|
SURGICAL PATH GROSS
|
Facility
|
IP
|
$125.01
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
3008830001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.52 |
| 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 |
$92.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$105.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$100.01
|
| 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: Multiplan Commercial |
$116.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.26
|
| Rate for Payer: United Healthcare Commercial |
$118.76
|
|
|
SURGICAL PATH GROSS
|
Professional
|
Both
|
$125.01
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
3008830001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$117.51 |
| Rate for Payer: Aetna of VT Commercial |
$117.51
|
| 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 |
$16.24
|
| 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 |
$22.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$26.33
|
| Rate for Payer: Cash Price |
$62.51
|
| Rate for Payer: Cash Price |
$62.51
|
| Rate for Payer: Cigna Commercial |
$20.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$15.77
|
| Rate for Payer: Multiplan Commercial |
$116.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$15.77
|
| Rate for Payer: United Healthcare Commercial |
$24.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.77
|
| Rate for Payer: United Healthcare VA CCN |
$15.77
|
|
|
SUSCEPTIBLTY STDY ANTIMICRBIAL
|
Facility
|
OP
|
$126.92
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
3008718601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$120.57 |
| Rate for Payer: Aetna of VT Commercial |
$120.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$42.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$56.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$42.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$76.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$107.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$102.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$57.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$100.90
|
| Rate for Payer: Cash Price |
$63.46
|
| Rate for Payer: Cash Price |
$63.46
|
| Rate for Payer: Cigna Commercial |
$101.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$101.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$101.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$57.11
|
| Rate for Payer: Multiplan Commercial |
$118.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.11
|
| Rate for Payer: United Healthcare Commercial |
$120.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.65
|
| Rate for Payer: United Healthcare VA CCN |
$57.11
|
|
|
SUSCEPTIBLTY STDY ANTIMICRBIAL
|
Facility
|
IP
|
$126.92
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
3008718601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.93 |
| Max. Negotiated Rate |
$120.57 |
| Rate for Payer: Aetna of VT Commercial |
$120.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$107.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$101.54
|
| Rate for Payer: Cash Price |
$63.46
|
| Rate for Payer: Cigna Commercial |
$101.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$101.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$101.54
|
| Rate for Payer: Multiplan Commercial |
$118.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.88
|
| Rate for Payer: United Healthcare Commercial |
$120.57
|
|
|
SUSCEPTIBLTY STDY ANTIMICRBIAL
|
Professional
|
Both
|
$126.92
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
3008718601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$119.30 |
| Rate for Payer: Aetna of VT Commercial |
$119.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$42.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$42.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$14.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$14.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.78
|
| Rate for Payer: Cash Price |
$63.46
|
| Rate for Payer: Cash Price |
$63.46
|
| Rate for Payer: Cigna Commercial |
$10.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.53
|
| Rate for Payer: Multiplan Commercial |
$118.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.65
|
| Rate for Payer: United Healthcare Commercial |
$13.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.65
|
| Rate for Payer: United Healthcare VA CCN |
$8.65
|
|
|
SUT 0 SILK TIE SA86G
|
Facility
|
IP
|
$2.66
|
|
| Hospital Charge Code |
2720026881
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Aetna of VT Commercial |
$2.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.13
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cigna Commercial |
$2.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.13
|
| Rate for Payer: Multiplan Commercial |
$2.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.26
|
| Rate for Payer: United Healthcare Commercial |
$2.53
|
|
|
SUT 0 SILK TIE SA86G
|
Facility
|
OP
|
$2.66
|
|
| Hospital Charge Code |
2720026881
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Aetna of VT Commercial |
$2.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.11
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cigna Commercial |
$2.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.13
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$2.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$2.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.20
|
| Rate for Payer: United Healthcare VA CCN |
$1.20
|
|
|
SUT CHR 2-0 801H
|
Facility
|
OP
|
$122.72
|
|
| Hospital Charge Code |
2720073291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.35 |
| Max. Negotiated Rate |
$116.58 |
| Rate for Payer: Aetna of VT Commercial |
$116.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$109.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$109.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$104.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$99.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$55.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$97.56
|
| Rate for Payer: Cash Price |
$61.36
|
| Rate for Payer: Cigna Commercial |
$98.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$98.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$98.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$55.22
|
| Rate for Payer: Multiplan Commercial |
$114.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$104.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$55.22
|
| Rate for Payer: United Healthcare Commercial |
