|
BX BREAST 1ST LESION US IMAG
|
Facility
|
IP
|
$1,711.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
9721908301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$1,266.31 |
| Max. Negotiated Rate |
$1,625.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,625.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,266.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,266.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,454.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,437.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,368.80
|
| Rate for Payer: Cash Price |
$855.50
|
| Rate for Payer: Cigna Commercial |
$1,368.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,368.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,368.80
|
| Rate for Payer: Multiplan Commercial |
$1,591.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,454.35
|
| Rate for Payer: United Healthcare Commercial |
$1,625.45
|
|
|
BX BREAST 1ST LESION US IMAG
|
Facility
|
OP
|
$1,711.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
9721908301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$757.80 |
| Max. Negotiated Rate |
$1,625.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,625.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,532.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$757.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,532.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,030.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,454.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,385.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$769.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,360.24
|
| Rate for Payer: Cash Price |
$855.50
|
| Rate for Payer: Cigna Commercial |
$1,368.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,368.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,368.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$769.95
|
| Rate for Payer: Multiplan Commercial |
$1,591.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,454.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$769.95
|
| Rate for Payer: United Healthcare Commercial |
$1,625.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$769.95
|
| Rate for Payer: United Healthcare VA CCN |
$769.95
|
|
|
BX BREAST ADD LESION STRTCTC
|
Facility
|
OP
|
$1,654.52
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
3201908201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$732.79 |
| Max. Negotiated Rate |
$1,571.79 |
| Rate for Payer: Aetna of VT Commercial |
$1,571.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,482.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$732.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,482.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$996.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,406.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,340.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$744.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,315.34
|
| Rate for Payer: Cash Price |
$827.26
|
| Rate for Payer: Cigna Commercial |
$1,323.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,323.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,323.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$744.53
|
| Rate for Payer: Multiplan Commercial |
$1,538.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,406.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$744.53
|
| Rate for Payer: United Healthcare Commercial |
$1,571.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$744.53
|
| Rate for Payer: United Healthcare VA CCN |
$744.53
|
|
|
BX BREAST ADD LESION STRTCTC
|
Facility
|
IP
|
$1,654.52
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
3201908201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,224.51 |
| Max. Negotiated Rate |
$1,571.79 |
| Rate for Payer: Aetna of VT Commercial |
$1,571.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,224.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,224.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,406.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,389.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,323.62
|
| Rate for Payer: Cash Price |
$827.26
|
| Rate for Payer: Cigna Commercial |
$1,323.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,323.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,323.62
|
| Rate for Payer: Multiplan Commercial |
$1,538.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,406.34
|
| Rate for Payer: United Healthcare Commercial |
$1,571.79
|
|
|
BX BREAST ADD LESION STRTCTC
|
Facility
|
IP
|
$1,395.00
|
|
|
Service Code
|
CPT 19082 26
|
| Hospital Charge Code |
9721908201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$1,032.44 |
| Max. Negotiated Rate |
$1,325.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,325.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,032.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,032.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,185.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,171.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,116.00
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cigna Commercial |
$1,116.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,116.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,116.00
|
| Rate for Payer: Multiplan Commercial |
$1,297.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,185.75
|
| Rate for Payer: United Healthcare Commercial |
$1,325.25
|
|
|
BX BREAST ADD LESION STRTCTC
|
Facility
|
OP
|
$1,395.00
|
|
|
Service Code
|
CPT 19082 26
|
| Hospital Charge Code |
9721908201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$617.85 |
| Max. Negotiated Rate |
$1,325.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,325.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,249.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$617.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,249.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$839.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,185.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,129.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$627.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,109.03
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cigna Commercial |
$1,116.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,116.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,116.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$627.75
|
| Rate for Payer: Multiplan Commercial |
$1,297.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,185.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$627.75
|
| Rate for Payer: United Healthcare Commercial |
$1,325.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$627.75
|
| Rate for Payer: United Healthcare VA CCN |
$627.75
|
|
|
BX BREAST ADD LESION STRTCTC
|
Professional
|
Both
|
$1,395.00
|
|
|
Service Code
|
CPT 19082 26
|
| Hospital Charge Code |
9721908201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$123.94 |
| Max. Negotiated Rate |
$1,311.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,311.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,249.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,249.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$826.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$826.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$826.72
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cigna Commercial |
$137.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$123.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$123.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$353.81
|
| Rate for Payer: Multiplan Commercial |
$1,297.35
|
| Rate for Payer: United Healthcare Commercial |
$1,185.75
|
| Rate for Payer: United Healthcare VA CCN |
$558.00
|
|
|
BX/CURETT OF CERVIX W/SCOPE
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
5105745401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.90 |
| Max. Negotiated Rate |
$201.40 |
| Rate for Payer: Aetna of VT Commercial |
$201.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$156.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$156.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$180.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$178.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.60
