|
SUGARS SINGLE QUAL
|
Facility
|
IP
|
$84.27
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
3008437601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$80.06 |
| Rate for Payer: Aetna of VT Commercial |
$80.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$67.42
|
| Rate for Payer: Cash Price |
$42.13
|
| Rate for Payer: Cigna Commercial |
$67.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.42
|
| Rate for Payer: Multiplan Commercial |
$78.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.63
|
| Rate for Payer: United Healthcare Commercial |
$80.06
|
|
|
SUGARS SINGLE QUAL
|
Professional
|
Both
|
$84.27
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
3008437601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$79.21 |
| Rate for Payer: Aetna of VT Commercial |
$79.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$27.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$27.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$7.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9.41
|
| Rate for Payer: Cash Price |
$42.13
|
| Rate for Payer: Cash Price |
$42.13
|
| Rate for Payer: Cigna Commercial |
$6.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.42
|
| Rate for Payer: Multiplan Commercial |
$78.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.50
|
| Rate for Payer: United Healthcare Commercial |
$8.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.50
|
| Rate for Payer: United Healthcare VA CCN |
$5.50
|
|
|
SUGARS SINGLE QUAL
|
Facility
|
OP
|
$84.27
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
3008437601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$80.06 |
| Rate for Payer: Aetna of VT Commercial |
$80.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$27.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$27.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.99
|
| Rate for Payer: Cash Price |
$42.13
|
| Rate for Payer: Cash Price |
$42.13
|
| Rate for Payer: Cigna Commercial |
$67.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.92
|
| Rate for Payer: Multiplan Commercial |
$78.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.92
|
| Rate for Payer: United Healthcare Commercial |
$80.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.50
|
| Rate for Payer: United Healthcare VA CCN |
$37.92
|
|
|
SULFAMETHOXAZOLE/TRIMETHOPRIM
|
Facility
|
IP
|
$0.01
|
|
| Hospital Charge Code |
2500000555
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
SULFAMETHOXAZOLE/TRIMETHOPRIM
|
Facility
|
OP
|
$0.01
|
|
| Hospital Charge Code |
2500000555
|
|
Hospital Revenue Code
|
250
|
| 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 Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| 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
|
|
|
SUPRV INTERFACILTY TRANSPORT
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 99485
|
| Hospital Charge Code |
9699948501
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$237.57 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna of VT Commercial |
$304.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$237.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$237.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$272.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$269.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$256.80
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$256.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$256.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$256.80
|
| Rate for Payer: Multiplan Commercial |
$298.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$272.85
|
| Rate for Payer: United Healthcare Commercial |
$304.95
|
|
|
SUPRV INTERFACILTY TRANSPORT
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 99485
|
| Hospital Charge Code |
9699948501
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$142.17 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna of VT Commercial |
$304.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$287.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$142.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$287.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$193.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$272.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$260.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$144.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$255.19
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$256.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$256.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$256.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$144.45
|
| Rate for Payer: Multiplan Commercial |
$298.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$272.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$144.45
|
| Rate for Payer: United Healthcare Commercial |
$304.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$144.45
|
| Rate for Payer: United Healthcare VA CCN |
$144.45
|
|
|
SUPRV INTERFAC TRNSPORT ADDL
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 99486
|
| Hospital Charge Code |
9699948601
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$82.82 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Aetna of VT Commercial |
$177.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$167.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$82.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$167.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$112.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$158.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$151.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$148.66
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$149.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$149.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$149.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$84.15
|
| Rate for Payer: Multiplan Commercial |
$173.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$84.15
|
| Rate for Payer: United Healthcare Commercial |
$177.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.15
|
| Rate for Payer: United Healthcare VA CCN |
$84.15
|
|
|
SUPRV INTERFAC TRNSPORT ADDL
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 99486
|
| Hospital Charge Code |
9699948601
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$138.40 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Aetna of VT Commercial |
$177.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$138.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$138.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$158.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$157.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$149.60
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$149.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$149.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$149.60
|
| Rate for Payer: Multiplan Commercial |
$173.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.95
|
| Rate for Payer: United Healthcare Commercial |
$177.65
|
|
|
SURG DX EXAM ANORECTAL
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
CPT 45990
|
| Hospital Charge Code |
9824599001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$98.12 |
| 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 |
$101.06
|
| 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 |
$137.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$112.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$149.98
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$178.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$164.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$164.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$98.12
|
| Rate for Payer: Multiplan Commercial |