$116.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.22
|
| Rate for Payer: United Healthcare VA CCN |
$55.22
|
|
|
SUT CHR 2-0 801H
|
Facility
|
IP
|
$122.72
|
|
| Hospital Charge Code |
2720073291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.83 |
| Max. Negotiated Rate |
$116.58 |
| Rate for Payer: Aetna of VT Commercial |
$116.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$90.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$90.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$104.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$103.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$98.18
|
| Rate for Payer: Cash Price |
$61.36
|
| Rate for Payer: Cigna Commercial |
$98.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$98.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$98.18
|
| Rate for Payer: Multiplan Commercial |
$114.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$104.31
|
| Rate for Payer: United Healthcare Commercial |
$116.58
|
|
|
SUT CHR 3-0 801H
|
Facility
|
OP
|
$1,565.30
|
|
| Hospital Charge Code |
2720073301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$693.27 |
| Max. Negotiated Rate |
$1,487.04 |
| Rate for Payer: Aetna of VT Commercial |
$1,487.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,402.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$693.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,402.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$942.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,330.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,267.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$704.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,244.41
|
| Rate for Payer: Cash Price |
$782.65
|
| Rate for Payer: Cigna Commercial |
$1,252.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,252.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,252.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$704.38
|
| Rate for Payer: Multiplan Commercial |
$1,455.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,330.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$704.38
|
| Rate for Payer: United Healthcare Commercial |
$1,487.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$704.38
|
| Rate for Payer: United Healthcare VA CCN |
$704.38
|
|
|
SUT CHR 3-0 801H
|
Facility
|
IP
|
$1,565.30
|
|
| Hospital Charge Code |
2720073301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,158.48 |
| Max. Negotiated Rate |
$1,487.04 |
| Rate for Payer: Aetna of VT Commercial |
$1,487.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,158.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,158.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,330.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,314.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,252.24
|
| Rate for Payer: Cash Price |
$782.65
|
| Rate for Payer: Cigna Commercial |
$1,252.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,252.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,252.24
|
| Rate for Payer: Multiplan Commercial |
$1,455.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,330.51
|
| Rate for Payer: United Healthcare Commercial |
$1,487.04
|
|
|
SUT ETHBD 5-0 MB47G
|
Facility
|
IP
|
$21.28
|
|
| Hospital Charge Code |
2720072941
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Aetna of VT Commercial |
$20.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$18.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$17.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$17.02
|
| Rate for Payer: Cash Price |
$10.64
|
| Rate for Payer: Cigna Commercial |
$17.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$17.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$17.02
|
| Rate for Payer: Multiplan Commercial |
$19.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.09
|
| Rate for Payer: United Healthcare Commercial |
$20.22
|
|
|
SUT ETHBD 5-0 MB47G
|
Facility
|
OP
|
$21.28
|
|
| Hospital Charge Code |
2720072941
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Aetna of VT Commercial |
$20.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$19.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$19.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$12.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$18.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$17.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.92
|
| Rate for Payer: Cash Price |
$10.64
|
| Rate for Payer: Cigna Commercial |
$17.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$17.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$17.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.58
|
| Rate for Payer: Multiplan Commercial |
$19.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.58
|
| Rate for Payer: United Healthcare Commercial |
$20.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.58
|
| Rate for Payer: United Healthcare VA CCN |
$9.58
|
|
|
SUT FRC FBR 5 38 STD W NEEDLE
|
Facility
|
OP
|
$2.36
|
|
| Hospital Charge Code |
2720037021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: Aetna of VT Commercial |
$2.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.88
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cigna Commercial |
$1.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$2.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.06
|
| Rate for Payer: United Healthcare Commercial |
$2.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.06
|
| Rate for Payer: United Healthcare VA CCN |
$1.06
|
|
|
SUT FRC FBR 5 38 STD W NEEDLE
|
Facility
|
IP
|
$2.36
|
|
| Hospital Charge Code |
2720037021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: Aetna of VT Commercial |
$2.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.89
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cigna Commercial |
$1.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.89
|
| Rate for Payer: Multiplan Commercial |
$2.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.01
|
| Rate for Payer: United Healthcare Commercial |
$2.24
|
|
|
SUT MONO 0 Y358H
|
Facility
|
IP
|
$8.53
|
|
| Hospital Charge Code |
2720075211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of VT Commercial |
$8.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6.82
|
| Rate for Payer: Cash Price |
$4.26
|
| Rate for Payer: Cigna Commercial |
$6.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.82
|
| Rate for Payer: Multiplan Commercial |
$7.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.25
|
| Rate for Payer: United Healthcare Commercial |
$8.10
|
|
|
SUT MONO 0 Y358H
|
