial |
$24,576.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$24,576.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$24,576.80
|
| Rate for Payer: Multiplan Commercial |
$28,570.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26,112.85
|
| Rate for Payer: United Healthcare Commercial |
$29,184.95
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
9602970002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$102.13 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Aetna of VT Commercial |
$131.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$117.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$115.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.40
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$110.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$110.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$110.40
|
| Rate for Payer: Multiplan Commercial |
$128.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$117.30
|
| Rate for Payer: United Healthcare Commercial |
$131.10
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
9602970002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$61.12 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Aetna of VT Commercial |
$131.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$123.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$123.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$83.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$117.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$111.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$109.71
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$110.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$110.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$110.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$62.10
|
| Rate for Payer: Multiplan Commercial |
$128.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$117.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$62.10
|
| Rate for Payer: United Healthcare Commercial |
$131.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.10
|
| Rate for Payer: United Healthcare VA CCN |
$62.10
|
|
|
REMOVAL/REVISION OF CAST
|
Professional
|
Both
|
$30,721.00
|
|
|
Service Code
|
CPT 29710
|
| Hospital Charge Code |
9812971001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$75.98 |
| Max. Negotiated Rate |
$28,877.74 |
| Rate for Payer: Aetna of VT Commercial |
$28,877.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$27,522.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$78.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$27,522.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$106.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$210.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$210.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$87.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$210.71
|
| Rate for Payer: Cash Price |
$15,360.50
|
| Rate for Payer: Cash Price |
$15,360.50
|
| Rate for Payer: Cigna Commercial |
$143.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$118.70
|
| Rate for Payer: Multiplan Commercial |
$28,570.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$75.98
|
| Rate for Payer: United Healthcare Commercial |
$116.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.98
|
| Rate for Payer: United Healthcare VA CCN |
$75.98
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
9812970501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
4502970001
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
9822970501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Aetna of VT Commercial |
$67.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$60.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.45
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cigna Commercial |
$56.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.95
|
| Rate for Payer: Multiplan Commercial |
$66.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.95
|
| Rate for Payer: United Healthcare Commercial |
$67.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.95
|
| Rate for Payer: United Healthcare VA CCN |
$31.95
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
9812970502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Aetna of VT Commercial |
$67.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$60.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.45
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cigna Commercial |
$56.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.95
|
| Rate for Payer: Multiplan Commercial |
$66.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.95
|
| Rate for Payer: United Healthcare Commercial |
$67.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.95
|
| Rate for Payer: United Healthcare VA CCN |
$31.95
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
9812970001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
IP
|
$610.06
|
|
|
Service Code
|
CPT 29710
|
| Hospital Charge Code |
4502971001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$451.51 |
| Max. Negotiated Rate |
$579.56 |
| Rate for Payer: Aetna of VT Commercial |
$579.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$451.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$451.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$518.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$512.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$488.05
|
| Rate for Payer: Cash Price |
$305.03
|
| Rate for Payer: Cigna Commercial |
$488.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.05
|
| Rate for Payer: Multiplan Commercial |
$567.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$518.55
|
| Rate for Payer: United Healthcare Commercial |
$579.56
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
9812970001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
9812970502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$52.55 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Aetna of VT Commercial |
$67.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$52.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$52.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$60.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.80
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cigna Commercial |
$56.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.80
|
| Rate for Payer: Multiplan Commercial |
$66.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.35
|
| Rate for Payer: United Healthcare Commercial |
$67.45
|
|
|
REMOVAL SWEAT GLAND LESION
|
Facility
|
IP
|
$998.00
|
|
|
Service Code
|
CPT 11462
|
| Hospital Charge Code |
9821146201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$738.62 |
| Max. Negotiated Rate |
$948.10 |
| Rate for Payer: Aetna of VT Commercial |
$948.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$738.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$738.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$848.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$838.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$798.40
|
| Rate for Payer: Cash Price |
$499.00
|
| Rate for Payer: Cigna Commercial |
$798.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$798.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$798.40
|
| Rate for Payer: Multiplan Commercial |
$928.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$848.30
|
| Rate for Payer: United Healthcare Commercial |
$948.10
|
|
|
REMOVAL SWEAT GLAND LESION
|
Professional
|
Both
|
$998.00
|
|
|
Service Code
|
CPT 11462
|
| Hospital Charge Code |
9821146201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$237.54 |
| Max. Negotiated Rate |
$938.12 |
| Rate for Payer: Aetna of VT Commercial |
$938.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$894.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$244.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$894.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$332.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$517.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$517.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$273.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$517.93
|
| Rate for Payer: Cash Price |
$499.00
|
| Rate for Payer: Cash Price |
$499.00
|
| Rate for Payer: Cigna Commercial |
$429.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$649.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$649.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$396.22
|
| Rate for Payer: Multiplan Commercial |
$928.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$337.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$237.54
|
| Rate for Payer: United Healthcare Commercial |
$365.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$237.54
|
| Rate for Payer: United Healthcare VA CCN |
