|
VENT MGMT INPAT SUBQ DAY
|
Facility
|
IP
|
$4,358.83
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
4109400301
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$3,225.97 |
| Max. Negotiated Rate |
$4,140.89 |
| Rate for Payer: Aetna of VT Commercial |
$4,140.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,225.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,225.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,705.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,661.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,487.06
|
| Rate for Payer: Cash Price |
$2,179.42
|
| Rate for Payer: Cigna Commercial |
$3,487.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,487.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,487.06
|
| Rate for Payer: Multiplan Commercial |
$4,053.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,705.01
|
| Rate for Payer: United Healthcare Commercial |
$4,140.89
|
|
|
VENT MGMT INPAT SUBQ DAY
|
Facility
|
OP
|
$4,358.83
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
4109400301
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,930.53 |
| Max. Negotiated Rate |
$4,140.89 |
| Rate for Payer: Aetna of VT Commercial |
$4,140.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,905.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,930.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,905.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,624.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,705.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,530.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,961.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,465.27
|
| Rate for Payer: Cash Price |
$2,179.42
|
| Rate for Payer: Cigna Commercial |
$3,487.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,487.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,487.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,961.47
|
| Rate for Payer: Multiplan Commercial |
$4,053.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,705.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,961.47
|
| Rate for Payer: United Healthcare Commercial |
$4,140.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,961.47
|
| Rate for Payer: United Healthcare VA CCN |
$1,961.47
|
|
|
VISUAL ACUITY SCREEN
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
5109917301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Aetna of VT Commercial |
$19.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$15.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$15.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$17.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$17.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.80
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$16.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$19.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.85
|
| Rate for Payer: United Healthcare Commercial |
$19.95
|
|
|
VISUAL ACUITY SCREEN
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
5109917301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$19.74 |
| Rate for Payer: Aetna of VT Commercial |
$19.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$18.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$18.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9.89
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$3.05
|
| Rate for Payer: Multiplan Commercial |
$19.53
|
| Rate for Payer: United Healthcare Commercial |
$17.85
|
| Rate for Payer: United Healthcare VA CCN |
$2.87
|
|
|
VISUAL ACUITY SCREEN
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
5109917301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Aetna of VT Commercial |
$19.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$18.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$18.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$12.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$17.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$17.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.70
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$16.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.45
|
| Rate for Payer: Multiplan Commercial |
$19.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.45
|
| Rate for Payer: United Healthcare Commercial |
$19.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.45
|
| Rate for Payer: United Healthcare VA CCN |
$9.45
|
|
|
VITAL CAPACITY TEST
|
Facility
|
OP
|
$410.50
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
4609415001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$389.98 |
| Rate for Payer: Aetna of VT Commercial |
$389.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$367.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$181.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$367.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$247.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$348.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$332.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$184.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$326.35
|
| Rate for Payer: Cash Price |
$205.25
|
| Rate for Payer: Cigna Commercial |
$328.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$328.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$328.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$184.72
|
| Rate for Payer: Multiplan Commercial |
$381.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$348.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$184.72
|
| Rate for Payer: United Healthcare Commercial |
$389.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.72
|
| Rate for Payer: United Healthcare VA CCN |
$184.72
|
|
|
VITAL CAPACITY TEST
|
Facility
|
IP
|
$410.50
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
4609415001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$303.81 |
| Max. Negotiated Rate |
$389.98 |
| Rate for Payer: Aetna of VT Commercial |
$389.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$303.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$303.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$348.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$344.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$328.40
|
| Rate for Payer: Cash Price |
$205.25
|
| Rate for Payer: Cigna Commercial |
$328.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$328.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$328.40
|
| Rate for Payer: Multiplan Commercial |
$381.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$348.93
|
| Rate for Payer: United Healthcare Commercial |
$389.98
|
|
|
VITAMIN A 10,000 UNIT CAPSULE
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 904208560
|
| Hospital Charge Code |
2500000590
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
VITAMIN A 10,000 UNIT CAPSULE
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 904208560
|
| Hospital Charge Code |
2500000590
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
VITAMIN D 25 HYDROXY
|
Professional
|
Both
|
$220.24
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
3008230601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.19 |
| Max. Negotiated Rate |
$207.03 |
| Rate for Payer: Aetna of VT Commercial |
$207.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$145.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$30.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$145.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$41.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$50.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$50.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$34.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$50.59
