|
BIOPSY NAIL UNIT
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
CPT 11755
|
| Hospital Charge Code |
9601175501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$56.88 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna of VT Commercial |
$338.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$322.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$322.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$179.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$179.03
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$104.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$187.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$187.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$115.66
|
| Rate for Payer: Multiplan Commercial |
$334.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.88
|
| Rate for Payer: United Healthcare Commercial |
$87.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.88
|
| Rate for Payer: United Healthcare VA CCN |
$56.88
|
|
|
BIOPSY NAIL UNIT
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 11755
|
| Hospital Charge Code |
5101175501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.73 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$57.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$57.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.40
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
|
|
BIOPSY NAIL UNIT
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT 11755
|
| Hospital Charge Code |
9601175502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$209.45 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Aetna of VT Commercial |
$268.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$209.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$209.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$240.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$237.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$226.40
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cigna Commercial |
$226.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$226.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$226.40
|
| Rate for Payer: Multiplan Commercial |
$263.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.55
|
| Rate for Payer: United Healthcare Commercial |
$268.85
|
|
|
BIOPSY NAIL UNIT
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
CPT 11755
|
| Hospital Charge Code |
9601175501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$159.44 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna of VT Commercial |
$342.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$322.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$159.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$322.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$216.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$291.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$162.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$286.20
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$288.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$288.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$288.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$334.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$162.00
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.00
|
| Rate for Payer: United Healthcare VA CCN |
$162.00
|
|
|
BIOPSY NAIL UNIT
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 11755
|
| Hospital Charge Code |
5101175501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.55 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.01
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.10
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare VA CCN |
$35.10
|
|
|
BIOPSY NAIL UNIT
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
CPT 11755
|
| Hospital Charge Code |
9601175502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$125.34 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Aetna of VT Commercial |
$268.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$253.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$125.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$253.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$170.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$240.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$229.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$127.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$224.99
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cigna Commercial |
$226.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$226.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$226.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$127.35
|
| Rate for Payer: Multiplan Commercial |
$263.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$127.35
|
| Rate for Payer: United Healthcare Commercial |
$268.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.35
|
| Rate for Payer: United Healthcare VA CCN |
$127.35
|
|
|
BIOPSY NAIL UNIT
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
CPT 11755
|
| Hospital Charge Code |
9601175502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$56.88 |
| Max. Negotiated Rate |
$266.02 |
| Rate for Payer: Aetna of VT Commercial |
$266.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$253.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$253.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$179.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$179.03
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cigna Commercial |
$104.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$187.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$187.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$115.66
|
| Rate for Payer: Multiplan Commercial |
$263.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.88
|
| Rate for Payer: United Healthcare Commercial |
$87.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.88
|
| Rate for Payer: United Healthcare VA CCN |
$56.88
|
|
|
BIOPSY OF CERVIX
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
5105750001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.98 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Aetna of VT Commercial |
$216.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$204.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$100.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$204.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$137.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$193.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$184.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$102.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$181.26
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cigna Commercial |
$182.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$182.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$182.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$102.60
|
| Rate for Payer: Multiplan Commercial |
$212.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$193.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$102.60
|
| Rate for Payer: United Healthcare Commercial |
$216.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.60
|
| Rate for Payer: United Healthcare VA CCN |
$102.60
|
|
|
BIOPSY OF CERVIX
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
9605750001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$401.87 |
| Max. Negotiated Rate |
$515.85 |
| Rate for Payer: Aetna of VT Commercial |
$515.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$401.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$401.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$461.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$456.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$434.40
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$434.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$434.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$434.40
|
| Rate for Payer: Multiplan Commercial |
$504.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$461.55
|
| Rate for Payer: United Healthcare Commercial |
$515.85
|
|
|
BIOPSY OF CERVIX
|
Professional
|
Both
|
$543.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
