|
TLH UTERUS OVER 250 G
|
Facility
|
IP
|
$2,949.00
|
|
|
Service Code
|
CPT 58572
|
| Hospital Charge Code |
9825857201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,182.55 |
| Max. Negotiated Rate |
$2,801.55 |
| Rate for Payer: Aetna of VT Commercial |
$2,801.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,182.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,182.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,506.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,477.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,359.20
|
| Rate for Payer: Cash Price |
$1,474.50
|
| Rate for Payer: Cigna Commercial |
$2,359.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,359.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,359.20
|
| Rate for Payer: Multiplan Commercial |
$2,742.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,506.65
|
| Rate for Payer: United Healthcare Commercial |
$2,801.55
|
|
|
TLH UTERUS OVER 250 G
|
Professional
|
Both
|
$2,949.00
|
|
|
Service Code
|
CPT 58572
|
| Hospital Charge Code |
9825857201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$965.98 |
| Max. Negotiated Rate |
$2,772.06 |
| Rate for Payer: Aetna of VT Commercial |
$2,772.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,642.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$994.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,642.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,352.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,397.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,397.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,110.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,397.25
|
| Rate for Payer: Cash Price |
$1,474.50
|
| Rate for Payer: Cash Price |
$1,474.50
|
| Rate for Payer: Cigna Commercial |
$1,658.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,613.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,613.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$965.98
|
| Rate for Payer: Multiplan Commercial |
$2,742.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,371.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$965.98
|
| Rate for Payer: United Healthcare Commercial |
$1,485.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$965.98
|
| Rate for Payer: United Healthcare VA CCN |
$965.98
|
|
|
TLH UTERUS OVER 250 G
|
Facility
|
OP
|
$2,949.00
|
|
|
Service Code
|
CPT 58572
|
| Hospital Charge Code |
9825857201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,306.11 |
| Max. Negotiated Rate |
$2,801.55 |
| Rate for Payer: Aetna of VT Commercial |
$2,801.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,642.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,306.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,642.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,775.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,506.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,388.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,327.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,344.45
|
| Rate for Payer: Cash Price |
$1,474.50
|
| Rate for Payer: Cigna Commercial |
$2,359.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,359.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,359.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,327.05
|
| Rate for Payer: Multiplan Commercial |
$2,742.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,506.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,327.05
|
| Rate for Payer: United Healthcare Commercial |
$2,801.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,327.05
|
| Rate for Payer: United Healthcare VA CCN |
$1,327.05
|
|
|
TLH W/T/O 250 G OR LESS
|
Facility
|
OP
|
$2,743.00
|
|
|
Service Code
|
CPT 58571
|
| Hospital Charge Code |
9825857101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,214.87 |
| Max. Negotiated Rate |
$2,605.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,605.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,457.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,214.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,457.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,651.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,331.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,221.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,234.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,180.68
|
| Rate for Payer: Cash Price |
$1,371.50
|
| Rate for Payer: Cigna Commercial |
$2,194.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,194.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,194.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,234.35
|
| Rate for Payer: Multiplan Commercial |
$2,550.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,331.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,234.35
|
| Rate for Payer: United Healthcare Commercial |
$2,605.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,234.35
|
| Rate for Payer: United Healthcare VA CCN |
$1,234.35
|
|
|
TLH W/T/O 250 G OR LESS
|
Professional
|
Both
|
$2,743.00
|
|
|
Service Code
|
CPT 58571
|
| Hospital Charge Code |
9825857101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$844.59 |
| Max. Negotiated Rate |
$2,578.42 |
| Rate for Payer: Aetna of VT Commercial |
$2,578.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,457.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$869.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,457.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,182.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,231.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,231.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$971.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,231.25
|
| Rate for Payer: Cash Price |
$1,371.50
|
| Rate for Payer: Cash Price |
$1,371.50
|
| Rate for Payer: Cigna Commercial |
$1,492.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,408.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,408.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$844.59
|
| Rate for Payer: Multiplan Commercial |
$2,550.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,199.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$844.59
|
| Rate for Payer: United Healthcare Commercial |
$1,299.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$844.59
|
