|
SYNCH AUDIO-VIDEO NEW MOD 45
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 98002
|
| Hospital Charge Code |
9609800201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$93.01 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Aetna of VT Commercial |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$188.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$93.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$188.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$126.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$94.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$166.95
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$168.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$195.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$178.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$94.50
|
| Rate for Payer: United Healthcare Commercial |
$199.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.50
|
| Rate for Payer: United Healthcare VA CCN |
$94.50
|
|
|
SYNCH AUDIO-VIDEO NEW MOD 45
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 98002
|
| Hospital Charge Code |
9609800201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$155.42 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Aetna of VT Commercial |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$155.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$155.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$168.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$168.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$195.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$178.50
|
| Rate for Payer: United Healthcare Commercial |
$199.50
|
|
|
SYNCH AUDIO-VIDEO NEW SF 15
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
CPT 98000
|
| Hospital Charge Code |
9609800001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$113.52 |
| Rate for Payer: Aetna of VT Commercial |
$50.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.52
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$45.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$79.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$79.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$48.90
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: United Healthcare Commercial |
$45.90
|
| Rate for Payer: United Healthcare VA CCN |
$21.60
|
|
|
SYNCH AUDIO-VIDEO NEW SF 15
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 98000
|
| Hospital Charge Code |
9609800001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.97 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of VT Commercial |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$45.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.20
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.90
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
|
|
SYNCH AUDIO-VIDEO NEW SF 15
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 98000
|
| Hospital Charge Code |
9609800001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of VT Commercial |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$43.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.93
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$24.30
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$24.30
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.30
|
| Rate for Payer: United Healthcare VA CCN |
$24.30
|
|
|
SYPHILIS TEST NON-TREP QUAL
|
Facility
|
IP
|
$80.95
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
3008659201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$76.90 |
| Rate for Payer: Aetna of VT Commercial |
$76.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.76
|
| Rate for Payer: Cash Price |
$40.48
|
| Rate for Payer: Cigna Commercial |
$64.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.76
|
| Rate for Payer: Multiplan Commercial |
$75.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.81
|
| Rate for Payer: United Healthcare Commercial |
$76.90
|
|
|
SYPHILIS TEST NON-TREP QUAL
|
Facility
|
OP
|
$80.95
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
3008659201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$76.90 |
| Rate for Payer: Aetna of VT Commercial |
$76.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$48.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.36
|
| Rate for Payer: Cash Price |
$40.48
|
| Rate for Payer: Cash Price |
$40.48
|
| Rate for Payer: Cigna Commercial |
$64.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.43
|
| Rate for Payer: Multiplan Commercial |
$75.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.43
|
| Rate for Payer: United Healthcare Commercial |
$76.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare VA CCN |
$36.43
|
|
|
SYPHILIS TEST NON-TREP QUAL
|
Professional
|
Both
|
$80.95
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
3008659201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$76.09 |
| Rate for Payer: Aetna of VT Commercial |
$76.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7.29
|
| Rate for Payer: Cash Price |
$40.48
|
| Rate for Payer: Cash Price |
$40.48
|
| Rate for Payer: Cigna Commercial |
$5.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.21
|
| Rate for Payer: Multiplan Commercial |
$75.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare Commercial |
$6.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare VA CCN |
$4.27
|
|
|
TACROLIMUS IMME REL ORAL 1MG
|
Facility
|
IP
|
$5.17
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
636J750701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$4.91 |
| Rate for Payer: Aetna of VT Commercial |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.14
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cigna Commercial |
$4.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.14
|
| Rate for Payer: Multiplan Commercial |
$4.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.39
|
| Rate for Payer: United Healthcare Commercial |
$4.91
|
|
|
TACROLIMUS IMME REL ORAL 1MG
|
Professional
|
Both
|
$5.17
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
636J750701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$4.86 |
| Rate for Payer: Aetna of VT Commercial |
$4.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.20
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$4.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.17
|
| Rate for Payer: United Healthcare Commercial |
$0.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.17
|
| Rate for Payer: United Healthcare VA CCN |
$0.17
|
|
|
TACROLIMUS IMME REL ORAL 1MG
|
Facility
|
OP
|
$5.17
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
636J750701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$4.91 |
| Rate for Payer: Aetna of VT Commercial |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.11
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cigna Commercial |
$4.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.33
|
| Rate for Payer: Multiplan Commercial |
$4.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.33
|
| Rate for Payer: United Healthcare Commercial |
$4.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.33
|
| Rate for Payer: United Healthcare VA CCN |
$2.33
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
5101110301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.53 |
| Max. Negotiated Rate |
$140.60 |
| Rate for Payer: Aetna of VT Commercial |
$140.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$109.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$109.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$125.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$118.40
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cigna Commercial |
$118.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$118.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$118.40
|
| Rate for Payer: Multiplan Commercial |
$137.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$125.80
|
| Rate for Payer: United Healthcare Commercial |
$140.60
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
9601110301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$216.85 |
| Max. Negotiated Rate |
$278.35 |
| Rate for Payer: Aetna of VT Commercial |
$278.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$216.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$216.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$249.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$246.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$234.40
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cigna Commercial |
$234.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$234.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$234.40
|
| Rate for Payer: Multiplan Commercial |
$272.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$249.05
|
| Rate for Payer: United Healthcare Commercial |
$278.35
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
9601110302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$64.66 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna of VT Commercial |
$138.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$64.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$124.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$116.07
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$65.70
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$124.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.70
|
| Rate for Payer: United Healthcare Commercial |
$138.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.70
|
| Rate for Payer: United Healthcare VA CCN |
$65.70
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
9601110302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$108.05 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna of VT Commercial |
$138.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$108.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$108.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$124.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$122.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$116.80
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.80