9605750001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$70.11 |
| Max. Negotiated Rate |
$510.42 |
| Rate for Payer: Aetna of VT Commercial |
$510.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$486.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$486.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$98.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$235.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$235.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$235.08
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$123.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$232.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$232.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.39
|
| Rate for Payer: Multiplan Commercial |
$504.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.11
|
| Rate for Payer: United Healthcare Commercial |
$107.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.11
|
| Rate for Payer: United Healthcare VA CCN |
$70.11
|
|
|
BIOPSY OF CERVIX
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
9605750001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$240.49 |
| Max. Negotiated Rate |
$515.85 |
| Rate for Payer: Aetna of VT Commercial |
$515.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$486.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$240.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$486.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$326.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$461.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$439.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$244.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$431.69
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$434.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$434.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$434.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$244.35
|
| Rate for Payer: Multiplan Commercial |
$504.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$461.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$244.35
|
| Rate for Payer: United Healthcare Commercial |
$515.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.35
|
| Rate for Payer: United Healthcare VA CCN |
$244.35
|
|
|
BIOPSY OF CERVIX
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
5105750001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.11 |
| Max. Negotiated Rate |
$235.08 |
| Rate for Payer: Aetna of VT Commercial |
$214.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$204.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$204.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$98.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$235.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$235.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$235.08
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cigna Commercial |
$123.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$232.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$232.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.39
|
| Rate for Payer: Multiplan Commercial |
$212.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.11
|
| Rate for Payer: United Healthcare Commercial |
$107.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.11
|
| Rate for Payer: United Healthcare VA CCN |
$70.11
|
|
|
BIOPSY OF CERVIX
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
5105750001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$168.74 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Aetna of VT Commercial |
$216.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$168.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$168.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$193.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$191.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$182.40
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cigna Commercial |
$182.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$182.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$182.40
|
| Rate for Payer: Multiplan Commercial |
$212.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$193.80
|
| Rate for Payer: United Healthcare Commercial |
$216.60
|
|
|
BIOPSY OF CERVIX
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
9605750002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$70.11 |
| Max. Negotiated Rate |
$297.04 |
| Rate for Payer: Aetna of VT Commercial |
$297.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$283.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$283.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$98.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$235.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$235.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$235.08
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cigna Commercial |
$123.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$232.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$232.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.39
|
| Rate for Payer: Multiplan Commercial |
$293.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.11
|
| Rate for Payer: United Healthcare Commercial |
$107.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.11
|
| Rate for Payer: United Healthcare VA CCN |
$70.11
|
|
|
BIOPSY OF CERVIX
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
9605750002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$139.96 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Aetna of VT Commercial |
$300.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$283.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$139.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$283.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$190.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$268.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$255.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$251.22
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cigna Commercial |
$252.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$252.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$252.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.20
|
| Rate for Payer: Multiplan Commercial |
$293.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$268.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$142.20
|
| Rate for Payer: United Healthcare Commercial |
$300.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.20
|
| Rate for Payer: United Healthcare VA CCN |
$142.20
|
|
|
BIOPSY OF CERVIX
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
9605750002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$233.87 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Aetna of VT Commercial |
$300.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$233.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$233.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$268.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$265.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$252.80
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cigna Commercial |
$252.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$252.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$252.80
|
| Rate for Payer: Multiplan Commercial |
$293.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$268.60
|
| Rate for Payer: United Healthcare Commercial |
$300.20
|
|
|
BIOPSY OF CERVIX W/SCOPE
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT 57455
|
| Hospital Charge Code |
9605745501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$270.61 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna of VT Commercial |
$580.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$270.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$367.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$519.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$494.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$274.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$485.75
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$274.95
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$519.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$274.95
|