| Rate for Payer: United Healthcare VA CCN |
$844.59
|
|
|
TLH W/T/O 250 G OR LESS
|
Facility
|
IP
|
$2,743.00
|
|
|
Service Code
|
CPT 58571
|
| Hospital Charge Code |
9825857101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,030.09 |
| Max. Negotiated Rate |
$2,605.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,605.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,030.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,030.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,331.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,304.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,194.40
|
| Rate for Payer: Cash Price |
$1,371.50
|
| Rate for Payer: Cigna Commercial |
$2,194.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,194.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,194.40
|
| Rate for Payer: Multiplan Commercial |
$2,550.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,331.55
|
| Rate for Payer: United Healthcare Commercial |
$2,605.85
|
|
|
TLH W/T/O UTERUS OVER 250 G
|
Professional
|
Both
|
$3,344.00
|
|
|
Service Code
|
CPT 58573
|
| Hospital Charge Code |
9825857301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,129.40 |
| Max. Negotiated Rate |
$3,143.36 |
| Rate for Payer: Aetna of VT Commercial |
$3,143.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,995.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,163.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,995.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,581.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,610.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,610.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,298.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,610.03
|
| Rate for Payer: Cash Price |
$1,672.00
|
| Rate for Payer: Cash Price |
$1,672.00
|
| Rate for Payer: Cigna Commercial |
$1,994.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,886.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,886.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,129.40
|
| Rate for Payer: Multiplan Commercial |
$3,109.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,603.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,129.40
|
| Rate for Payer: United Healthcare Commercial |
$1,737.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,129.40
|
| Rate for Payer: United Healthcare VA CCN |
$1,129.40
|
|
|
TLH W/T/O UTERUS OVER 250 G
|
Facility
|
IP
|
$3,344.00
|
|
|
Service Code
|
CPT 58573
|
| Hospital Charge Code |
9825857301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,474.89 |
| Max. Negotiated Rate |
$3,176.80 |
| Rate for Payer: Aetna of VT Commercial |
$3,176.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,474.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,474.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,842.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,808.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,675.20
|
| Rate for Payer: Cash Price |
$1,672.00
|
| Rate for Payer: Cigna Commercial |
$2,675.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,675.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,675.20
|
| Rate for Payer: Multiplan Commercial |
$3,109.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,842.40
|
| Rate for Payer: United Healthcare Commercial |
$3,176.80
|
|
|
TLH W/T/O UTERUS OVER 250 G
|
Facility
|
OP
|
$3,344.00
|
|
|
Service Code
|
CPT 58573
|
| Hospital Charge Code |
9825857301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,481.06 |
| Max. Negotiated Rate |
$3,176.80 |
| Rate for Payer: Aetna of VT Commercial |
$3,176.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,995.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,481.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,995.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,013.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,842.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,708.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,504.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,658.48
|
| Rate for Payer: Cash Price |
$1,672.00
|
| Rate for Payer: Cigna Commercial |
$2,675.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,675.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,675.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,504.80
|
| Rate for Payer: Multiplan Commercial |
$3,109.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,842.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,504.80
|
| Rate for Payer: United Healthcare Commercial |
$3,176.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,504.80
|
| Rate for Payer: United Healthcare VA CCN |
$1,504.80
|
|
|
TOBACCO CESSATION INTENS >10M
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
9609940701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$35.87 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Aetna of VT Commercial |
$76.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$48.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.39
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$64.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.45
|
| Rate for Payer: Multiplan Commercial |
$75.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.45
|
| Rate for Payer: United Healthcare Commercial |
$76.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.45
|
| Rate for Payer: United Healthcare VA CCN |
$36.45
|
|
|
TOBACCO CESSATION INTENS >10M
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
9609940702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.93 |
| Max. Negotiated Rate |
$55.10 |
| Rate for Payer: Aetna of VT Commercial |
$55.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$49.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$48.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$46.40
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$46.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$46.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$46.40
|
| Rate for Payer: Multiplan Commercial |
$53.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.30
|
| Rate for Payer: United Healthcare Commercial |
$55.10
|
|
|
TOBACCO CESSATION INTENS >10M
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
9609940701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$76.14 |
| Rate for Payer: Aetna of VT Commercial |