|
| Rate for Payer: Cash Price |
$110.12
|
| Rate for Payer: Cash Price |
$110.12
|
| Rate for Payer: Cigna Commercial |
$35.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$29.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$29.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.19
|
| Rate for Payer: Multiplan Commercial |
$204.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$29.60
|
| Rate for Payer: United Healthcare Commercial |
$45.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.60
|
| Rate for Payer: United Healthcare VA CCN |
$29.60
|
|
|
VITAMIN D 25 HYDROXY
|
Facility
|
IP
|
$220.24
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
3008230601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.00 |
| Max. Negotiated Rate |
$209.23 |
| Rate for Payer: Aetna of VT Commercial |
$209.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$185.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.19
|
| Rate for Payer: Cash Price |
$110.12
|
| Rate for Payer: Cigna Commercial |
$176.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.19
|
| Rate for Payer: Multiplan Commercial |
$204.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.20
|
| Rate for Payer: United Healthcare Commercial |
$209.23
|
|
|
VITAMIN D 25 HYDROXY
|
Facility
|
OP
|
$220.24
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
3008230601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$209.23 |
| Rate for Payer: Aetna of VT Commercial |
$209.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$145.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$97.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$145.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$132.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$178.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$175.09
|
| Rate for Payer: Cash Price |
$110.12
|
| Rate for Payer: Cash Price |
$110.12
|
| Rate for Payer: Cigna Commercial |
$176.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$99.11
|
| Rate for Payer: Multiplan Commercial |
$204.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.11
|
| Rate for Payer: United Healthcare Commercial |
$209.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.60
|
| Rate for Payer: United Healthcare VA CCN |
$99.11
|
|
|
VIT D 1 25-DIHYDROXY
|
Professional
|
Both
|
$294.17
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
3008265201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$276.52 |
| Rate for Payer: Aetna of VT Commercial |
$276.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$189.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$189.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$65.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.81
|
| Rate for Payer: Cash Price |
$147.08
|
| Rate for Payer: Cash Price |
$147.08
|
| Rate for Payer: Cigna Commercial |
$46.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$38.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$38.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.96
|
| Rate for Payer: Multiplan Commercial |
$273.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.50
|
| Rate for Payer: United Healthcare Commercial |
$59.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.50
|
| Rate for Payer: United Healthcare VA CCN |
$38.50
|
|
|
VIT D 1 25-DIHYDROXY
|
Facility
|
IP
|
$294.17
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
3008265201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$217.72 |
| Max. Negotiated Rate |
$279.46 |
| Rate for Payer: Aetna of VT Commercial |
$279.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$217.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$217.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$250.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$247.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$235.34
|
| Rate for Payer: Cash Price |
$147.08
|
| Rate for Payer: Cigna Commercial |
$235.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$235.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$235.34
|
| Rate for Payer: Multiplan Commercial |
$273.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.04
|
| Rate for Payer: United Healthcare Commercial |
$279.46
|
|
|
VIT D 1 25-DIHYDROXY
|
Facility
|
OP
|
$294.17
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
3008265201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$279.46 |
| Rate for Payer: Aetna of VT Commercial |
$279.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$189.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$130.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$189.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$177.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$250.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$238.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$132.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$233.87
|
| Rate for Payer: Cash Price |
$147.08
|
| Rate for Payer: Cash Price |
$147.08
|
| Rate for Payer: Cigna Commercial |
$235.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$235.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$235.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$132.38
|
| Rate for Payer: Multiplan Commercial |
$273.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$132.38
|
| Rate for Payer: United Healthcare Commercial |
$279.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.50
|
| Rate for Payer: United Healthcare VA CCN |
$132.38
|
|
|
VOLTAGE-GTD CA CHNL ANTB EA
|
Professional
|
Both
|
$130.68
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
3008659601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$122.84 |
| Rate for Payer: Aetna of VT Commercial |
$122.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$21.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$21.68
|
| Rate for Payer: Cash Price |
$65.34
|
| Rate for Payer: Cash Price |
$65.34
|
| Rate for Payer: Cigna Commercial |
$14.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.88
|
| Rate for Payer: Multiplan Commercial |
$121.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare Commercial |
$18.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare VA CCN |
$12.05
|
|
|
VOLTAGE-GTD CA CHNL ANTB EA
|
Facility
|
OP
|
$130.68
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
3008659601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$124.15 |
| Rate for Payer: Aetna of VT Commercial |
$124.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$57.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$78.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$111.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$105.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$58.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$103.89
|
| Rate for Payer: Cash Price |
$65.34
|
| Rate for Payer: Cash Price |
$65.34
|
| Rate for Payer: Cigna Commercial |
$104.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$104.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$104.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$58.81
|
| Rate for Payer: Multiplan Commercial |
$121.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$111.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$58.81
|
| Rate for Payer: United Healthcare Commercial |
$124.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare VA CCN |
$58.81
|
|
|
VOLTAGE-GTD CA CHNL ANTB EA
|
Facility
|
IP
|
$130.68
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
