|
SKIN SUB GRAFT TRNK/ARM/LEG
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
9821527101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$244.97 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Aetna of VT Commercial |
$314.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$244.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$244.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$281.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$264.80
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$264.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$264.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$264.80
|
| Rate for Payer: Multiplan Commercial |
$307.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$281.35
|
| Rate for Payer: United Healthcare Commercial |
$314.45
|
|
|
SKIN SUB GRAFT TRNK/ARM/LEG
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
9821527101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$146.60 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Aetna of VT Commercial |
$314.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$296.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$146.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$296.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$199.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$281.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$268.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$148.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$263.14
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$264.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$264.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$264.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$148.95
|
| Rate for Payer: Multiplan Commercial |
$307.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$281.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$148.95
|
| Rate for Payer: United Healthcare Commercial |
$314.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.95
|
| Rate for Payer: United Healthcare VA CCN |
$148.95
|
|
|
SKIN SUB GRAFT TRNK/ARM/LEG
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
9601527101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$78.06 |
| Max. Negotiated Rate |
$311.14 |
| Rate for Payer: Aetna of VT Commercial |
$311.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$296.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$80.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$296.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$109.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$208.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$208.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$89.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$208.06
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$87.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$144.54
|
| Rate for Payer: Multiplan Commercial |
$307.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$78.06
|
| Rate for Payer: United Healthcare Commercial |
$120.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.06
|
| Rate for Payer: United Healthcare VA CCN |
$78.06
|
|
|
SKIN SUB GRAFT TRNK/ARM/LEG
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
9601527101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$244.97 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Aetna of VT Commercial |
$314.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$244.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$244.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$281.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$264.80
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$264.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$264.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$264.80
|
| Rate for Payer: Multiplan Commercial |
$307.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$281.35
|
| Rate for Payer: United Healthcare Commercial |
$314.45
|
|
|
SKIN SUB GRAFT TRNK/ARM/LEG
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
9821527101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$78.06 |
| Max. Negotiated Rate |
$311.14 |
| Rate for Payer: Aetna of VT Commercial |
$311.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$296.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$80.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$296.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$109.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$208.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$208.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$89.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$208.06
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$87.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$144.54
|
| Rate for Payer: Multiplan Commercial |
$307.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$78.06
|
| Rate for Payer: United Healthcare Commercial |
$120.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.06
|
| Rate for Payer: United Healthcare VA CCN |
$78.06
|
|
|
SKIN SUB GRAFT TRNK/ARM/LEG
|
Professional
|
Both
|
$198.60
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
9601527102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$78.06 |
| Max. Negotiated Rate |
$236.07 |
| Rate for Payer: Aetna of VT Commercial |
$186.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$177.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$80.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$177.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$109.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$208.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$208.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$89.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$208.06
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$87.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$144.54
|
| Rate for Payer: Multiplan Commercial |
$184.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$78.06
|
| Rate for Payer: United Healthcare Commercial |
$120.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.06
|
| Rate for Payer: United Healthcare VA CCN |
$78.06
|
|
|
SKIN SUB GRAFT TRNK/ARM/LEG
|
Facility
|
OP
|
$198.60
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
9601527102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$87.96 |
| Max. Negotiated Rate |
$188.67 |
| Rate for Payer: Aetna of VT Commercial |
$188.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$177.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$177.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$119.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$168.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$160.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$89.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$157.89
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$158.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$158.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$158.88
|
| Rate for Payer: Martins Point Health Care Commercial |
$89.37
|
| Rate for Payer: Multiplan Commercial |
$184.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$168.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$89.37
|
| Rate for Payer: United Healthcare Commercial |
$188.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.37
|
| Rate for Payer: United Healthcare VA CCN |
$89.37
|
|
|
SKIN SUB GRAFT TRNK/ARM/LEG
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
9601527101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$146.60 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Aetna of VT Commercial |
$314.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$296.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$146.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$296.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$199.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$281.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$268.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$148.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$263.14
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$264.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$264.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$264.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$148.95
|
| Rate for Payer: Multiplan Commercial |
$307.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$281.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$148.95
|
| Rate for Payer: United Healthcare Commercial |
$314.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.95
|
| Rate for Payer: United Healthcare VA CCN |
$148.95
|
|
|
SKIN TAG RMVL ADDL 10 LES
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
9601120101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$113.98 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna of VT Commercial |
$146.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$123.20
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$123.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$123.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$123.20
|
| Rate for Payer: Multiplan Commercial |
$143.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.90
|
| Rate for Payer: United Healthcare Commercial |
$146.30
|
|
|
SKIN TAG RMVL ADDL 10 LES
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
9601120102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$68.62 |
| Rate for Payer: Aetna of VT Commercial |
$68.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$21.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$25.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$25.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.60
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$17.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$67.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$15.02
|
| Rate for Payer: United Healthcare Commercial |