$237.54
|
|
|
REMOVAL SWEAT GLAND LESION
|
Facility
|
OP
|
$998.00
|
|
|
Service Code
|
CPT 11462
|
| Hospital Charge Code |
9821146201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$442.01 |
| Max. Negotiated Rate |
$948.10 |
| Rate for Payer: Aetna of VT Commercial |
$948.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$894.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$442.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$894.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$600.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$848.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$808.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$449.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$793.41
|
| Rate for Payer: Cash Price |
$499.00
|
| Rate for Payer: Cigna Commercial |
$798.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$798.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$798.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$449.10
|
| Rate for Payer: Multiplan Commercial |
$928.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$848.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$449.10
|
| Rate for Payer: United Healthcare Commercial |
$948.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$449.10
|
| Rate for Payer: United Healthcare VA CCN |
$449.10
|
|
|
REMOVAL TUNNELED CV CATH
|
Professional
|
Both
|
$799.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
9823659001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$174.04 |
| Max. Negotiated Rate |
$751.06 |
| Rate for Payer: Aetna of VT Commercial |
$751.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$715.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$179.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$715.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$243.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$393.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$393.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$200.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$393.63
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cigna Commercial |
$318.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$205.52
|
| Rate for Payer: Multiplan Commercial |
$743.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$247.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$174.04
|
| Rate for Payer: United Healthcare Commercial |
$267.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$174.04
|
| Rate for Payer: United Healthcare VA CCN |
$174.04
|
|
|
REMOVAL TUNNELED CV CATH
|
Facility
|
OP
|
$799.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
9823659001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$353.88 |
| Max. Negotiated Rate |
$759.05 |
| Rate for Payer: Aetna of VT Commercial |
$759.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$715.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$353.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$715.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$481.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$679.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$647.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$359.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$635.21
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cigna Commercial |
$639.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$639.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$639.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$359.55
|
| Rate for Payer: Multiplan Commercial |
$743.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$679.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$359.55
|
| Rate for Payer: United Healthcare Commercial |
$759.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$359.55
|
| Rate for Payer: United Healthcare VA CCN |
$359.55
|
|
|
REMOVAL TUNNELED CV CATH
|
Facility
|
IP
|
$799.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
9823659001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$591.34 |
| Max. Negotiated Rate |
$759.05 |
| Rate for Payer: Aetna of VT Commercial |
$759.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$591.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$591.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$679.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$671.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$639.20
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cigna Commercial |
$639.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$639.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$639.20
|
| Rate for Payer: Multiplan Commercial |
$743.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$679.15
|
| Rate for Payer: United Healthcare Commercial |
$759.05
|
|
|
REMOVE BLADDER STONE
|
Professional
|
Both
|
$2,261.00
|
|
|
Service Code
|
CPT 52318
|
| Hospital Charge Code |
9825231801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$435.19 |
| Max. Negotiated Rate |
$2,125.34 |
| Rate for Payer: Aetna of VT Commercial |
$2,125.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,025.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$448.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,025.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$609.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$882.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$882.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$500.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$882.74
|
| Rate for Payer: Cash Price |
$1,130.50
|
| Rate for Payer: Cash Price |
$1,130.50
|
| Rate for Payer: Cigna Commercial |
$757.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$721.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$721.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$435.20
|
| Rate for Payer: Multiplan Commercial |
$2,102.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$617.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$435.19
|
| Rate for Payer: United Healthcare Commercial |
$669.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$435.19
|
| Rate for Payer: United Healthcare VA CCN |
$435.19
|
|
|
REMOVE BLADDER STONE
|
Facility
|
OP
|
$2,020.00
|
|
|
Service Code
|
CPT 52317
|
| Hospital Charge Code |
9825231701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$894.66 |
| Max. Negotiated Rate |
$1,919.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,919.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,809.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$894.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,809.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,216.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,717.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,636.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$909.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,605.90
|
| Rate for Payer: Cash Price |
$1,010.00
|
| Rate for Payer: Cigna Commercial |
$1,616.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,616.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,616.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$909.00
|
| Rate for Payer: Multiplan Commercial |
$1,878.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,717.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$909.00
|
| Rate for Payer: United Healthcare Commercial |
$1,919.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$909.00
|
| Rate for Payer: United Healthcare VA CCN |
$909.00
|
|
|
REMOVE BLADDER STONE
|
Facility
|
OP
|
$2,261.00
|
|
|
Service Code
|
CPT 52318
|
| Hospital Charge Code |
9825231801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,001.40 |
| Max. Negotiated Rate |
$2,147.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,147.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,025.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,001.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,025.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,361.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,921.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,831.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,017.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,797.49
|
| Rate for Payer: Cash Price |
$1,130.50
|
| Rate for Payer: Cigna Commercial |
$1,808.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,808.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,808.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,017.45
|
| Rate for Payer: Multiplan Commercial |
$2,102.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,921.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,017.45
|
| Rate for Payer: United Healthcare Commercial |
$2,147.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,017.45
|
| Rate for Payer: United Healthcare VA CCN |
$1,017.45
|
|