Facility
|
OP
|
$8.53
|
|
| Hospital Charge Code |
2720075211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of VT Commercial |
$8.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6.78
|
| Rate for Payer: Cash Price |
$4.26
|
| Rate for Payer: Cigna Commercial |
$6.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$7.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3.84
|
| Rate for Payer: United Healthcare Commercial |
$8.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.84
|
| Rate for Payer: United Healthcare VA CCN |
$3.84
|
|
|
SUT PRO 3.0 8832H
|
Facility
|
OP
|
$25.25
|
|
| Hospital Charge Code |
2720025371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$23.99 |
| Rate for Payer: Aetna of VT Commercial |
$23.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$22.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$22.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.07
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cigna Commercial |
$20.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$20.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$20.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.36
|
| Rate for Payer: Multiplan Commercial |
$23.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.36
|
| Rate for Payer: United Healthcare Commercial |
$23.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.36
|
| Rate for Payer: United Healthcare VA CCN |
$11.36
|
|
|
SUT PRO 3.0 8832H
|
Facility
|
IP
|
$25.25
|
|
| Hospital Charge Code |
2720025371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.69 |
| Max. Negotiated Rate |
$23.99 |
| Rate for Payer: Aetna of VT Commercial |
$23.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$18.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$18.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$21.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.20
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cigna Commercial |
$20.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$20.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$20.20
|
| Rate for Payer: Multiplan Commercial |
$23.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.46
|
| Rate for Payer: United Healthcare Commercial |
$23.99
|
|
|
SUT SILK 0 624H
|
Facility
|
IP
|
$3.39
|
|
| Hospital Charge Code |
2720024931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$3.22 |
| Rate for Payer: Aetna of VT Commercial |
$3.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.71
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cigna Commercial |
$2.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.71
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.88
|
| Rate for Payer: United Healthcare Commercial |
$3.22
|
|
|
SUT SILK 0 624H
|
Facility
|
OP
|
$3.39
|
|
| Hospital Charge Code |
2720024931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.22 |
| Rate for Payer: Aetna of VT Commercial |
$3.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.70
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cigna Commercial |
$2.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.53
|
| Rate for Payer: United Healthcare Commercial |
$3.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.53
|
| Rate for Payer: United Healthcare VA CCN |
$1.53
|
|
|
SUT SILK 4.0 SA63H
|
Facility
|
OP
|
$1.62
|
|
| Hospital Charge Code |
2720026821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna of VT Commercial |
$1.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.29
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna Commercial |
$1.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$1.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.73
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.73
|
| Rate for Payer: United Healthcare VA CCN |
$0.73
|
|
|
SUT SILK 4.0 SA63H
|
Facility
|
IP
|
$1.62
|
|
| Hospital Charge Code |
2720026821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna of VT Commercial |
$1.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.30
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna Commercial |
$1.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$1.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.38
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
|
|
SUTURE LARGE INTESTINE
|
Facility
|
IP
|
$2,885.00
|
|
|
Service Code
|
CPT 44604
|
| Hospital Charge Code |
9824460401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,135.19 |
| Max. Negotiated Rate |
$2,740.75 |
| Rate for Payer: Aetna of VT Commercial |
$2,740.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,135.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,135.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,452.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,423.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,308.00
|
| Rate for Payer: Cash Price |
$1,442.50
|
| Rate for Payer: Cigna Commercial |
$2,308.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,308.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,308.00
|
| Rate for Payer: Multiplan Commercial |
$2,683.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,452.25
|
| Rate for Payer: United Healthcare Commercial |
$2,740.75
|
|
|
SUTURE LARGE INTESTINE
|
Professional
|
Both
|
$2,885.00
|
|
|
Service Code
|
CPT 44604
|
| Hospital Charge Code |
9824460401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$957.43 |
| Max. Negotiated Rate |
$2,711.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,711.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,584.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$986.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,584.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,340.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,570.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,570.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,101.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,570.04
|
| Rate for Payer: Cash Price |
$1,442.50
|
| Rate for Payer: Cash Price |
$1,442.50
|
| Rate for Payer: Cigna Commercial |
$1,753.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,628.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,628.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$957.43
|
| Rate for Payer: Multiplan Commercial |
$2,683.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,359.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$957.44
|
| Rate for Payer: United Healthcare Commercial |
$1,472.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$957.44
|
| Rate for Payer: United Healthcare VA CCN |
$957.44
|
|
