|
VAGINAL DELIVERY ONLY
|
Facility
|
OP
|
$1,979.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
9695940901
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$876.50 |
| Max. Negotiated Rate |
$1,880.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,880.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,772.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$876.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,772.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,191.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,682.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,602.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$890.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,573.31
|
| Rate for Payer: Cash Price |
$989.50
|
| Rate for Payer: Cigna Commercial |
$1,583.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,583.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,583.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$890.55
|
| Rate for Payer: Multiplan Commercial |
$1,840.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,682.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$890.55
|
| Rate for Payer: United Healthcare Commercial |
$1,880.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$890.55
|
| Rate for Payer: United Healthcare VA CCN |
$890.55
|
|
|
VAGINAL DELIVERY ONLY
|
Facility
|
IP
|
$6,489.38
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
7225940901
|
|
Hospital Revenue Code
|
722
|
| Min. Negotiated Rate |
$4,802.79 |
| Max. Negotiated Rate |
$6,164.91 |
| Rate for Payer: Aetna of VT Commercial |
$6,164.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,802.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,802.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,515.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,451.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,191.50
|
| Rate for Payer: Cash Price |
$3,244.69
|
| Rate for Payer: Cigna Commercial |
$5,191.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,191.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,191.50
|
| Rate for Payer: Multiplan Commercial |
$6,035.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,515.97
|
| Rate for Payer: United Healthcare Commercial |
$6,164.91
|
|
|
VAGINAL DELIVERY ONLY
|
Facility
|
OP
|
$1,568.47
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
4505940901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$694.68 |
| Max. Negotiated Rate |
$1,490.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,490.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,405.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$694.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,405.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$944.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,333.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,270.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$705.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,246.93
|
| Rate for Payer: Cash Price |
$784.24
|
| Rate for Payer: Cigna Commercial |
$1,254.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,254.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,254.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$705.81
|
| Rate for Payer: Multiplan Commercial |
$1,458.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,333.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$705.81
|
| Rate for Payer: United Healthcare Commercial |
$1,490.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$705.81
|
| Rate for Payer: United Healthcare VA CCN |
$705.81
|
|
|
VAGINAL DELIVERY ONLY
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
9815940901
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$735.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,000.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,400.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,400.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$821.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,400.34
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$783.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,233.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,233.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$907.40
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,800.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$714.51
|
| Rate for Payer: United Healthcare Commercial |
$1,099.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$714.51
|
| Rate for Payer: United Healthcare VA CCN |
$714.51
|
|
|
VAGINAL DELIVERY ONLY
|
Professional
|
Both
|
$1,979.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
9695940901
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$714.51 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,860.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,772.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$735.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,772.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,000.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,400.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,400.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$821.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,400.34
|
| Rate for Payer: Cash Price |
$989.50
|
| Rate for Payer: Cash Price |
$989.50
|
| Rate for Payer: Cash Price |
$989.50
|
| Rate for Payer: Cigna Commercial |
$783.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,233.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,233.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$907.40
|
| Rate for Payer: Multiplan Commercial |
$1,840.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,800.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$714.51
|
| Rate for Payer: United Healthcare Commercial |
$1,099.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$714.51
|
| Rate for Payer: United Healthcare VA CCN |
$714.51
|
|
|
VAGINAL DELIVERY ONLY
|
Professional
|
Both
|
$6,489.38
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
7225940901
|
|
Hospital Revenue Code
|
722
|
| Min. Negotiated Rate |
$714.51 |
| Max. Negotiated Rate |
$6,100.02 |
| Rate for Payer: Aetna of VT Commercial |
$6,100.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,813.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$735.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,813.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,000.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,400.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,400.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$821.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,400.34
|
| Rate for Payer: Cash Price |
$3,244.69
|
| Rate for Payer: Cash Price |
$3,244.69
|
| Rate for Payer: Cash Price |
$3,244.69
|
| Rate for Payer: Cigna Commercial |
$783.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,233.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,233.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$907.40
|
| Rate for Payer: Multiplan Commercial |
$6,035.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,800.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$714.51
|
| Rate for Payer: United Healthcare Commercial |
$1,099.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$714.51
|
| Rate for Payer: United Healthcare VA CCN |
$714.51
|
|
|
VAGINAL DELIVERY ONLY
|
Facility
|
OP
|
$1,979.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
9815940902
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$876.50 |
| Max. Negotiated Rate |
$1,880.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,880.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,772.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$876.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,772.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,191.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,682.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,602.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$890.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,573.31
|
| Rate for Payer: Cash Price |
$989.50
|
| Rate for Payer: Cigna Commercial |
$1,583.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,583.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,583.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$890.55