$76.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$40.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$40.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$40.01
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$25.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$25.83
|
| Rate for Payer: Multiplan Commercial |
$75.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.27
|
| Rate for Payer: United Healthcare Commercial |
$35.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.27
|
| Rate for Payer: United Healthcare VA CCN |
$23.27
|
|
|
TOBACCO CESSATION INTENS >10M
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
9609940702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$54.52 |
| Rate for Payer: Aetna of VT Commercial |
$54.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$40.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$40.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$40.01
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$25.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$25.83
|
| Rate for Payer: Multiplan Commercial |
$53.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.27
|
| Rate for Payer: United Healthcare Commercial |
$35.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.27
|
| Rate for Payer: United Healthcare VA CCN |
$23.27
|
|
|
TOBACCO CESSATION INTENS >10M
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
5109940701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.61 |
| Max. Negotiated Rate |
$42.17 |
| Rate for Payer: Aetna of VT Commercial |
$21.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$20.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$20.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$40.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$40.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$40.01
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$25.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$25.83
|
| Rate for Payer: Multiplan Commercial |
$21.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.27
|
| Rate for Payer: United Healthcare Commercial |
$35.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.27
|
| Rate for Payer: United Healthcare VA CCN |
$23.27
|
|
|
TOBACCO CESSATION INTENS >10M
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
5109940701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$21.85 |
| Rate for Payer: Aetna of VT Commercial |
$21.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$20.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$20.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$13.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$19.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$18.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$10.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$18.29
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.35
|
| Rate for Payer: Multiplan Commercial |
$21.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.35
|
| Rate for Payer: United Healthcare Commercial |
$21.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.35
|
| Rate for Payer: United Healthcare VA CCN |
$10.35
|
|
|
TOBACCO CESSATION INTENS >10M
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
9609940702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$25.69 |
| Max. Negotiated Rate |
$55.10 |
| Rate for Payer: Aetna of VT Commercial |
$55.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$25.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$34.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$49.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$46.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$46.11
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$46.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$46.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$46.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.10
|
| Rate for Payer: Multiplan Commercial |
$53.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.10
|
| Rate for Payer: United Healthcare Commercial |
$55.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.10
|
| Rate for Payer: United Healthcare VA CCN |
$26.10
|
|
|
TOBACCO CESSATION INTENS >10M
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
5109940701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.02 |
| Max. Negotiated Rate |
$21.85 |
| Rate for Payer: Aetna of VT Commercial |
$21.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$19.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$18.40
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$21.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.55
|
| Rate for Payer: United Healthcare Commercial |
$21.85
|
|
|
TOBACCO CESSATION INTENS >10M
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
9609940701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$59.95 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Aetna of VT Commercial |
$76.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.80
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$64.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$75.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.85
|
| Rate for Payer: United Healthcare Commercial |
$76.95
|
|
|
TOBRAMYCIN SULFATE INJECTION
|
Facility
|
IP
|
$295.20
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
636J326001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$218.48 |
| Max. Negotiated Rate |
$280.44 |
| Rate for Payer: Aetna of VT Commercial |
$280.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$218.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$218.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$250.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$247.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$236.16
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cigna Commercial |
$236.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.16
|
| Rate for Payer: Multiplan Commercial |
$274.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.92
|
| Rate for Payer: United Healthcare Commercial |
$280.44
|
|
|
TOBRAMYCIN SULFATE INJECTION
|
Professional
|
Both
|
$295.20
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
636J326001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$277.49 |
| Rate for Payer: Aetna of VT Commercial |
$277.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.73
