|
BIOPSY VAGINAL MUCOSA EXTENSIV
|
Facility
|
OP
|
$5,939.00
|
|
|
Service Code
|
CPT 57105
|
| Hospital Charge Code |
9605710501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,630.38 |
| Max. Negotiated Rate |
$5,642.05 |
| Rate for Payer: Aetna of VT Commercial |
$5,642.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,320.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,630.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,320.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,575.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,048.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,810.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,672.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,721.51
|
| Rate for Payer: Cash Price |
$2,969.50
|
| Rate for Payer: Cigna Commercial |
$4,751.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,751.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,751.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,672.55
|
| Rate for Payer: Multiplan Commercial |
$5,523.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,048.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,672.55
|
| Rate for Payer: United Healthcare Commercial |
$5,642.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,672.55
|
| Rate for Payer: United Healthcare VA CCN |
$2,672.55
|
|
|
BIOPSY VAGINAL MUCOSA EXTENSIV
|
Facility
|
IP
|
$5,543.00
|
|
|
Service Code
|
CPT 57105
|
| Hospital Charge Code |
5105710501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,102.37 |
| Max. Negotiated Rate |
$5,265.85 |
| Rate for Payer: Aetna of VT Commercial |
$5,265.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,102.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,102.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,711.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,656.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,434.40
|
| Rate for Payer: Cash Price |
$2,771.50
|
| Rate for Payer: Cigna Commercial |
$4,434.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,434.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,434.40
|
| Rate for Payer: Multiplan Commercial |
$5,154.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,711.55
|
| Rate for Payer: United Healthcare Commercial |
$5,265.85
|
|
|
BIOPSY VAGINAL MUCOSA EXTENSIV
|
Facility
|
OP
|
$5,543.00
|
|
|
Service Code
|
CPT 57105
|
| Hospital Charge Code |
5105710501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,454.99 |
| Max. Negotiated Rate |
$5,265.85 |
| Rate for Payer: Aetna of VT Commercial |
$5,265.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,965.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,454.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,965.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,336.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,711.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,489.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,494.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,406.69
|
| Rate for Payer: Cash Price |
$2,771.50
|
| Rate for Payer: Cigna Commercial |
$4,434.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,434.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,434.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,494.35
|
| Rate for Payer: Multiplan Commercial |
$5,154.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,711.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,494.35
|
| Rate for Payer: United Healthcare Commercial |
$5,265.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,494.35
|
| Rate for Payer: United Healthcare VA CCN |
$2,494.35
|
|
|
BIOPSY VAGINAL MUCOSA EXTENSIV
|
Professional
|
Both
|
$5,543.00
|
|
|
Service Code
|
CPT 57105
|
| Hospital Charge Code |
5105710501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$138.06 |
| Max. Negotiated Rate |
$5,210.42 |
| Rate for Payer: Aetna of VT Commercial |
$5,210.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,965.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$142.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,965.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$193.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$237.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$237.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$158.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$237.24
|
| Rate for Payer: Cash Price |
$2,771.50
|
| Rate for Payer: Cash Price |
$2,771.50
|
| Rate for Payer: Cigna Commercial |
$245.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$272.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$272.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$166.00
|
| Rate for Payer: Multiplan Commercial |
$5,154.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$196.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$138.06
|
| Rate for Payer: United Healthcare Commercial |
$212.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.06
|
| Rate for Payer: United Healthcare VA CCN |
$138.06
|
|
|
BIOPSY VAGINAL MUCOSA EXTENSIV
|
Professional
|
Both
|
$397.00
|
|
|
Service Code
|
CPT 57105
|
| Hospital Charge Code |
9605710502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$138.06 |
| Max. Negotiated Rate |
$373.18 |
| Rate for Payer: Aetna of VT Commercial |
$373.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$355.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$142.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$355.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$193.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$237.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$237.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$158.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$237.24
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cigna Commercial |
$245.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$272.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$272.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$166.00
|
| Rate for Payer: Multiplan Commercial |
$369.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$196.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$138.06
|
| Rate for Payer: United Healthcare Commercial |
$212.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.06
|
| Rate for Payer: United Healthcare VA CCN |
$138.06
|
|
|
BIOPSY VAGINAL MUCOSA EXTENSIV
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 57105
|
| Hospital Charge Code |
9825710501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$293.82 |
| Max. Negotiated Rate |
$377.15 |
| Rate for Payer: Aetna of VT Commercial |
$377.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$293.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$293.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$337.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$333.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$317.60
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cigna Commercial |
$317.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$317.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$317.60
|
| Rate for Payer: Multiplan Commercial |
$369.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$337.45
|
| Rate for Payer: United Healthcare Commercial |
$377.15
|
|
|
BIOPSY VAGINAL MUCOSA SIMPLE
|
Facility
|
IP
|
$582.00
|
|
|
Service Code
|
CPT 57100
|
| Hospital Charge Code |
5105710001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$430.74 |
| Max. Negotiated Rate |
$552.90 |
| Rate for Payer: Aetna of VT Commercial |
$552.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$430.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$430.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$494.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$488.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$465.60