|
| Rate for Payer: Multiplan Commercial |
$1,840.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,682.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$890.55
|
| Rate for Payer: United Healthcare Commercial |
$1,880.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$890.55
|
| Rate for Payer: United Healthcare VA CCN |
$890.55
|
|
|
VAGINAL DELIVERY ONLY
|
Professional
|
Both
|
$1,979.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
9815940902
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$714.51 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,860.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,772.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$735.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,772.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,000.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,400.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,400.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$821.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,400.34
|
| Rate for Payer: Cash Price |
$989.50
|
| Rate for Payer: Cash Price |
$989.50
|
| Rate for Payer: Cash Price |
$989.50
|
| Rate for Payer: Cigna Commercial |
$783.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,233.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,233.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$907.40
|
| Rate for Payer: Multiplan Commercial |
$1,840.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,800.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$714.51
|
| Rate for Payer: United Healthcare Commercial |
$1,099.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$714.51
|
| Rate for Payer: United Healthcare VA CCN |
$714.51
|
|
|
VAGINAL DELIVERY ONLY
|
Facility
|
OP
|
$6,489.38
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
7225940901
|
|
Hospital Revenue Code
|
722
|
| Min. Negotiated Rate |
$2,874.15 |
| Max. Negotiated Rate |
$6,164.91 |
| Rate for Payer: Aetna of VT Commercial |
$6,164.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,813.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,874.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,813.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,906.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,515.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,256.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,920.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,159.06
|
| Rate for Payer: Cash Price |
$3,244.69
|
| Rate for Payer: Cigna Commercial |
$5,191.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,191.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,191.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,920.22
|
| Rate for Payer: Multiplan Commercial |
$6,035.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,515.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,920.22
|
| Rate for Payer: United Healthcare Commercial |
$6,164.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,920.22
|
| Rate for Payer: United Healthcare VA CCN |
$2,920.22
|
|
|
VAGINAL DELIVERY ONLY
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
9815940901
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
VAGINAL DELIVERY ONLY
|
Facility
|
IP
|
$1,979.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
9815940902
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,464.66 |
| Max. Negotiated Rate |
$1,880.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,880.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,464.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,464.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,682.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,662.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,583.20
|
| Rate for Payer: Cash Price |
$989.50
|
| Rate for Payer: Cigna Commercial |
$1,583.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,583.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,583.20
|
| Rate for Payer: Multiplan Commercial |
$1,840.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,682.15
|
| Rate for Payer: United Healthcare Commercial |
$1,880.05
|
|
|
VAGINAL DELIVERY ONLY
|
Facility
|
IP
|
$1,568.47
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
4505940901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,160.82 |
| Max. Negotiated Rate |
$1,490.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,490.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,160.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,160.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,333.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,317.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,254.78
|
| Rate for Payer: Cash Price |
$784.24
|
| Rate for Payer: Cigna Commercial |
$1,254.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,254.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,254.78
|
| Rate for Payer: Multiplan Commercial |
$1,458.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,333.20
|
| Rate for Payer: United Healthcare Commercial |
$1,490.05
|
|
|
VAGINAL DELIVERY ONLY
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
9815940901
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
VAGINAL DELIVERY ONLY
|
Facility
|
IP
|
$1,979.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
9695940901
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$1,464.66 |
| Max. Negotiated Rate |
$1,880.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,880.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,464.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,464.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,682.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,662.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,583.20
|
| Rate for Payer: Cash Price |
$989.50
|
| Rate for Payer: Cigna Commercial |
$1,583.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,583.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,583.20
|
| Rate for Payer: Multiplan Commercial |
$1,840.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,682.15
|
| Rate for Payer: United Healthcare Commercial |
$1,880.05
|
|
|
VAGINAL DELIVERY ONLY W/POSTP
|
Facility
|
OP
|
$2,138.00
|
|
|
Service Code
|
CPT 59410
|
| Hospital Charge Code |
9695941001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$946.92 |
| Max. Negotiated Rate |
$2,031.10 |
| Rate for Payer: Aetna of VT Commercial |
$2,031.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,915.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$946.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,915.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,287.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,817.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,731.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$962.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,699.71
|
| Rate for Payer: Cash Price |
$1,069.00
|
| Rate for Payer: Cigna Commercial |
$1,710.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,710.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,710.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$962.10
|
| Rate for Payer: Multiplan Commercial |
$1,988.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,817.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$962.10
|
| Rate for Payer: United Healthcare Commercial |
$2,031.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$962.10
|
| Rate for Payer: United Healthcare VA CCN |
$962.10
|
|
|
VAGINAL DELIVERY ONLY W/POSTP
|
Facility
|
IP
|
$2,138.00
|
|
|
Service Code
|
CPT 59410
|
| Hospital Charge Code |
9695941001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$1,582.33 |
| Max. Negotiated Rate |
$2,031.10 |
| Rate for Payer: Aetna of VT Commercial |
$2,031.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,582.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,582.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,817.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,795.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,710.40
|
| Rate for Payer: Cash Price |
$1,069.00
|
| Rate for Payer: Cigna Commercial |
$1,710.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,710.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,710.40