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$274.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.37
|
| Rate for Payer: United Healthcare Commercial |
$3.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.37
|
| Rate for Payer: United Healthcare VA CCN |
$2.37
|
|
|
TOBRAMYCIN SULFATE INJECTION
|
Facility
|
OP
|
$295.20
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
636J326001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$280.44 |
| Rate for Payer: Aetna of VT Commercial |
$280.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$130.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$177.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$250.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$239.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$132.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$234.68
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cigna Commercial |
$236.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$132.84
|
| Rate for Payer: Multiplan Commercial |
$274.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$132.84
|
| Rate for Payer: United Healthcare Commercial |
$280.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.84
|
| Rate for Payer: United Healthcare VA CCN |
$132.84
|
|
|
TOTAL HIP ARTHROPLASTY
|
Professional
|
Both
|
$3,409.00
|
|
|
Service Code
|
CPT 27130
|
| Hospital Charge Code |
9822713001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,193.57 |
| Max. Negotiated Rate |
$3,204.46 |
| Rate for Payer: Aetna of VT Commercial |
$3,204.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,054.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,229.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,054.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,671.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,924.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,924.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,372.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,924.58
|
| Rate for Payer: Cash Price |
$1,704.50
|
| Rate for Payer: Cash Price |
$1,704.50
|
| Rate for Payer: Cigna Commercial |
$2,261.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,002.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,002.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,193.57
|
| Rate for Payer: Multiplan Commercial |
$3,170.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,694.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,193.57
|
| Rate for Payer: United Healthcare Commercial |
$1,836.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,193.57
|
| Rate for Payer: United Healthcare VA CCN |
$1,193.57
|
|
|
TOTAL HIP ARTHROPLASTY
|
Facility
|
OP
|
$3,409.00
|
|
|
Service Code
|
CPT 27130
|
| Hospital Charge Code |
9822713001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,509.85 |
| Max. Negotiated Rate |
$3,238.55 |
| Rate for Payer: Aetna of VT Commercial |
$3,238.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,054.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,509.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,054.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,052.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,897.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,761.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,534.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,710.16
|
| Rate for Payer: Cash Price |
$1,704.50
|
| Rate for Payer: Cigna Commercial |
$2,727.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,727.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,727.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,534.05
|
| Rate for Payer: Multiplan Commercial |
$3,170.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,897.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,534.05
|
| Rate for Payer: United Healthcare Commercial |
$3,238.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,534.05
|
| Rate for Payer: United Healthcare VA CCN |
$1,534.05
|
|
|
TOTAL HIP ARTHROPLASTY
|
Professional
|
Both
|
$6,723.00
|
|
|
Service Code
|
CPT 27132
|
| Hospital Charge Code |
9822713201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,548.98 |
| Max. Negotiated Rate |
$6,319.62 |
| Rate for Payer: Aetna of VT Commercial |
$6,319.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,023.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,595.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,023.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,168.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,758.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,758.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,781.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,758.04
|
| Rate for Payer: Cash Price |
$3,361.50
|
| Rate for Payer: Cash Price |
$3,361.50
|
| Rate for Payer: Cigna Commercial |
$2,935.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,599.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,599.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,548.98
|
| Rate for Payer: Multiplan Commercial |
$6,252.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,199.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,548.98
|
| Rate for Payer: United Healthcare Commercial |
$2,382.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,548.98
|
| Rate for Payer: United Healthcare VA CCN |
$1,548.98
|
|
|
TOTAL HIP ARTHROPLASTY
|
Facility
|
IP
|
$3,409.00
|
|
|
Service Code
|
CPT 27130
|
| Hospital Charge Code |
9822713001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,523.00 |
| Max. Negotiated Rate |
$3,238.55 |
| Rate for Payer: Aetna of VT Commercial |
$3,238.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,523.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,523.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,897.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,863.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,727.20
|
| Rate for Payer: Cash Price |
$1,704.50
|
| Rate for Payer: Cigna Commercial |
$2,727.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,727.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,727.20
|
| Rate for Payer: Multiplan Commercial |
$3,170.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,897.65
|
| Rate for Payer: United Healthcare Commercial |
$3,238.55
|
|
