|
SHOULDER DEEP ABSCESS/HEMATOMA
|
Facility
|
IP
|
$1,831.89
|
|
|
Service Code
|
CPT 23030
|
| Hospital Charge Code |
4502303001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,355.78 |
| Max. Negotiated Rate |
$1,740.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,740.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,355.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,355.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,557.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,538.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,465.51
|
| Rate for Payer: Cash Price |
$915.94
|
| Rate for Payer: Cigna Commercial |
$1,465.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,465.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,465.51
|
| Rate for Payer: Multiplan Commercial |
$1,703.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,557.11
|
| Rate for Payer: United Healthcare Commercial |
$1,740.30
|
|
|
SHOULDER DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$944.00
|
|
|
Service Code
|
CPT 23030
|
| Hospital Charge Code |
9812303001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$240.72 |
| Max. Negotiated Rate |
$887.36 |
| Rate for Payer: Aetna of VT Commercial |
$887.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$845.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$247.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$845.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$337.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$779.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$779.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$276.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$779.29
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cigna Commercial |
$455.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$677.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$677.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$413.53
|
| Rate for Payer: Multiplan Commercial |
$877.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$341.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$240.72
|
| Rate for Payer: United Healthcare Commercial |
$370.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$240.72
|
| Rate for Payer: United Healthcare VA CCN |
$240.72
|
|
|
SHOULDER DEEP ABSCESS/HEMATOMA
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 23030
|
| Hospital Charge Code |
9812303001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$418.10 |
| Max. Negotiated Rate |
$896.80 |
| Rate for Payer: Aetna of VT Commercial |
$896.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$845.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$418.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$845.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$568.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$802.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$764.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$424.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$750.48
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cigna Commercial |
$755.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$755.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$755.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$424.80
|
| Rate for Payer: Multiplan Commercial |
$877.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$802.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$424.80
|
| Rate for Payer: United Healthcare Commercial |
$896.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$424.80
|
| Rate for Payer: United Healthcare VA CCN |
$424.80
|
|
|
SHOULDER DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$944.00
|
|
|
Service Code
|
CPT 23030
|
| Hospital Charge Code |
9812303002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$240.72 |
| Max. Negotiated Rate |
$887.36 |
| Rate for Payer: Aetna of VT Commercial |
$887.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$845.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$247.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$845.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$337.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$779.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$779.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$276.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$779.29
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cigna Commercial |
$455.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$677.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$677.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$413.53
|
| Rate for Payer: Multiplan Commercial |
$877.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$341.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$240.72
|
| Rate for Payer: United Healthcare Commercial |
$370.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$240.72
|
| Rate for Payer: United Healthcare VA CCN |
$240.72
|
|
|
SHOULDER DEEP ABSCESS/HEMATOMA
|
Facility
|
OP
|
$1,831.89
|
|
|
Service Code
|
CPT 23030
|
| Hospital Charge Code |
4502303001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$811.34 |
| Max. Negotiated Rate |
$1,740.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,740.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,641.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$811.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,641.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,102.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,557.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,483.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$824.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,456.35
|
| Rate for Payer: Cash Price |
$915.94
|
| Rate for Payer: Cigna Commercial |
$1,465.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,465.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,465.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$824.35
|
| Rate for Payer: Multiplan Commercial |
$1,703.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,557.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$824.35
|
| Rate for Payer: United Healthcare Commercial |
$1,740.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$824.35
|
| Rate for Payer: United Healthcare VA CCN |
$824.35
|
|
|
SHOULDER DEEP ABSCESS/HEMATOMA
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 23030
|
| Hospital Charge Code |
9812303001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$698.65 |
| Max. Negotiated Rate |
$896.80 |
| Rate for Payer: Aetna of VT Commercial |
$896.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$698.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$698.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$802.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$792.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$755.20
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cigna Commercial |
$755.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$755.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$755.20
|
| Rate for Payer: Multiplan Commercial |
$877.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$802.40
|
| Rate for Payer: United Healthcare Commercial |
$896.80
|
|
|
SHOULDER DEEP ABSCESS/HEMATOMA
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 23030
|
| Hospital Charge Code |
9812303002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$698.65 |
| Max. Negotiated Rate |
$896.80 |
| Rate for Payer: Aetna of VT Commercial |
$896.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$698.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$698.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$802.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$792.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$755.20
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cigna Commercial |
$755.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$755.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$755.20
|
| Rate for Payer: Multiplan Commercial |
$877.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$802.40
|
| Rate for Payer: United Healthcare Commercial |
$896.80
|
|
|
SHVG LES 1 F/E/E/N/L/M 0.5CM/<
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
9601131002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Aetna of VT Commercial |
$180.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$140.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$140.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$161.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$152.00
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$152.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$152.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$152.00
|
| Rate for Payer: Multiplan Commercial |
$176.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$161.50
|
| Rate for Payer: United Healthcare Commercial |
