|
US URINE CAPACITY MEASURE
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
9605179801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$61.56 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Aetna of VT Commercial |
$132.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$61.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$83.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$112.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.50
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$111.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$111.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$111.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$62.55
|
| Rate for Payer: Multiplan Commercial |
$129.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$62.55
|
| Rate for Payer: United Healthcare Commercial |
$132.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.55
|
| Rate for Payer: United Healthcare VA CCN |
$62.55
|
|
|
US URINE CAPACITY MEASURE
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
9815179801
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$65.80 |
| Rate for Payer: Aetna of VT Commercial |
$65.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.27
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$18.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.93
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.93
|
| Rate for Payer: United Healthcare Commercial |
$16.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.93
|
| Rate for Payer: United Healthcare VA CCN |
$10.93
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
9815179801
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of VT Commercial |
$66.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$56.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.65
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.50
|
| Rate for Payer: United Healthcare Commercial |
$66.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.50
|
| Rate for Payer: United Healthcare VA CCN |
$31.50
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
9605179802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of VT Commercial |
$66.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$56.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.65
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.50
|
| Rate for Payer: United Healthcare Commercial |
$66.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.50
|
| Rate for Payer: United Healthcare VA CCN |
$31.50
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
9605179802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$51.81 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of VT Commercial |
$66.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.50
|
| Rate for Payer: United Healthcare Commercial |
$66.50
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
OP
|
$69.28
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
4505179801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$30.68 |
| Max. Negotiated Rate |
$65.82 |
| Rate for Payer: Aetna of VT Commercial |
$65.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$30.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$41.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$58.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.08
|
| Rate for Payer: Cash Price |
$34.64
|
| Rate for Payer: Cigna Commercial |
$55.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$55.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$55.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.18
|
| Rate for Payer: Multiplan Commercial |
$64.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$58.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.18
|
| Rate for Payer: United Healthcare Commercial |
$65.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.18
|
| Rate for Payer: United Healthcare VA CCN |
$31.18
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
9825179801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$51.81 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of VT Commercial |
$66.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.50
|
| Rate for Payer: United Healthcare Commercial |
$66.50
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
5105179801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of VT Commercial |
$66.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$56.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.65
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.50
|
| Rate for Payer: United Healthcare Commercial |
$66.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.50
|
| Rate for Payer: United Healthcare VA CCN |
$31.50
|
|
|
US URINE CAPACITY MEASURE
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
9825179801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$65.80 |
| Rate for Payer: Aetna of VT Commercial |
$65.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.27
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$18.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.93
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.93
|
| Rate for Payer: United Healthcare Commercial |
$16.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.93
|
| Rate for Payer: United Healthcare VA CCN |
$10.93
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
9815179801
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$51.81 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of VT Commercial |
$66.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.50
|
| Rate for Payer: United Healthcare Commercial |
$66.50
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
5105179801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.81 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of VT Commercial |
$66.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.50
|
| Rate for Payer: United Healthcare Commercial |
$66.50
|
|
|
US URINE CAPACITY MEASURE
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
5105179801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$65.80 |
| Rate for Payer: Aetna of VT Commercial |
$65.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.27
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$18.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.93
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.93
|
| Rate for Payer: United Healthcare Commercial |
$16.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.93
|
| Rate for Payer: United Healthcare VA CCN |
$10.93
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
9815179802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$51.81 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of VT Commercial |
$66.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.50
|
| Rate for Payer: United Healthcare Commercial |
$66.50
|
|
|
VAG HYST COMPLEX
|
Facility
|
IP
|
$2,954.00
|
|
|
Service Code
|
CPT 58290
|
| Hospital Charge Code |
9825829001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,186.26 |
| Max. Negotiated Rate |