|
| Rate for Payer: Multiplan Commercial |
$1,988.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,817.30
|
| Rate for Payer: United Healthcare Commercial |
$2,031.10
|
|
|
VAGINAL DELIVERY ONLY W/POSTP
|
Professional
|
Both
|
$2,138.00
|
|
|
Service Code
|
CPT 59410
|
| Hospital Charge Code |
9695941001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$969.16 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna of VT Commercial |
$2,009.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,915.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$998.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,915.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,356.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,611.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,611.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,114.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,611.13
|
| Rate for Payer: Cash Price |
$1,069.00
|
| Rate for Payer: Cash Price |
$1,069.00
|
| Rate for Payer: Cash Price |
$1,069.00
|
| Rate for Payer: Cigna Commercial |
$1,063.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,670.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,670.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$991.67
|
| Rate for Payer: Multiplan Commercial |
$1,988.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,800.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$969.16
|
| Rate for Payer: United Healthcare Commercial |
$1,490.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$969.16
|
| Rate for Payer: United Healthcare VA CCN |
$969.16
|
|
|
VAGINAL HYSTERECTOMY
|
Facility
|
OP
|
$2,353.00
|
|
|
Service Code
|
CPT 58260
|
| Hospital Charge Code |
9825826001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,042.14 |
| Max. Negotiated Rate |
$2,235.35 |
| Rate for Payer: Aetna of VT Commercial |
$2,235.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,108.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,042.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,108.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,416.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,000.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,905.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,058.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,870.63
|
| Rate for Payer: Cash Price |
$1,176.50
|
| Rate for Payer: Cigna Commercial |
$1,882.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,882.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,882.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,058.85
|
| Rate for Payer: Multiplan Commercial |
$2,188.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,000.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,058.85
|
| Rate for Payer: United Healthcare Commercial |
$2,235.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,058.85
|
| Rate for Payer: United Healthcare VA CCN |
$1,058.85
|
|
|
VAGINAL HYSTERECTOMY
|
Professional
|
Both
|
$2,353.00
|
|
|
Service Code
|
CPT 58260
|
| Hospital Charge Code |
9825826001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$778.60 |
| Max. Negotiated Rate |
$2,211.82 |
| Rate for Payer: Aetna of VT Commercial |
$2,211.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,108.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$801.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,108.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,090.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,446.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,446.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$895.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,446.15
|
| Rate for Payer: Cash Price |
$1,176.50
|
| Rate for Payer: Cash Price |
$1,176.50
|
| Rate for Payer: Cigna Commercial |
$1,376.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,299.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,299.13
|
| Rate for Payer: Martins Point Health Care Commercial |
$778.60
|
| Rate for Payer: Multiplan Commercial |
$2,188.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,105.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$778.60
|
| Rate for Payer: United Healthcare Commercial |
$1,197.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$778.60
|
| Rate for Payer: United Healthcare VA CCN |
$778.60
|
|
|
VAGINAL HYSTERECTOMY
|
Facility
|
IP
|
$2,353.00
|
|
|
Service Code
|
CPT 58260
|
| Hospital Charge Code |
9825826001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,741.46 |
| Max. Negotiated Rate |
$2,235.35 |
| Rate for Payer: Aetna of VT Commercial |
$2,235.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,741.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,741.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,000.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,976.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,882.40
|
| Rate for Payer: Cash Price |
$1,176.50
|
| Rate for Payer: Cigna Commercial |
$1,882.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,882.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,882.40
|
| Rate for Payer: Multiplan Commercial |
$2,188.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,000.05
|
| Rate for Payer: United Healthcare Commercial |
$2,235.35
|
|
|
VALVE HEIMLICH CHEST DRAINAGE
|
Facility
|
OP
|
$67.21
|
|
| Hospital Charge Code |
2720018491
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$63.85 |
| Rate for Payer: Aetna of VT Commercial |
$63.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$60.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$29.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$60.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$40.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$57.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$54.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$53.43
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$53.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$53.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$53.77
|
| Rate for Payer: Martins Point Health Care Commercial |
$30.24
|
| Rate for Payer: Multiplan Commercial |
$62.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$30.24
|
| Rate for Payer: United Healthcare Commercial |
$63.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.24
|
| Rate for Payer: United Healthcare VA CCN |
$30.24
|
|
|
VALVE HEIMLICH CHEST DRAINAGE
|
Facility
|
IP
|
$67.21
|
|
| Hospital Charge Code |
2720018491
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.74 |
| Max. Negotiated Rate |
$63.85 |
| Rate for Payer: Aetna of VT Commercial |
$63.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$49.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$49.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$57.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$56.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$53.77
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$53.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$53.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$53.77
|
| Rate for Payer: Multiplan Commercial |
$62.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.13
|
| Rate for Payer: United Healthcare Commercial |
$63.85
|
|
|
VALVE LOPEZ FEEDG
|
Facility
|
OP
|
$1.61
|
|
| Hospital Charge Code |
2720023511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Aetna of VT Commercial |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.28
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna Commercial |
$1.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.72
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.72
|
| Rate for Payer: United Healthcare VA CCN |
$0.72
|
|
|
VALVE LOPEZ FEEDG
|
Facility
|
IP
|
$1.61
|
|
| Hospital Charge Code |
2720023511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Aetna of VT Commercial |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.29
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna Commercial |
$1.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.29
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.37
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
|
|
VANCOMYCIN 1.75 GM/350 ML IV
|
Facility
|
OP
|
$0.01
|
|
| Hospital Charge Code |
2500000557
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
