|
SESAMOIDECTOMY FIRST TOE SPX
|
Facility
|
OP
|
$1,008.00
|
|
|
Service Code
|
CPT 28315
|
| Hospital Charge Code |
9822831501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$446.44 |
| Max. Negotiated Rate |
$957.60 |
| Rate for Payer: Aetna of VT Commercial |
$957.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$903.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$446.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$903.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$606.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$856.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$816.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$453.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$801.36
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna Commercial |
$806.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$806.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$806.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$453.60
|
| Rate for Payer: Multiplan Commercial |
$937.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$856.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$453.60
|
| Rate for Payer: United Healthcare Commercial |
$957.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$453.60
|
| Rate for Payer: United Healthcare VA CCN |
$453.60
|
|
|
SESAMOIDECTOMY FIRST TOE SPX
|
Professional
|
Both
|
$1,008.00
|
|
|
Service Code
|
CPT 28315
|
| Hospital Charge Code |
9822831501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$313.85 |
| Max. Negotiated Rate |
$947.52 |
| Rate for Payer: Aetna of VT Commercial |
$947.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$903.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$323.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$903.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$439.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$712.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$712.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$360.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$712.31
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna Commercial |
$593.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$737.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$737.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$453.90
|
| Rate for Payer: Multiplan Commercial |
$937.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$445.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$313.85
|
| Rate for Payer: United Healthcare Commercial |
$482.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.85
|
| Rate for Payer: United Healthcare VA CCN |
$313.85
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
9601130502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$34.91 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna of VT Commercial |
$169.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$48.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$133.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$133.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.76
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$39.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$159.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$159.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$98.83
|
| Rate for Payer: Multiplan Commercial |
$167.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.91
|
| Rate for Payer: United Healthcare Commercial |
$53.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.91
|
| Rate for Payer: United Healthcare VA CCN |
$34.91
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
9601130001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$249.41 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Aetna of VT Commercial |
$320.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$249.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$249.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$269.60
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$269.60
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.45
|
| Rate for Payer: United Healthcare Commercial |
$320.15
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
9601130001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Aetna of VT Commercial |
$320.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$202.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$272.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$151.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$267.92
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$269.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$151.65
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$151.65
|
| Rate for Payer: United Healthcare Commercial |
$320.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.65
|
| Rate for Payer: United Healthcare VA CCN |
$151.65
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
9811130502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$133.22 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of VT Commercial |
$171.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$133.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$133.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$151.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$144.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$167.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.00
|
| Rate for Payer: United Healthcare Commercial |
$171.00
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
9601130501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$176.14 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Aetna of VT Commercial |
$226.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$176.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$176.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$202.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$199.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$190.40
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$190.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$221.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$202.30
|
| Rate for Payer: United Healthcare Commercial |
$226.10
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
9601130501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$105.41 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Aetna of VT Commercial |
$226.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$213.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$105.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$213.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$143.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$202.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$192.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$189.21
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$190.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$190.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$107.10
|
| Rate for Payer: Multiplan Commercial |
$221.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$202.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$107.10
|
| Rate for Payer: United Healthcare Commercial |
$226.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.10
|
| Rate for Payer: United Healthcare VA CCN |
$107.10
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
9601130002
|
|
Hospital Revenue Code
|
960
|
| 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
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
9601130002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$31.66 |
| 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 |
$32.61
|
| 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 |
$44.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$127.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$127.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$127.47
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$35.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$151.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$151.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.97
|
| Rate for Payer: Multiplan Commercial |
$181.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.66
|
| Rate for Payer: United Healthcare Commercial |
$48.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.66
|
| Rate for Payer: United Healthcare VA CCN |
$31.66
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
9601130001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$31.66 |
| Max. Negotiated Rate |
$316.78 |
| Rate for Payer: Aetna of VT Commercial |
$316.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$44.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$127.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$127.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$127.47
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$35.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$151.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$151.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.97
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.66
|
| Rate for Payer: United Healthcare Commercial |
$48.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.66
|
| Rate for Payer: United Healthcare VA CCN |
$31.66
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
5101130501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.93 |
| Max. Negotiated Rate |
$55.10 |
| Rate for Payer: Aetna of VT Commercial |
$55.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$49.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$48.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$46.40
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$46.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$46.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$46.40
|
| Rate for Payer: Multiplan Commercial |
$53.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.30
|
| Rate for Payer: United Healthcare Commercial |
$55.10
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
5101130501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.69 |
| Max. Negotiated Rate |
$55.10 |
| Rate for Payer: Aetna of VT Commercial |
