|
REMOVE INT/EXT HEM 1 GROUP
|
Facility
|
IP
|
$1,085.00
|
|
|
Service Code
|
CPT 46255
|
| Hospital Charge Code |
9824625501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$803.01 |
| Max. Negotiated Rate |
$1,030.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,030.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$803.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$803.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$922.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$911.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$868.00
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cigna Commercial |
$868.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$868.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$868.00
|
| Rate for Payer: Multiplan Commercial |
$1,009.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$922.25
|
| Rate for Payer: United Healthcare Commercial |
$1,030.75
|
|
|
REMOVE INT/EXT HEM 1 GROUP
|
Facility
|
OP
|
$1,085.00
|
|
|
Service Code
|
CPT 46255
|
| Hospital Charge Code |
9824625501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$480.55 |
| Max. Negotiated Rate |
$1,030.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,030.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$972.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$480.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$972.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$653.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$922.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$878.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$488.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$862.58
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cigna Commercial |
$868.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$868.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$868.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$488.25
|
| Rate for Payer: Multiplan Commercial |
$1,009.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$922.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$488.25
|
| Rate for Payer: United Healthcare Commercial |
$1,030.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$488.25
|
| Rate for Payer: United Healthcare VA CCN |
$488.25
|
|
|
REMOVE INTRAUTERINE DEVICE
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
5105830101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$86.37 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Aetna of VT Commercial |
$185.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$174.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$86.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$174.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$117.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$157.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$87.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.03
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$156.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$156.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$156.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$87.75
|
| Rate for Payer: Multiplan Commercial |
$181.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$87.75
|
| Rate for Payer: United Healthcare Commercial |
$185.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.75
|
| Rate for Payer: United Healthcare VA CCN |
$87.75
|
|
|
REMOVE INTRAUTERINE DEVICE
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
9825830101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$60.66 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna of VT Commercial |
$219.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$209.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$209.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$177.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$177.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$177.12
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$107.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$102.42
|
| Rate for Payer: Multiplan Commercial |
$217.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$60.66
|
| Rate for Payer: United Healthcare Commercial |
$93.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.66
|
| Rate for Payer: United Healthcare VA CCN |
$60.66
|
|
|
REMOVE INTRAUTERINE DEVICE
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
9825830101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$103.64 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna of VT Commercial |
$222.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$209.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$209.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$140.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$189.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$105.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$186.03
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$187.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$105.30
|
| Rate for Payer: Multiplan Commercial |
$217.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.30
|
| Rate for Payer: United Healthcare Commercial |
$222.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.30
|
| Rate for Payer: United Healthcare VA CCN |
$105.30
|
|
|
REMOVE INTRAUTERINE DEVICE
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
9605830101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$60.66 |
| Max. Negotiated Rate |
$403.26 |
| Rate for Payer: Aetna of VT Commercial |
$403.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$384.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$384.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$177.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$177.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$177.12
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna Commercial |
$107.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$102.42
|
| Rate for Payer: Multiplan Commercial |
$398.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$60.66
|
| Rate for Payer: United Healthcare Commercial |
$93.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.66
|
| Rate for Payer: United Healthcare VA CCN |
$60.66
|
|
|
REMOVE INTRAUTERINE DEVICE
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
9605830102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$103.64 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna of VT Commercial |
$222.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$209.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$209.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$140.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$189.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$105.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$186.03
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$187.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$105.30
|
| Rate for Payer: Multiplan Commercial |
$217.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.30
|
| Rate for Payer: United Healthcare Commercial |
$222.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.30
|
| Rate for Payer: United Healthcare VA CCN |
$105.30
|
|
|
REMOVE INTRAUTERINE DEVICE
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
9605830101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$407.55 |
| Rate for Payer: Aetna of VT Commercial |
$407.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$384.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$190.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$384.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$258.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$347.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$193.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$341.06
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna Commercial |
$343.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$343.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$343.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$193.05
|
| Rate for Payer: Multiplan Commercial |
$398.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$364.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$193.05
|
| Rate for Payer: United Healthcare Commercial |
$407.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.05
|
| Rate for Payer: United Healthcare VA CCN |
$193.05
|
|
|
REMOVE INTRAUTERINE DEVICE
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