$307.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$139.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$98.12
|
| Rate for Payer: United Healthcare Commercial |
$150.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.12
|
| Rate for Payer: United Healthcare VA CCN |
$98.12
|
|
|
SURG DX EXAM ANORECTAL
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 45990
|
| Hospital Charge Code |
9824599001
|
|
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
|
|
|
SURG DX EXAM ANORECTAL
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 45990
|
| Hospital Charge Code |
9824599001
|
|
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
|
|
|
SURGERY FOR VULVA LESION
|
Professional
|
Both
|
$7,151.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
9605644001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$169.63 |
| Max. Negotiated Rate |
$6,721.94 |
| Rate for Payer: Aetna of VT Commercial |
$6,721.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,406.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$174.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,406.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$237.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$364.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$364.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$195.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$364.02
|
| Rate for Payer: Cash Price |
$3,575.50
|
| Rate for Payer: Cash Price |
$3,575.50
|
| Rate for Payer: Cigna Commercial |
$299.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$282.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$282.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$169.64
|
| Rate for Payer: Multiplan Commercial |
$6,650.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$169.63
|
| Rate for Payer: United Healthcare Commercial |
$260.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.63
|
| Rate for Payer: United Healthcare VA CCN |
$169.63
|
|
|
SURGERY FOR VULVA LESION
|
Facility
|
OP
|
$6,472.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
5105644001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,866.45 |
| Max. Negotiated Rate |
$6,148.40 |
| Rate for Payer: Aetna of VT Commercial |
$6,148.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,798.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,866.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,798.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,896.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,501.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,242.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,912.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,145.24
|
| Rate for Payer: Cash Price |
$3,236.00
|
| Rate for Payer: Cigna Commercial |
$5,177.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,177.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,177.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,912.40
|
| Rate for Payer: Multiplan Commercial |
$6,018.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,501.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,912.40
|
| Rate for Payer: United Healthcare Commercial |
$6,148.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,912.40
|
| Rate for Payer: United Healthcare VA CCN |
$2,912.40
|
|
|
SURGERY FOR VULVA LESION
|
Facility
|
IP
|
$6,472.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
5105644001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,789.93 |
| Max. Negotiated Rate |
$6,148.40 |
| Rate for Payer: Aetna of VT Commercial |
$6,148.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,789.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,789.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,501.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,436.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,177.60
|
| Rate for Payer: Cash Price |
$3,236.00
|
| Rate for Payer: Cigna Commercial |
$5,177.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,177.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,177.60
|
| Rate for Payer: Multiplan Commercial |
$6,018.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,501.20
|
| Rate for Payer: United Healthcare Commercial |
$6,148.40
|
|
|
SURGERY FOR VULVA LESION
|
Facility
|
IP
|
$7,151.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
9605644001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$5,292.46 |
| Max. Negotiated Rate |
$6,793.45 |
| Rate for Payer: Aetna of VT Commercial |
$6,793.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,292.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,292.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,078.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,006.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,720.80
|
| Rate for Payer: Cash Price |
$3,575.50
|
| Rate for Payer: Cigna Commercial |
$5,720.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,720.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,720.80
|
| Rate for Payer: Multiplan Commercial |
$6,650.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,078.35
|
| Rate for Payer: United Healthcare Commercial |
$6,793.45
|
|
|
SURGERY FOR VULVA LESION
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
9605644002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$503.27 |
| Max. Negotiated Rate |
$646.00 |
| Rate for Payer: Aetna of VT Commercial |
$646.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$503.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$503.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$578.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$571.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$544.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cigna Commercial |
$544.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$544.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$544.00
|
| Rate for Payer: Multiplan Commercial |
$632.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$578.00
|
| Rate for Payer: United Healthcare Commercial |
$646.00
|
|
|
SURGERY FOR VULVA LESION
|
Professional
|
Both
|
$680.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
9605644002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$169.63 |
| Max. Negotiated Rate |
$639.20 |
| Rate for Payer: Aetna of VT Commercial |
$639.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$609.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$174.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$609.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$237.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$364.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$364.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$195.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$364.02
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cigna Commercial |
$299.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$282.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$282.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$169.64
|
| Rate for Payer: Multiplan Commercial |
$632.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$169.63
|
| Rate for Payer: United Healthcare Commercial |
$260.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.63
|
| Rate for Payer: United Healthcare VA CCN |
$169.63
|
|
|
SURGERY FOR VULVA LESION
|
Professional
|
Both
|
$6,472.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
5105644001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$169.63 |
| Max. Negotiated Rate |
$6,083.68 |
| Rate for Payer: Aetna of VT Commercial |