$180.50
|
|
|
SHVG LES 1 F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
9601131001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.31 |
| Max. Negotiated Rate |
$260.38 |
| Rate for Payer: Aetna of VT Commercial |
$260.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$248.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$43.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$248.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$59.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$143.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$143.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$48.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.62
|
| Rate for Payer: Cash Price |
$138.50
|
| Rate for Payer: Cash Price |
$138.50
|
| Rate for Payer: Cigna Commercial |
$47.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$175.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$175.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$108.48
|
| Rate for Payer: Multiplan Commercial |
$257.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$42.31
|
| Rate for Payer: United Healthcare Commercial |
$65.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.31
|
| Rate for Payer: United Healthcare VA CCN |
$42.31
|
|
|
SHVG LES 1 F/E/E/N/L/M 0.5CM/<
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
9601131001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$122.68 |
| Max. Negotiated Rate |
$263.15 |
| Rate for Payer: Aetna of VT Commercial |
$263.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$248.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$122.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$248.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$166.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$235.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$224.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$124.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$220.22
|
| Rate for Payer: Cash Price |
$138.50
|
| Rate for Payer: Cigna Commercial |
$221.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$221.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$221.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$124.65
|
| Rate for Payer: Multiplan Commercial |
$257.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$235.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$124.65
|
| Rate for Payer: United Healthcare Commercial |
$263.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.65
|
| Rate for Payer: United Healthcare VA CCN |
$124.65
|
|
|
SHVG LES 1 F/E/E/N/L/M 0.5CM/<
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
5101131001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.53 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Aetna of VT Commercial |
$82.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$77.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$77.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.17
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$69.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$39.15
|
| Rate for Payer: Multiplan Commercial |
$80.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.15
|
| Rate for Payer: United Healthcare Commercial |
$82.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.15
|
| Rate for Payer: United Healthcare VA CCN |
$39.15
|
|
|
SHVG LES 1 F/E/E/N/L/M 0.5CM/<
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
5101131001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.39 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Aetna of VT Commercial |
$82.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.60
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$69.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.60
|
| Rate for Payer: Multiplan Commercial |
$80.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.95
|
| Rate for Payer: United Healthcare Commercial |
$82.65
|
|
|
SHVG LES 1 F/E/E/N/L/M 0.5CM/<
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
9601131002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Aetna of VT Commercial |
$180.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$170.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$170.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$114.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$161.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$153.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$151.05
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$152.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$152.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$152.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$85.50
|
| Rate for Payer: Multiplan Commercial |
$176.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$161.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$180.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.50
|
| Rate for Payer: United Healthcare VA CCN |
$85.50
|
|
|
SHVG LES 1 F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
5101131001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.31 |
| Max. Negotiated Rate |
$175.37 |
| Rate for Payer: Aetna of VT Commercial |
$81.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$77.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$43.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$77.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$59.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$143.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$143.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$48.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.62
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$47.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$175.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$175.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$108.48
|
| Rate for Payer: Multiplan Commercial |
$80.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$42.31
|
| Rate for Payer: United Healthcare Commercial |
$65.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.31
|
| Rate for Payer: United Healthcare VA CCN |
$42.31
|
|
|
SHVG LES 1 F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
9601131002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.31 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Aetna of VT Commercial |
$178.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$170.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$43.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$170.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$59.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$143.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$143.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$48.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.62
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$47.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$175.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$175.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$108.48
|
| Rate for Payer: Multiplan Commercial |
$176.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$42.31
|
| Rate for Payer: United Healthcare Commercial |
$65.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.31
|
| Rate for Payer: United Healthcare VA CCN |
$42.31
|
|
|
SHVG LES 1 F/E/E/N/L/M 0.5CM/<
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
9601131001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$205.01 |
| Max. Negotiated Rate |
$263.15 |
| Rate for Payer: Aetna of VT Commercial |
$263.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$205.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$205.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$235.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$232.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$221.60
|
| Rate for Payer: Cash Price |
$138.50
|
| Rate for Payer: Cigna Commercial |
$221.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$221.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$221.60
|
| Rate for Payer: Multiplan Commercial |
$257.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$235.45
|
| Rate for Payer: United Healthcare Commercial |
$263.15
|
|
|
SICKLING RBC REDUCTION
|
Facility
|
OP
|
$256.18
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
3008566001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$243.37 |
| Rate for Payer: Aetna of VT Commercial |
$243.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$113.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$154.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$217.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$207.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$115.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$203.66
|
| Rate for Payer: Cash Price |
$128.09
|
| Rate for Payer: Cash Price |
$128.09
|