$55.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$25.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$34.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$49.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$46.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$46.11
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$46.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$46.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$46.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.10
|
| Rate for Payer: Multiplan Commercial |
$53.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.10
|
| Rate for Payer: United Healthcare Commercial |
$55.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.10
|
| Rate for Payer: United Healthcare VA CCN |
$26.10
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
9601130002
|
|
Hospital Revenue Code
|
960
|
| 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
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
9811130502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$79.72 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of VT Commercial |
$171.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$108.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.10
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$144.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$167.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$81.00
|
| Rate for Payer: United Healthcare Commercial |
$171.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.00
|
| Rate for Payer: United Healthcare VA CCN |
$81.00
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
5101130501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.91 |
| Max. Negotiated Rate |
$159.43 |
| Rate for Payer: Aetna of VT Commercial |
$54.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$48.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$133.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$133.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.76
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$39.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$159.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$159.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$98.83
|
| Rate for Payer: Multiplan Commercial |
$53.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.91
|
| Rate for Payer: United Healthcare Commercial |
$53.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.91
|
| Rate for Payer: United Healthcare VA CCN |
$34.91
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
9811130502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$34.91 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna of VT Commercial |
$169.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$48.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$133.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$133.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.76
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$39.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$159.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$159.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$98.83
|
| Rate for Payer: Multiplan Commercial |
$167.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.91
|
| Rate for Payer: United Healthcare Commercial |
$53.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.91
|
| Rate for Payer: United Healthcare VA CCN |
$34.91
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Facility
|
OP
|
$57.90
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
4501130501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$55.01 |
| Rate for Payer: Aetna of VT Commercial |
$55.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$25.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$34.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$49.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$46.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$46.03
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: Cigna Commercial |
$46.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$46.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$46.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.05
|
| Rate for Payer: Multiplan Commercial |
$53.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.05
|
| Rate for Payer: United Healthcare Commercial |
$55.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.05
|
| Rate for Payer: United Healthcare VA CCN |
$26.05
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
5101130001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.09 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Aetna of VT Commercial |
$134.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$119.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.60
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$113.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.60
|
| Rate for Payer: Multiplan Commercial |
$132.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.70
|
| Rate for Payer: United Healthcare Commercial |
$134.90
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Facility
|
IP
|
$57.90
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
4501130501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$55.01 |
| Rate for Payer: Aetna of VT Commercial |
$55.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$42.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$42.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$49.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$48.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$46.32
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: Cigna Commercial |
$46.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$46.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$46.32
|
| Rate for Payer: Multiplan Commercial |
$53.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.22
|
| Rate for Payer: United Healthcare Commercial |
$55.01
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
9811130501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$34.91 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna of VT Commercial |
$169.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$48.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$133.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$133.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.76
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$39.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$159.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$159.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$98.83
|
| Rate for Payer: Multiplan Commercial |
$167.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.91
|
| Rate for Payer: United Healthcare Commercial |
$53.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.91
|
| Rate for Payer: United Healthcare VA CCN |
$34.91
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
9811130501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$79.72 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of VT Commercial |
$171.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$108.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.10
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$144.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$167.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$81.00
|
| Rate for Payer: United Healthcare Commercial |
$171.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.00
|
| Rate for Payer: United Healthcare VA CCN |
$81.00
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
9601130501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$34.91 |
| Max. Negotiated Rate |
$223.72 |
| Rate for Payer: Aetna of VT Commercial |
$223.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$213.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$213.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$48.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$133.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$133.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.76
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cigna Commercial |
$39.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$159.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$159.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$98.83
|
| Rate for Payer: Multiplan Commercial |
$221.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.91
|
| Rate for Payer: United Healthcare Commercial |
$53.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.91
|
| Rate for Payer: United Healthcare VA CCN |
$34.91
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
5101130001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.89 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Aetna of VT Commercial |
$134.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$127.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$127.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$85.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$115.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.89
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$113.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.90
|
| Rate for Payer: Multiplan Commercial |
$132.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.90
|
| Rate for Payer: United Healthcare Commercial |
$134.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.90
|
| Rate for Payer: United Healthcare VA CCN |
$63.90
|
|
|
SHAVE SKIN LESION 0.5 CM/<
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
9601130502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$133.22 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of VT Commercial |
$171.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$133.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$133.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$151.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$144.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$167.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.00
|
| Rate for Payer: United Healthcare Commercial |
$171.00
|
|