| Rate for Payer: United Healthcare Commercial |
$580.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$274.95
|
| Rate for Payer: United Healthcare VA CCN |
$274.95
|
|
|
BIOPSY OF CERVIX W/SCOPE
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT 57455
|
| Hospital Charge Code |
9605745501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$452.20 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna of VT Commercial |
$580.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$519.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$513.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$488.80
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.80
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$519.35
|
| Rate for Payer: United Healthcare Commercial |
$580.45
|
|
|
BIOPSY OF CERVIX W/SCOPE
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 57455
|
| Hospital Charge Code |
5105745501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$182.06 |
| Max. Negotiated Rate |
$233.70 |
| Rate for Payer: Aetna of VT Commercial |
$233.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$182.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$182.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$206.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.80
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$196.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.80
|
| Rate for Payer: Multiplan Commercial |
$228.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.10
|
| Rate for Payer: United Healthcare Commercial |
$233.70
|
|
|
BIOPSY OF CERVIX W/SCOPE
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
CPT 57455
|
| Hospital Charge Code |
5105745501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.26 |
| Max. Negotiated Rate |
$255.06 |
| Rate for Payer: Aetna of VT Commercial |
$231.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$220.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$220.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$140.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$255.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$255.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$115.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$255.06
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$176.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$249.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$249.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$151.33
|
| Rate for Payer: Multiplan Commercial |
$228.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.26
|
| Rate for Payer: United Healthcare Commercial |
$154.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.26
|
| Rate for Payer: United Healthcare VA CCN |
$100.26
|
|
|
BIOPSY OF CERVIX W/SCOPE
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
CPT 57455
|
| Hospital Charge Code |
9605745502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$162.10 |
| Max. Negotiated Rate |
$347.70 |
| Rate for Payer: Aetna of VT Commercial |
$347.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$327.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$162.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$327.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$220.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$311.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$296.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$164.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$290.97
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$292.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$292.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$292.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$164.70
|
| Rate for Payer: Multiplan Commercial |
$340.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$311.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$164.70
|
| Rate for Payer: United Healthcare Commercial |
$347.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$164.70
|
| Rate for Payer: United Healthcare VA CCN |
$164.70
|
|
|
BIOPSY OF CERVIX W/SCOPE
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
CPT 57455
|
| Hospital Charge Code |
9605745502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$270.88 |
| Max. Negotiated Rate |
$347.70 |
| Rate for Payer: Aetna of VT Commercial |
$347.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$270.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$270.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$311.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$307.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$292.80
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$292.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$292.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$292.80
|
| Rate for Payer: Multiplan Commercial |
$340.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$311.10
|
| Rate for Payer: United Healthcare Commercial |
$347.70
|
|
|
BIOPSY OF CERVIX W/SCOPE
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 57455
|
| Hospital Charge Code |
5105745501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.95 |
| Max. Negotiated Rate |
$233.70 |
| Rate for Payer: Aetna of VT Commercial |
$233.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$220.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$108.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$220.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$148.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$199.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$110.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$195.57
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$196.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$110.70
|
| Rate for Payer: Multiplan Commercial |
$228.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$110.70
|
| Rate for Payer: United Healthcare Commercial |
$233.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.70
|
| Rate for Payer: United Healthcare VA CCN |
$110.70
|
|
|
BIOPSY OF CERVIX W/SCOPE
|
Professional
|
Both
|
$366.00
|
|
|
Service Code
|
CPT 57455
|
| Hospital Charge Code |
9605745502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$100.26 |
| Max. Negotiated Rate |
$344.04 |
| Rate for Payer: Aetna of VT Commercial |
$344.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$327.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$327.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$140.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$255.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$255.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$115.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$255.06
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$176.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$249.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$249.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$151.33
|
| Rate for Payer: Multiplan Commercial |
$340.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.26
|
| Rate for Payer: United Healthcare Commercial |
$154.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.26
|
| Rate for Payer: United Healthcare VA CCN |
$100.26
|
|
|
BIOPSY OF CERVIX W/SCOPE
|
Professional
|
Both
|
$611.00
|
|
|
Service Code
|
CPT 57455
|
| Hospital Charge Code |
9605745501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$100.26 |
| Max. Negotiated Rate |
$574.34 |
| Rate for Payer: Aetna of VT Commercial |
$574.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$140.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$255.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$255.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$115.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$255.06
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$176.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$249.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$249.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$151.33
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.26
|
| Rate for Payer: United Healthcare Commercial |
$154.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.26
|
| Rate for Payer: United Healthcare VA CCN |
$100.26
|
|