| Rate for Payer: Cigna Commercial |
$204.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$204.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$204.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$115.28
|
| Rate for Payer: Multiplan Commercial |
$238.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$115.28
|
| Rate for Payer: United Healthcare Commercial |
$243.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.51
|
| Rate for Payer: United Healthcare VA CCN |
$115.28
|
|
|
SICKLING RBC REDUCTION
|
Professional
|
Both
|
$256.18
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
3008566001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$240.81 |
| Rate for Payer: Aetna of VT Commercial |
$240.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$7.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9.42
|
| Rate for Payer: Cash Price |
$128.09
|
| Rate for Payer: Cash Price |
$128.09
|
| Rate for Payer: Cigna Commercial |
$6.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$238.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.51
|
| Rate for Payer: United Healthcare Commercial |
$8.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.51
|
| Rate for Payer: United Healthcare VA CCN |
$5.51
|
|
|
SICKLING RBC REDUCTION
|
Facility
|
IP
|
$256.18
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
3008566001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$243.37 |
| Rate for Payer: Aetna of VT Commercial |
$243.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$189.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$189.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$217.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$215.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$204.94
|
| Rate for Payer: Cash Price |
$128.09
|
| Rate for Payer: Cigna Commercial |
$204.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$204.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$204.94
|
| Rate for Payer: Multiplan Commercial |
$238.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.75
|
| Rate for Payer: United Healthcare Commercial |
$243.37
|
|
|
SIGMOIDOSCOPY AND BIOPSY
|
Facility
|
OP
|
$1,719.00
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
9604533101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$761.35 |
| Max. Negotiated Rate |
$1,633.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,633.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,540.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$761.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,540.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,034.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,461.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,392.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$773.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,366.61
|
| Rate for Payer: Cash Price |
$859.50
|
| Rate for Payer: Cigna Commercial |
$1,375.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,375.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,375.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$773.55
|
| Rate for Payer: Multiplan Commercial |
$1,598.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,461.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$773.55
|
| Rate for Payer: United Healthcare Commercial |
$1,633.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$773.55
|
| Rate for Payer: United Healthcare VA CCN |
$773.55
|
|
|
SIGMOIDOSCOPY AND BIOPSY
|
Facility
|
IP
|
$1,719.00
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
9604533101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,272.23 |
| Max. Negotiated Rate |
$1,633.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,633.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,272.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,272.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,461.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,443.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,375.20
|
| Rate for Payer: Cash Price |
$859.50
|
| Rate for Payer: Cigna Commercial |
$1,375.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,375.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,375.20
|
| Rate for Payer: Multiplan Commercial |
$1,598.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,461.15
|
| Rate for Payer: United Healthcare Commercial |
$1,633.05
|
|
|
SIGMOIDOSCOPY AND BIOPSY
|
Professional
|
Both
|
$1,719.00
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
9604533101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$1,615.86 |
| Rate for Payer: Aetna of VT Commercial |
$1,615.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,540.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,540.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$94.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$365.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$365.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$365.77
|
| Rate for Payer: Cash Price |
$859.50
|
| Rate for Payer: Cash Price |
$859.50
|
| Rate for Payer: Cigna Commercial |
$123.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$432.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$432.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$267.93
|
| Rate for Payer: Multiplan Commercial |
$1,598.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.50
|
| Rate for Payer: United Healthcare Commercial |
$103.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.50
|
| Rate for Payer: United Healthcare VA CCN |
$67.50
|
|
|
SIGMOIDOSCOPY AND BIOPSY
|
Facility
|
OP
|
$1,303.00
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
5104533101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$577.10 |
| Max. Negotiated Rate |
$1,237.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,237.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,167.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$577.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,167.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$784.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,107.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,055.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$586.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,035.88
|
| Rate for Payer: Cash Price |
$651.50
|
| Rate for Payer: Cigna Commercial |
$1,042.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,042.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,042.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$586.35
|
| Rate for Payer: Multiplan Commercial |
$1,211.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,107.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$586.35
|
| Rate for Payer: United Healthcare Commercial |
$1,237.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$586.35
|
| Rate for Payer: United Healthcare VA CCN |
$586.35
|
|
|
SIGMOIDOSCOPY AND BIOPSY
|
Facility
|
IP
|
$1,303.00
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
5104533101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$964.35 |
| Max. Negotiated Rate |
$1,237.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,237.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$964.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$964.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,107.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,094.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,042.40
|
| Rate for Payer: Cash Price |
$651.50
|
| Rate for Payer: Cigna Commercial |
$1,042.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,042.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,042.40
|
| Rate for Payer: Multiplan Commercial |
$1,211.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,107.55
|
| Rate for Payer: United Healthcare Commercial |
$1,237.85
|
|
|
SIGMOIDOSCOPY AND BIOPSY
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
9604533102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$432.53 |
| Rate for Payer: Aetna of VT Commercial |
$391.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$372.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$372.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$94.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$365.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$365.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$365.77
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cigna Commercial |
$123.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$432.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$432.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$267.93
|
| Rate for Payer: Multiplan Commercial |
$386.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.50
|
| Rate for Payer: United Healthcare Commercial |
$103.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.50
|
| Rate for Payer: United Healthcare VA CCN |
$67.50
|
|