9605830102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$60.66 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna of VT Commercial |
$219.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$209.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$209.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$177.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$177.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$177.12
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$107.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$102.42
|
| Rate for Payer: Multiplan Commercial |
$217.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$60.66
|
| Rate for Payer: United Healthcare Commercial |
$93.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.66
|
| Rate for Payer: United Healthcare VA CCN |
$60.66
|
|
|
REMOVE INTRAUTERINE DEVICE
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
9825830101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$173.18 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna of VT Commercial |
$222.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$173.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$173.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$187.20
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$217.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.90
|
| Rate for Payer: United Healthcare Commercial |
$222.30
|
|
|
REMOVE INTRAUTERINE DEVICE
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
9605830102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$173.18 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna of VT Commercial |
$222.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$173.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$173.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$187.20
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$217.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.90
|
| Rate for Payer: United Healthcare Commercial |
$222.30
|
|
|
REMOVE INTRAUTERINE DEVICE
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
5105830101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.66 |
| Max. Negotiated Rate |
$183.30 |
| Rate for Payer: Aetna of VT Commercial |
$183.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$174.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$174.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$177.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$177.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$177.12
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$107.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$102.42
|
| Rate for Payer: Multiplan Commercial |
$181.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$60.66
|
| Rate for Payer: United Healthcare Commercial |
$93.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.66
|
| Rate for Payer: United Healthcare VA CCN |
$60.66
|
|
|
REMOVE INTRAUTERINE DEVICE
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
9605830101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$317.50 |
| Max. Negotiated Rate |
$407.55 |
| Rate for Payer: Aetna of VT Commercial |
$407.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$317.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$317.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$360.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$343.20
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna Commercial |
$343.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$343.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$343.20
|
| Rate for Payer: Multiplan Commercial |
$398.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$364.65
|
| Rate for Payer: United Healthcare Commercial |
$407.55
|
|
|
REMOVE INTRAUTERINE DEVICE
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
5105830101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.32 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Aetna of VT Commercial |
$185.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$144.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$144.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$163.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$156.00
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$156.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$156.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$181.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.75
|
| Rate for Payer: United Healthcare Commercial |
$185.25
|
|
|
REMOVE KNEE CYST
|
Facility
|
IP
|
$2,007.00
|
|
|
Service Code
|
CPT 27347
|
| Hospital Charge Code |
9822734701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,485.38 |
| Max. Negotiated Rate |
$1,906.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,906.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,485.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,485.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,705.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,685.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,605.60
|
| Rate for Payer: Cash Price |
$1,003.50
|
| Rate for Payer: Cigna Commercial |
$1,605.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,605.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,605.60
|
| Rate for Payer: Multiplan Commercial |
$1,866.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,705.95
|
| Rate for Payer: United Healthcare Commercial |
$1,906.65
|
|
|
REMOVE KNEE CYST
|
Facility
|
OP
|
$2,007.00
|
|
|
Service Code
|
CPT 27347
|
| Hospital Charge Code |
9822734701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$888.90 |
| Max. Negotiated Rate |
$1,906.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,906.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,798.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$888.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,798.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,208.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,705.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,625.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$903.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,595.57
|
| Rate for Payer: Cash Price |
$1,003.50
|
| Rate for Payer: Cigna Commercial |
$1,605.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,605.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,605.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$903.15
|
| Rate for Payer: Multiplan Commercial |
$1,866.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,705.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$903.15
|
| Rate for Payer: United Healthcare Commercial |
$1,906.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$903.15
|
| Rate for Payer: United Healthcare VA CCN |
$903.15
|
|
|
REMOVE KNEE CYST
|
Professional
|
Both
|
$2,007.00
|
|
|
Service Code
|
CPT 27347
|
| Hospital Charge Code |
9822734701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$504.34 |
| Max. Negotiated Rate |
$1,886.58 |
| Rate for Payer: Aetna of VT Commercial |
$1,886.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,798.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$519.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,798.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$706.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$706.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$706.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$579.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$706.92
|
| Rate for Payer: Cash Price |
$1,003.50
|
| Rate for Payer: Cash Price |
$1,003.50
|
| Rate for Payer: Cigna Commercial |
$954.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$838.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$838.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$504.34
|
| Rate for Payer: Multiplan Commercial |
$1,866.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$716.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$504.34
|
| Rate for Payer: United Healthcare Commercial |
$775.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$504.34
|
| Rate for Payer: United Healthcare VA CCN |
$504.34
|
|
|
REMOVE LUNG CATHETER
|
Professional
|
Both
|
$636.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
9813255201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$145.04 |
| Max. Negotiated Rate |
$597.84 |
| Rate for Payer: Aetna of VT Commercial |