$23.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.02
|
| Rate for Payer: United Healthcare VA CCN |
$15.02
|
|
|
SKIN TAG RMVL ADDL 10 LES
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
9601120102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$32.33 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Aetna of VT Commercial |
$69.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$32.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.03
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$58.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$32.85
|
| Rate for Payer: Multiplan Commercial |
$67.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.85
|
| Rate for Payer: United Healthcare Commercial |
$69.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.85
|
| Rate for Payer: United Healthcare VA CCN |
$32.85
|
|
|
SKIN TAG RMVL ADDL 10 LES
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
9601120101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$68.21 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna of VT Commercial |
$146.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.43
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$123.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$123.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$123.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.30
|
| Rate for Payer: Multiplan Commercial |
$143.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$146.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.30
|
| Rate for Payer: United Healthcare VA CCN |
$69.30
|
|
|
SKIN TAG RMVL ADDL 10 LES
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
9601120101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$144.76 |
| Rate for Payer: Aetna of VT Commercial |
$144.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$21.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$25.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$25.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.60
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$17.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$143.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$15.02
|
| Rate for Payer: United Healthcare Commercial |
$23.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.02
|
| Rate for Payer: United Healthcare VA CCN |
$15.02
|
|
|
SKIN TAG RMVL ADDL 10 LES
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
9601120102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$54.03 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Aetna of VT Commercial |
$69.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$61.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.40
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$58.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.40
|
| Rate for Payer: Multiplan Commercial |
$67.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.05
|
| Rate for Payer: United Healthcare Commercial |
$69.35
|
|
|
SKIN TAG RMVL ADDL 10 LES
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
5101120101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.69 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Aetna of VT Commercial |
$77.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$60.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$60.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$69.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.60
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$65.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$65.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$65.60
|
| Rate for Payer: Multiplan Commercial |
$76.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.70
|
| Rate for Payer: United Healthcare Commercial |
$77.90
|
|
|
SKIN TAG RMVL ADDL 10 LES
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
5101120101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.32 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Aetna of VT Commercial |
$77.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$73.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$73.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$69.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$66.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.19
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$65.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$65.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$65.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.90
|
| Rate for Payer: Multiplan Commercial |
$76.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.90
|
| Rate for Payer: United Healthcare Commercial |
$77.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.90
|
| Rate for Payer: United Healthcare VA CCN |
$36.90
|
|
|
SKIN TAG RMVL ADDL 10 LES
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
5101120101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$77.08 |
| Rate for Payer: Aetna of VT Commercial |
$77.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$73.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$73.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$21.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$25.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$25.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.60
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$17.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$76.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$15.02
|
| Rate for Payer: United Healthcare Commercial |
$23.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.02
|
| Rate for Payer: United Healthcare VA CCN |
$15.02
|
|
|
SKYLA (LEVONORGESTREL) IUD
|
Facility
|
OP
|
$2,781.30
|
|
|
Service Code
|
HCPCS J7301
|
| Hospital Charge Code |
636J730101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,781.30 |
| Max. Negotiated Rate |
$2,781.30 |
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,781.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,781.30
|
|
|
SKYLA (LEVONORGESTREL) IUD
|
Professional
|
Both
|
$4,298.36
|
|
|
Service Code
|
HCPCS J7301
|
| Hospital Charge Code |
636J730101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$915.00 |
| Max. Negotiated Rate |
$4,040.46 |
| Rate for Payer: Aetna of VT Commercial |
$4,040.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,781.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,781.30
|
| Rate for Payer: Cash Price |
$2,149.18
|
| Rate for Payer: Cash Price |
$2,149.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$982.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$982.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,152.98
|
| Rate for Payer: Multiplan Commercial |
$3,997.47
|
| Rate for Payer: United Healthcare Commercial |
$3,653.61
|
| Rate for Payer: United Healthcare VA CCN |
$915.00
|
|
|
SL 9VHPV VACCINE 2/3 DOSE IM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
6369065101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
SL 9VHPV VACCINE 2/3 DOSE IM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
6369065101
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$845.93 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$845.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$845.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
SL 9VHPV VACCINE 2/3 DOSE IM
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
6369065101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$845.93 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$845.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$845.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$369.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$369.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$369.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$435.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$435.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$326.07
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$280.00
|
|
|
SL CCIIV4 VACC ABX FREE IM
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
CPT 90756 SL
|
| Hospital Charge Code |
6369075601
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$78.43 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$78.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$78.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$33.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$33.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$44.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$44.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$32.38
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
SL DTAP-IPV-HIB-HEPB VACCINE
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
CPT 90697 SL
|
| Hospital Charge Code |
6369069701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$430.71 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$430.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$430.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$187.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$187.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$212.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$212.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$166.10
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$161.00
|
|
|
SL DTAP-IPV/HIB VACCINE IM
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
CPT 90698 SL
|
| Hospital Charge Code |
6369069802
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$330.17 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$330.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$330.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$93.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$93.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$93.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$161.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$161.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$127.27
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$122.00
|
|