$2,806.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,806.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,186.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,186.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,510.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,481.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,363.20
|
| Rate for Payer: Cash Price |
$1,477.00
|
| Rate for Payer: Cigna Commercial |
$2,363.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,363.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,363.20
|
| Rate for Payer: Multiplan Commercial |
$2,747.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,510.90
|
| Rate for Payer: United Healthcare Commercial |
$2,806.30
|
|
|
VAG HYST COMPLEX
|
Professional
|
Both
|
$2,954.00
|
|
|
Service Code
|
CPT 58290
|
| Hospital Charge Code |
9825829001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,062.91 |
| Max. Negotiated Rate |
$2,776.76 |
| Rate for Payer: Aetna of VT Commercial |
$2,776.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,646.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,094.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,646.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,488.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,945.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,945.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,222.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,945.98
|
| Rate for Payer: Cash Price |
$1,477.00
|
| Rate for Payer: Cash Price |
$1,477.00
|
| Rate for Payer: Cigna Commercial |
$1,878.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,778.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,778.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,062.91
|
| Rate for Payer: Multiplan Commercial |
$2,747.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,509.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,062.91
|
| Rate for Payer: United Healthcare Commercial |
$1,635.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,062.91
|
| Rate for Payer: United Healthcare VA CCN |
$1,062.91
|
|
|
VAG HYST COMPLEX
|
Facility
|
OP
|
$2,954.00
|
|
|
Service Code
|
CPT 58290
|
| Hospital Charge Code |
9825829001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,308.33 |
| Max. Negotiated Rate |
$2,806.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,806.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,646.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,308.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,646.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,778.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,510.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,392.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,329.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,348.43
|
| Rate for Payer: Cash Price |
$1,477.00
|
| Rate for Payer: Cigna Commercial |
$2,363.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,363.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,363.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,329.30
|
| Rate for Payer: Multiplan Commercial |
$2,747.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,510.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,329.30
|
| Rate for Payer: United Healthcare Commercial |
$2,806.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,329.30
|
| Rate for Payer: United Healthcare VA CCN |
$1,329.30
|
|
|
VAG HYST INCL T/O COMPLEX
|
Facility
|
IP
|
$3,415.00
|
|
|
Service Code
|
CPT 58291
|
| Hospital Charge Code |
9825829101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,527.44 |
| Max. Negotiated Rate |
$3,244.25 |
| Rate for Payer: Aetna of VT Commercial |
$3,244.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,527.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,527.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,902.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,868.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,732.00
|
| Rate for Payer: Cash Price |
$1,707.50
|
| Rate for Payer: Cigna Commercial |
$2,732.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,732.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,732.00
|
| Rate for Payer: Multiplan Commercial |
$3,175.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,902.75
|
| Rate for Payer: United Healthcare Commercial |
$3,244.25
|
|
|
VAG HYST INCL T/O COMPLEX
|
Facility
|
OP
|
$3,415.00
|
|
|
Service Code
|
CPT 58291
|
| Hospital Charge Code |
9825829101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,512.50 |
| Max. Negotiated Rate |
$3,244.25 |
| Rate for Payer: Aetna of VT Commercial |
$3,244.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,059.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,512.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,059.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,055.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,902.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,766.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,536.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,714.93
|
| Rate for Payer: Cash Price |
$1,707.50
|
| Rate for Payer: Cigna Commercial |
$2,732.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,732.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,732.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,536.75
|
| Rate for Payer: Multiplan Commercial |
$3,175.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,902.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,536.75
|
| Rate for Payer: United Healthcare Commercial |
$3,244.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,536.75
|
| Rate for Payer: United Healthcare VA CCN |
$1,536.75
|
|
|
VAG HYST INCL T/O COMPLEX
|
Professional
|
Both
|
$3,415.00
|
|
|
Service Code
|
CPT 58291
|
| Hospital Charge Code |
9825829101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,147.66 |
| Max. Negotiated Rate |
$3,210.10 |
| Rate for Payer: Aetna of VT Commercial |
$3,210.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,059.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,182.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,059.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,606.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,121.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,121.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,319.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,121.86
|
| Rate for Payer: Cash Price |
$1,707.50
|
| Rate for Payer: Cash Price |
$1,707.50
|
| Rate for Payer: Cigna Commercial |
$2,028.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,920.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,920.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,147.66
|
| Rate for Payer: Multiplan Commercial |
$3,175.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,629.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,147.66
|
| Rate for Payer: United Healthcare Commercial |
$1,765.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,147.66
|
| Rate for Payer: United Healthcare VA CCN |
$1,147.66
|
|
|
VAG HYST INCLUDING T/O
|
Facility
|
OP
|
$2,394.00
|
|
|