$6,083.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,798.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$174.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,798.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$237.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$364.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$364.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$195.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$364.02
|
| Rate for Payer: Cash Price |
$3,236.00
|
| Rate for Payer: Cash Price |
$3,236.00
|
| Rate for Payer: Cigna Commercial |
$299.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$282.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$282.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$169.64
|
| Rate for Payer: Multiplan Commercial |
$6,018.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$169.63
|
| Rate for Payer: United Healthcare Commercial |
$260.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.63
|
| Rate for Payer: United Healthcare VA CCN |
$169.63
|
|
|
SURGERY FOR VULVA LESION
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
9825644001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$503.27 |
| Max. Negotiated Rate |
$646.00 |
| Rate for Payer: Aetna of VT Commercial |
$646.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$503.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$503.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$578.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$571.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$544.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cigna Commercial |
$544.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$544.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$544.00
|
| Rate for Payer: Multiplan Commercial |
$632.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$578.00
|
| Rate for Payer: United Healthcare Commercial |
$646.00
|
|
|
SURGERY FOR VULVA LESION
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
9825644001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$301.17 |
| Max. Negotiated Rate |
$646.00 |
| Rate for Payer: Aetna of VT Commercial |
$646.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$609.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$301.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$609.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$409.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$578.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$550.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$540.60
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cigna Commercial |
$544.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$544.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$544.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$306.00
|
| Rate for Payer: Multiplan Commercial |
$632.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$578.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$306.00
|
| Rate for Payer: United Healthcare Commercial |
$646.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$306.00
|
| Rate for Payer: United Healthcare VA CCN |
$306.00
|
|
|
SURGERY FOR VULVA LESION
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
9605644002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$301.17 |
| Max. Negotiated Rate |
$646.00 |
| Rate for Payer: Aetna of VT Commercial |
$646.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$609.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$301.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$609.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$409.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$578.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$550.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$540.60
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cigna Commercial |
$544.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$544.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$544.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$306.00
|
| Rate for Payer: Multiplan Commercial |
$632.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$578.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$306.00
|
| Rate for Payer: United Healthcare Commercial |
$646.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$306.00
|
| Rate for Payer: United Healthcare VA CCN |
$306.00
|
|
|
SURGERY FOR VULVA LESION
|
Facility
|
OP
|
$7,151.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
9605644001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,167.18 |
| Max. Negotiated Rate |
$6,793.45 |
| Rate for Payer: Aetna of VT Commercial |
$6,793.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,406.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,167.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,406.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,304.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,078.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,792.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,217.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,685.05
|
| Rate for Payer: Cash Price |
$3,575.50
|
| Rate for Payer: Cigna Commercial |
$5,720.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,720.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,720.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,217.95
|
| Rate for Payer: Multiplan Commercial |
$6,650.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,078.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,217.95
|
| Rate for Payer: United Healthcare Commercial |
$6,793.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,217.95
|
| Rate for Payer: United Healthcare VA CCN |
$3,217.95
|
|
|
SURGERY FOR VULVA LESION
|
Professional
|
Both
|
$680.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
9825644001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$169.63 |
| Max. Negotiated Rate |
$639.20 |
| Rate for Payer: Aetna of VT Commercial |
$639.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$609.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$174.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$609.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$237.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$364.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$364.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$195.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$364.02
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cigna Commercial |
$299.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$282.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$282.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$169.64
|
| Rate for Payer: Multiplan Commercial |
$632.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$169.63
|
| Rate for Payer: United Healthcare Commercial |
$260.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.63
|
| Rate for Payer: United Healthcare VA CCN |
$169.63
|
|
|
SURGICAL PATH GROSS
|
Facility
|
OP
|
$125.01
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
3008830001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$118.76 |
| Rate for Payer: Aetna of VT Commercial |
$118.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$101.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$56.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$99.38
|
| Rate for Payer: Cash Price |
$62.51
|
| Rate for Payer: Cash Price |
$62.51
|
| Rate for Payer: Cigna Commercial |
$100.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$100.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$100.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$116.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.25
|
| Rate for Payer: United Healthcare Commercial |
$118.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.77
|
| Rate for Payer: United Healthcare VA CCN |
$56.25
|
|