|
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cigna Commercial |
$465.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$465.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$465.60
|
| Rate for Payer: Multiplan Commercial |
$541.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$494.70
|
| Rate for Payer: United Healthcare Commercial |
$552.90
|
|
|
BIOPSY VAGINAL MUCOSA SIMPLE
|
Professional
|
Both
|
$582.00
|
|
|
Service Code
|
CPT 57100
|
| Hospital Charge Code |
5105710001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$547.08 |
| Rate for Payer: Aetna of VT Commercial |
$547.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$521.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$521.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$155.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.88
|
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cigna Commercial |
$106.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$159.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$159.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$96.77
|
| Rate for Payer: Multiplan Commercial |
$541.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$60.48
|
| Rate for Payer: United Healthcare Commercial |
$93.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.48
|
| Rate for Payer: United Healthcare VA CCN |
$60.48
|
|
|
BIOPSY VAGINAL MUCOSA SIMPLE
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 57100
|
| Hospital Charge Code |
9605710001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$603.18 |
| Max. Negotiated Rate |
$774.25 |
| Rate for Payer: Aetna of VT Commercial |
$774.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$603.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$603.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$692.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$684.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$652.00
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cigna Commercial |
$652.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$652.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$652.00
|
| Rate for Payer: Multiplan Commercial |
$757.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$692.75
|
| Rate for Payer: United Healthcare Commercial |
$774.25
|
|
|
BIOPSY VAGINAL MUCOSA SIMPLE
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 57100
|
| Hospital Charge Code |
9605710001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$360.96 |
| Max. Negotiated Rate |
$774.25 |
| Rate for Payer: Aetna of VT Commercial |
$774.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$730.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$360.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$730.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$490.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$692.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$660.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$366.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$647.92
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cigna Commercial |
$652.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$652.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$652.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$366.75
|
| Rate for Payer: Multiplan Commercial |
$757.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$692.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$366.75
|
| Rate for Payer: United Healthcare Commercial |
$774.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$366.75
|
| Rate for Payer: United Healthcare VA CCN |
$366.75
|
|
|
BIOPSY VAGINAL MUCOSA SIMPLE
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
CPT 57100
|
| Hospital Charge Code |
9605710002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$219.02 |
| Rate for Payer: Aetna of VT Commercial |
$219.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$208.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$208.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$155.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.88
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cigna Commercial |
$106.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$159.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$159.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$96.77
|
| Rate for Payer: Multiplan Commercial |
$216.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$60.48
|
| Rate for Payer: United Healthcare Commercial |
$93.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.48
|
| Rate for Payer: United Healthcare VA CCN |
$60.48
|
|
|
BIOPSY VAGINAL MUCOSA SIMPLE
|
Professional
|
Both
|
$815.00
|
|
|
Service Code
|
CPT 57100
|
| Hospital Charge Code |
9605710001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$766.10 |
| Rate for Payer: Aetna of VT Commercial |
$766.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$730.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$730.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$155.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.88
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cigna Commercial |
$106.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$159.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$159.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$96.77
|
| Rate for Payer: Multiplan Commercial |
$757.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$60.48
|
| Rate for Payer: United Healthcare Commercial |
$93.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.48
|
| Rate for Payer: United Healthcare VA CCN |
$60.48
|
|
|
BIOPSY VAGINAL MUCOSA SIMPLE
|
Facility
|
OP
|
$582.00
|
|
|
Service Code
|
CPT 57100
|
| Hospital Charge Code |
5105710001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$257.77 |
| Max. Negotiated Rate |
$552.90 |
| Rate for Payer: Aetna of VT Commercial |
$552.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$521.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$257.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$521.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$350.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$494.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$471.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$261.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$462.69
|
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cigna Commercial |
$465.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$465.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$465.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$261.90
|
| Rate for Payer: Multiplan Commercial |
$541.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$494.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$261.90
|
| Rate for Payer: United Healthcare Commercial |
$552.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$261.90
|
| Rate for Payer: United Healthcare VA CCN |
$261.90
|
|
|
BIOPSY VAGINAL MUCOSA SIMPLE
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 57100
|
| Hospital Charge Code |
9605710002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$172.44 |
| Max. Negotiated Rate |
$221.35 |
| Rate for Payer: Aetna of VT Commercial |
$221.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$195.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$186.40
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cigna Commercial |
$186.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$186.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$186.40
|
| Rate for Payer: Multiplan Commercial |
$216.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.05
|
| Rate for Payer: United Healthcare Commercial |
$221.35
|
|
|
BIOPSY VAGINAL MUCOSA SIMPLE
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 57100
|
| Hospital Charge Code |