Service Code
|
CPT 58262
|
| Hospital Charge Code |
9825826201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,060.30 |
| Max. Negotiated Rate |
$2,274.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,274.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,144.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,060.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,144.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,441.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,034.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,939.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,077.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,903.23
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cigna Commercial |
$1,915.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,915.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,915.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,077.30
|
| Rate for Payer: Multiplan Commercial |
$2,226.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,034.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,077.30
|
| Rate for Payer: United Healthcare Commercial |
$2,274.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,077.30
|
| Rate for Payer: United Healthcare VA CCN |
$1,077.30
|
|
|
VAG HYST INCLUDING T/O
|
Facility
|
IP
|
$2,394.00
|
|
|
Service Code
|
CPT 58262
|
| Hospital Charge Code |
9825826201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,771.80 |
| Max. Negotiated Rate |
$2,274.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,274.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,771.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,771.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,034.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,010.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,915.20
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cigna Commercial |
$1,915.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,915.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,915.20
|
| Rate for Payer: Multiplan Commercial |
$2,226.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,034.90
|
| Rate for Payer: United Healthcare Commercial |
$2,274.30
|
|
|
VAG HYST INCLUDING T/O
|
Professional
|
Both
|
$2,394.00
|
|
|
Service Code
|
CPT 58262
|
| Hospital Charge Code |
9825826201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$860.14 |
| Max. Negotiated Rate |
$2,250.36 |
| Rate for Payer: Aetna of VT Commercial |
$2,250.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,144.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$885.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,144.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,204.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,543.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,543.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$989.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,543.68
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cigna Commercial |
$1,519.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,435.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,435.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$860.14
|
| Rate for Payer: Multiplan Commercial |
$2,226.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,221.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$860.15
|
| Rate for Payer: United Healthcare Commercial |
$1,323.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$860.15
|
| Rate for Payer: United Healthcare VA CCN |
$860.15
|
|
|
VAG HYST W/ENTEROCELE REPAIR
|
Professional
|
Both
|
$2,601.00
|
|
|
Service Code
|
CPT 58270
|
| Hospital Charge Code |
9825827001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$829.57 |
| Max. Negotiated Rate |
$2,444.94 |
| Rate for Payer: Aetna of VT Commercial |
$2,444.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,330.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$854.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,330.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,161.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,574.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,574.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$954.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,574.15
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$1,464.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,384.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,384.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$829.57
|
| Rate for Payer: Multiplan Commercial |
$2,418.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,177.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$829.57
|
| Rate for Payer: United Healthcare Commercial |
$1,276.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$829.57
|
| Rate for Payer: United Healthcare VA CCN |
$829.57
|
|
|
VAG HYST W/ENTEROCELE REPAIR
|
Facility
|
IP
|
$2,601.00
|
|
|
Service Code
|
CPT 58270
|
| Hospital Charge Code |
9825827001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,925.00 |
| Max. Negotiated Rate |
$2,470.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,470.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,925.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,925.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,210.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,184.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,080.80
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$2,080.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,080.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,080.80
|
| Rate for Payer: Multiplan Commercial |
$2,418.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,210.85
|
| Rate for Payer: United Healthcare Commercial |
$2,470.95
|
|
|
VAG HYST W/ENTEROCELE REPAIR
|
Facility
|
OP
|
$2,601.00
|
|
|
Service Code
|
CPT 58270
|
| Hospital Charge Code |
9825827001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,151.98 |
| Max. Negotiated Rate |
$2,470.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,470.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,330.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,151.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,330.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,565.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,210.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,106.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,170.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,067.80
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$2,080.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,080.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,080.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,170.45
|
| Rate for Payer: Multiplan Commercial |
$2,418.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,210.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,170.45
|
| Rate for Payer: United Healthcare Commercial |
$2,470.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,170.45
|
| Rate for Payer: United Healthcare VA CCN |
$1,170.45
|
|