3008659601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.72 |
| Max. Negotiated Rate |
$124.15 |
| Rate for Payer: Aetna of VT Commercial |
$124.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$96.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$96.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$111.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.54
|
| Rate for Payer: Cash Price |
$65.34
|
| Rate for Payer: Cigna Commercial |
$104.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$104.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$104.54
|
| Rate for Payer: Multiplan Commercial |
$121.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$111.08
|
| Rate for Payer: United Healthcare Commercial |
$124.15
|
|
|
VULVECTOMY SIMPLE PARTIAL
|
Professional
|
Both
|
$1,561.00
|
|
|
Service Code
|
CPT 56620
|
| Hospital Charge Code |
9825662001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$552.00 |
| Max. Negotiated Rate |
$1,467.34 |
| Rate for Payer: Aetna of VT Commercial |
$1,467.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,398.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$568.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,398.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$772.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$843.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$843.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$634.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$843.81
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$978.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$912.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$912.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$552.00
|
| Rate for Payer: Multiplan Commercial |
$1,451.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$783.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$552.00
|
| Rate for Payer: United Healthcare Commercial |
$849.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$552.00
|
| Rate for Payer: United Healthcare VA CCN |
$552.00
|
|
|
VULVECTOMY SIMPLE PARTIAL
|
Facility
|
OP
|
$1,561.00
|
|
|
Service Code
|
CPT 56620
|
| Hospital Charge Code |
9825662001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$691.37 |
| Max. Negotiated Rate |
$1,482.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,482.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,398.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$691.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,398.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$939.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,326.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,264.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$702.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,240.99
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,248.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,248.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,248.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$702.45
|
| Rate for Payer: Multiplan Commercial |
$1,451.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,326.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$702.45
|
| Rate for Payer: United Healthcare Commercial |
$1,482.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$702.45
|
| Rate for Payer: United Healthcare VA CCN |
$702.45
|
|
|
VULVECTOMY SIMPLE PARTIAL
|
Facility
|
IP
|
$1,561.00
|
|
|
Service Code
|
CPT 56620
|
| Hospital Charge Code |
9825662001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,155.30 |
| Max. Negotiated Rate |
$1,482.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,482.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,155.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,155.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,326.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,311.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,248.80
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,248.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,248.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,248.80
|
| Rate for Payer: Multiplan Commercial |
$1,451.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,326.85
|
| Rate for Payer: United Healthcare Commercial |
$1,482.95
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
IP
|
$585.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
9601176501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$432.96 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: Aetna of VT Commercial |
$555.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$432.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$432.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$497.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$491.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$468.00
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$468.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$468.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$544.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$497.25
|
| Rate for Payer: United Healthcare Commercial |
$555.75
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Professional
|
Both
|
$399.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
9811176502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$89.32 |
| Max. Negotiated Rate |
$375.06 |
| Rate for Payer: Aetna of VT Commercial |
$375.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$357.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$357.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$102.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$204.20
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$163.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$254.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$254.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$157.41
|
| Rate for Payer: Multiplan Commercial |
$371.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$89.32
|
| Rate for Payer: United Healthcare Commercial |
$137.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.32
|
| Rate for Payer: United Healthcare VA CCN |
$89.32
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
9811176502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$295.30 |
| Max. Negotiated Rate |
$379.05 |
| Rate for Payer: Aetna of VT Commercial |
$379.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$295.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$295.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$339.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$335.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$319.20
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$319.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$319.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$319.20
|
| Rate for Payer: Multiplan Commercial |
$371.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$339.15
|
| Rate for Payer: United Healthcare Commercial |
$379.05
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
5101176501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$137.66 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna of VT Commercial |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$158.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$156.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$148.80
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.80
|
| Rate for Payer: Multiplan Commercial |
$172.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.10
|
| Rate for Payer: United Healthcare Commercial |
$176.70
|
|