9605710002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$103.20 |
| Max. Negotiated Rate |
$221.35 |
| Rate for Payer: Aetna of VT Commercial |
$221.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$208.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$208.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$140.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$188.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$104.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$185.24
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cigna Commercial |
$186.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$186.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$186.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$104.85
|
| Rate for Payer: Multiplan Commercial |
$216.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$104.85
|
| Rate for Payer: United Healthcare Commercial |
$221.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$104.85
|
| Rate for Payer: United Healthcare VA CCN |
$104.85
|
|
|
BIOVANCE 1 SQUARE CM
|
Facility
|
OP
|
$8,900.00
|
|
|
Service Code
|
HCPCS Q4154
|
| Hospital Charge Code |
2780075651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,941.81 |
| Max. Negotiated Rate |
$8,455.00 |
| Rate for Payer: Aetna of VT Commercial |
$8,455.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7,973.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,941.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7,973.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5,357.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7,565.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7,209.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4,005.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,075.50
|
| Rate for Payer: Cash Price |
$4,450.00
|
| Rate for Payer: Cigna Commercial |
$7,120.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,120.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,120.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$4,005.00
|
| Rate for Payer: Multiplan Commercial |
$8,277.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,565.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4,005.00
|
| Rate for Payer: United Healthcare Commercial |
$8,455.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,005.00
|
| Rate for Payer: United Healthcare VA CCN |
$4,005.00
|
|
|
BIOVANCE 1 SQUARE CM
|
Facility
|
IP
|
$8,900.00
|
|
|
Service Code
|
HCPCS Q4154
|
| Hospital Charge Code |
2780075651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,586.89 |
| Max. Negotiated Rate |
$8,455.00 |
| Rate for Payer: Aetna of VT Commercial |
$8,455.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,586.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,586.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7,565.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7,476.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,120.00
|
| Rate for Payer: Cash Price |
$4,450.00
|
| Rate for Payer: Cigna Commercial |
$7,120.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,120.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,120.00
|
| Rate for Payer: Multiplan Commercial |
$8,277.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,565.00
|
| Rate for Payer: United Healthcare Commercial |
$8,455.00
|
|
|
BLASTOMYCES ANTIBODY
|
Facility
|
IP
|
$80.55
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
3008661201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.62 |
| Max. Negotiated Rate |
$76.52 |
| Rate for Payer: Aetna of VT Commercial |
$76.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$67.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.44
|
| Rate for Payer: Cash Price |
$40.27
|
| Rate for Payer: Cigna Commercial |
$64.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.44
|
| Rate for Payer: Multiplan Commercial |
$74.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.47
|
| Rate for Payer: United Healthcare Commercial |
$76.52
|
|
|
BLASTOMYCES ANTIBODY
|
Professional
|
Both
|
$80.55
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
3008661201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$75.72 |
| Rate for Payer: Aetna of VT Commercial |
$75.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.06
|
| Rate for Payer: Cash Price |
$40.27
|
| Rate for Payer: Cash Price |
$40.27
|
| Rate for Payer: Cigna Commercial |
$15.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.72
|
| Rate for Payer: Multiplan Commercial |
$74.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.90
|
| Rate for Payer: United Healthcare Commercial |
$19.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.90
|
| Rate for Payer: United Healthcare VA CCN |
$12.90
|
|
|
BLASTOMYCES ANTIBODY
|
Facility
|
OP
|
$80.55
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
3008661201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$76.52 |
| Rate for Payer: Aetna of VT Commercial |
$76.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$48.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.04
|
| Rate for Payer: Cash Price |
$40.27
|
| Rate for Payer: Cash Price |
$40.27
|
| Rate for Payer: Cigna Commercial |
$64.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.25
|
| Rate for Payer: Multiplan Commercial |
$74.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.25
|
| Rate for Payer: United Healthcare Commercial |
$76.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.90
|
| Rate for Payer: United Healthcare VA CCN |
$36.25
|
|
|
BL DRAW < 3 YRS FEM/JUGULAR
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
9823640001
|
|
Hospital Revenue Code
|
982
|
| 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
|
|
|
BL DRAW < 3 YRS FEM/JUGULAR
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
9823640001
|
|
Hospital Revenue Code
|
982
|
| 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
|
|
|
BL DRAW < 3 YRS FEM/JUGULAR
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
9813640001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$17.29 |
| Max. Negotiated Rate |
$73.32 |
| Rate for Payer: Aetna of VT Commercial |
$73.32
|
| 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 |
$17.81
|
| 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 |
$24.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$60.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$60.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$60.94
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$31.83
|
| 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 |
$25.96
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$17.29
|
| Rate for Payer: United Healthcare Commercial |
$26.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.29
|
| Rate for Payer: United Healthcare VA CCN |
$17.29
|
|
|
BL DRAW < 3 YRS FEM/JUGULAR
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
9823640001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$17.29 |
| Max. Negotiated Rate |
$73.32 |
| Rate for Payer: Aetna of VT Commercial |
$73.32
|
| 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 |
$17.81
|
| 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 |
$24.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$60.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$60.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$60.94
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$31.83
|
| 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 |
$25.96
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$17.29
|
| Rate for Payer: United Healthcare Commercial |
$26.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.29
|
| Rate for Payer: United Healthcare VA CCN |
$17.29
|
|
|
BL DRAW < 3 YRS FEM/JUGULAR
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
9813640001
|
|
Hospital Revenue Code
|
982
|
| 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
|
|