$597.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$569.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$569.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$203.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$222.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$222.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$166.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$222.81
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$263.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$280.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$280.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$170.42
|
| Rate for Payer: Multiplan Commercial |
$591.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$205.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$145.04
|
| Rate for Payer: United Healthcare Commercial |
$223.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$145.04
|
| Rate for Payer: United Healthcare VA CCN |
$145.04
|
|
|
REMOVE LUNG CATHETER
|
Facility
|
OP
|
$636.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
9813255202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$604.20 |
| Rate for Payer: Aetna of VT Commercial |
$604.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$569.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$281.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$569.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$382.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$540.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$515.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$286.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$505.62
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$508.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$508.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$508.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$286.20
|
| Rate for Payer: Multiplan Commercial |
$591.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$540.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$286.20
|
| Rate for Payer: United Healthcare Commercial |
$604.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.20
|
| Rate for Payer: United Healthcare VA CCN |
$286.20
|
|
|
REMOVE LUNG CATHETER
|
Facility
|
OP
|
$1,922.21
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
4503255201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$851.35 |
| Max. Negotiated Rate |
$1,826.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,826.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,722.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$851.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,722.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,157.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,633.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,556.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$864.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,528.16
|
| Rate for Payer: Cash Price |
$961.10
|
| Rate for Payer: Cigna Commercial |
$1,537.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,537.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,537.77
|
| Rate for Payer: Martins Point Health Care Commercial |
$864.99
|
| Rate for Payer: Multiplan Commercial |
$1,787.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,633.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$864.99
|
| Rate for Payer: United Healthcare Commercial |
$1,826.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$864.99
|
| Rate for Payer: United Healthcare VA CCN |
$864.99
|
|
|
REMOVE LUNG CATHETER
|
Facility
|
IP
|
$636.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
9813255202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$470.70 |
| Max. Negotiated Rate |
$604.20 |
| Rate for Payer: Aetna of VT Commercial |
$604.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$470.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$470.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$540.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$508.80
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$508.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$508.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$508.80
|
| Rate for Payer: Multiplan Commercial |
$591.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$540.60
|
| Rate for Payer: United Healthcare Commercial |
$604.20
|
|
|
REMOVE LUNG CATHETER
|
Facility
|
IP
|
$636.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
9813255201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$470.70 |
| Max. Negotiated Rate |
$604.20 |
| Rate for Payer: Aetna of VT Commercial |
$604.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$470.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$470.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$540.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$508.80
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$508.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$508.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$508.80
|
| Rate for Payer: Multiplan Commercial |
$591.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$540.60
|
| Rate for Payer: United Healthcare Commercial |
$604.20
|
|
|
REMOVE LUNG CATHETER
|
Professional
|
Both
|
$636.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
9813255202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$145.04 |
| Max. Negotiated Rate |
$597.84 |
| Rate for Payer: Aetna of VT Commercial |
$597.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$569.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$569.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$203.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$222.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$222.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$166.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$222.81
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$263.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$280.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$280.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$170.42
|
| Rate for Payer: Multiplan Commercial |
$591.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$205.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$145.04
|
| Rate for Payer: United Healthcare Commercial |
$223.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$145.04
|
| Rate for Payer: United Healthcare VA CCN |
$145.04
|
|
|
REMOVE LUNG CATHETER
|
Professional
|
Both
|
$636.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
9823255201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$145.04 |
| Max. Negotiated Rate |
$597.84 |
| Rate for Payer: Aetna of VT Commercial |
$597.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$569.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$569.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$203.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$222.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$222.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$166.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$222.81
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$263.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$280.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$280.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$170.42
|
| Rate for Payer: Multiplan Commercial |
$591.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$205.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$145.04
|
| Rate for Payer: United Healthcare Commercial |
$223.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$145.04
|
| Rate for Payer: United Healthcare VA CCN |
$145.04
|
|
|
REMOVE LUNG CATHETER
|
Facility
|
IP
|
$1,922.21
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
4503255201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,422.63 |
| Max. Negotiated Rate |
$1,826.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,826.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,422.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,422.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,633.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,614.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,537.77
|
| Rate for Payer: Cash Price |
$961.10
|
| Rate for Payer: Cigna Commercial |
$1,537.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,537.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,537.77
|
| Rate for Payer: Multiplan Commercial |
$1,787.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,633.88
|
| Rate for Payer: United Healthcare Commercial |
$1,826.10
|
|