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$124.10
|
| Rate for Payer: United Healthcare Commercial |
$138.70
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
9601110302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$20.35 |
| Max. Negotiated Rate |
$137.24 |
| Rate for Payer: Aetna of VT Commercial |
$137.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$28.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$76.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$76.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.77
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$23.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.01
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.35
|
| Rate for Payer: United Healthcare Commercial |
$31.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.35
|
| Rate for Payer: United Healthcare VA CCN |
$20.35
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Professional
|
Both
|
$293.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
9601110301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$20.35 |
| Max. Negotiated Rate |
$275.42 |
| Rate for Payer: Aetna of VT Commercial |
$275.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$262.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$262.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$28.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$76.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$76.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.77
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cigna Commercial |
$23.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.01
|
| Rate for Payer: Multiplan Commercial |
$272.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.35
|
| Rate for Payer: United Healthcare Commercial |
$31.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.35
|
| Rate for Payer: United Healthcare VA CCN |
$20.35
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
5101110301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$140.60 |
| Rate for Payer: Aetna of VT Commercial |
$140.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$132.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$65.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$132.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$89.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$125.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$119.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$66.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$117.66
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cigna Commercial |
$118.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$118.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$118.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$66.60
|
| Rate for Payer: Multiplan Commercial |
$137.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$125.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.60
|
| Rate for Payer: United Healthcare Commercial |
$140.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.60
|
| Rate for Payer: United Healthcare VA CCN |
$66.60
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
5101110301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.35 |
| Max. Negotiated Rate |
$139.12 |
| Rate for Payer: Aetna of VT Commercial |
$139.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$132.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$132.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$28.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$76.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$76.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.77
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cigna Commercial |
$23.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.01
|
| Rate for Payer: Multiplan Commercial |
$137.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.35
|
| Rate for Payer: United Healthcare Commercial |
$31.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.35
|
| Rate for Payer: United Healthcare VA CCN |
$20.35
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
9601110301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$129.77 |
| Max. Negotiated Rate |
$278.35 |
| Rate for Payer: Aetna of VT Commercial |
$278.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$262.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$129.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$262.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$176.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$249.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$237.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$131.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$232.94
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cigna Commercial |
$234.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$234.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$234.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$131.85
|
| Rate for Payer: Multiplan Commercial |
$272.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$249.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$131.85
|
| Rate for Payer: United Healthcare Commercial |
$278.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.85
|
| Rate for Payer: United Healthcare VA CCN |
$131.85
|
|
|
TANGNTL BX SKIN SINGLE LES
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
5101110201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$173.90 |
| Rate for Payer: Aetna of VT Commercial |
$173.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$165.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$165.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$149.82
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$39.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$152.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$152.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.31
|
| Rate for Payer: Multiplan Commercial |
$172.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.20
|
| Rate for Payer: United Healthcare Commercial |
$54.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.20
|
| Rate for Payer: United Healthcare VA CCN |
$35.20
|
|
|
TANGNTL BX SKIN SINGLE LES
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
5101110201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$136.92 |
| Max. Negotiated Rate |
$175.75 |
| Rate for Payer: Aetna of VT Commercial |
$175.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$157.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$155.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$148.00
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$148.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.00
|
| Rate for Payer: Multiplan Commercial |
$172.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$157.25
|
| Rate for Payer: United Healthcare Commercial |
$175.75
|
|
|
TANGNTL BX SKIN SINGLE LES
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
9601110201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$168.30 |
| Max. Negotiated Rate |
$361.00 |
| Rate for Payer: Aetna of VT Commercial |
$361.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$340.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$340.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$228.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$307.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$171.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$302.10
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cigna Commercial |
$304.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$304.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$304.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$171.00
|
| Rate for Payer: Multiplan Commercial |
$353.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$323.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$171.00
|
| Rate for Payer: United Healthcare Commercial |
$361.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.00
|
| Rate for Payer: United Healthcare VA CCN |
$171.00
|
|
|
TANGNTL BX SKIN SINGLE LES
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
9601110202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$86.81 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Aetna of VT Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$175.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$86.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$175.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$117.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$158.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.82
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cigna Commercial |
$156.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$156.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$156.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$88.20
|
| Rate for Payer: Multiplan Commercial |
$182.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$166.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$88.20
|
| Rate for Payer: United Healthcare Commercial |
$186.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.20
|
| Rate for Payer: United Healthcare VA CCN |
$88.20
|
|
|
TANGNTL BX SKIN SINGLE LES
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
9601110202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$184.24 |
| Rate for Payer: Aetna of VT Commercial |
$184.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$175.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$175.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$149.82
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cigna Commercial |
$39.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$152.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$152.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.31
|
| Rate for Payer: Multiplan Commercial |
$182.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.20
|
| Rate for Payer: United Healthcare Commercial |
$54.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.20
|
| Rate for Payer: United Healthcare VA CCN |
$35.20
|
|