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna Commercial |
$169.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$169.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$169.60
|
| Rate for Payer: Multiplan Commercial |
$197.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.20
|
| Rate for Payer: United Healthcare Commercial |
$201.40
|
|
|
BX/CURETT OF CERVIX W/SCOPE
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
9605745402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$123.66 |
| Max. Negotiated Rate |
$418.30 |
| Rate for Payer: Aetna of VT Commercial |
$418.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$398.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$127.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$398.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$173.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$273.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$273.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$273.95
|
| Rate for Payer: Cash Price |
$222.50
|
| Rate for Payer: Cash Price |
$222.50
|
| Rate for Payer: Cigna Commercial |
$217.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$260.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$260.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$157.39
|
| Rate for Payer: Multiplan Commercial |
$413.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$123.66
|
| Rate for Payer: United Healthcare Commercial |
$190.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.66
|
| Rate for Payer: United Healthcare VA CCN |
$123.66
|
|
|
BX/CURETT OF CERVIX W/SCOPE
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
5105745401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.89 |
| Max. Negotiated Rate |
$201.40 |
| Rate for Payer: Aetna of VT Commercial |
$201.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$189.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$93.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$189.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$127.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$180.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$95.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$168.54
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna Commercial |
$169.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$169.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$169.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$95.40
|
| Rate for Payer: Multiplan Commercial |
$197.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$95.40
|
| Rate for Payer: United Healthcare Commercial |
$201.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.40
|
| Rate for Payer: United Healthcare VA CCN |
$95.40
|
|
|
BX/CURETT OF CERVIX W/SCOPE
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
5105745401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.66 |
| Max. Negotiated Rate |
$273.95 |
| Rate for Payer: Aetna of VT Commercial |
$199.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$189.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$127.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$189.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$173.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$273.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$273.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$273.95
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna Commercial |
$217.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$260.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$260.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$157.39
|
| Rate for Payer: Multiplan Commercial |
$197.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$123.66
|
| Rate for Payer: United Healthcare Commercial |
$190.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.66
|
| Rate for Payer: United Healthcare VA CCN |
$123.66
|
|
|
BX/CURETT OF CERVIX W/SCOPE
|
Facility
|
IP
|
$657.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
9605745401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$486.25 |
| Max. Negotiated Rate |
$624.15 |
| Rate for Payer: Aetna of VT Commercial |
$624.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$486.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$486.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$558.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$551.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$525.60
|
| Rate for Payer: Cash Price |
$328.50
|
| Rate for Payer: Cigna Commercial |
$525.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$525.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$525.60
|
| Rate for Payer: Multiplan Commercial |
$611.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$558.45
|
| Rate for Payer: United Healthcare Commercial |
$624.15
|
|
|
BX/CURETT OF CERVIX W/SCOPE
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
9605745402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$329.34 |
| Max. Negotiated Rate |
$422.75 |
| Rate for Payer: Aetna of VT Commercial |
$422.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$329.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$329.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$378.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$373.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$356.00
|
| Rate for Payer: Cash Price |
$222.50
|
| Rate for Payer: Cigna Commercial |
$356.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$356.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$356.00
|
| Rate for Payer: Multiplan Commercial |
$413.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$378.25
|
| Rate for Payer: United Healthcare Commercial |
$422.75
|
|
|
BX/CURETT OF CERVIX W/SCOPE
|
Professional
|
Both
|
$657.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
9605745401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$123.66 |
| Max. Negotiated Rate |
$617.58 |
| Rate for Payer: Aetna of VT Commercial |
$617.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$588.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$127.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$588.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$173.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$273.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$273.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$273.95
|
| Rate for Payer: Cash Price |
$328.50
|
| Rate for Payer: Cash Price |
$328.50
|
| Rate for Payer: Cigna Commercial |
$217.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$260.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$260.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$157.39
|
| Rate for Payer: Multiplan Commercial |
$611.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$123.66
|
| Rate for Payer: United Healthcare Commercial |
$190.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.66
|
| Rate for Payer: United Healthcare VA CCN |
$123.66
|
|
|
BX/CURETT OF CERVIX W/SCOPE
|
Facility
|
OP
|
$657.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
9605745401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$290.99 |
| Max. Negotiated Rate |
$624.15 |
| Rate for Payer: Aetna of VT Commercial |
$624.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$588.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$290.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$588.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$395.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$558.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$532.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$295.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$522.32
|
| Rate for Payer: Cash Price |
$328.50
|
| Rate for Payer: Cigna Commercial |
$525.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$525.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$525.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$295.65
|
| Rate for Payer: Multiplan Commercial |
$611.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$558.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$295.65
|
| Rate for Payer: United Healthcare Commercial |
$624.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.65
|
| Rate for Payer: United Healthcare VA CCN |
$295.65
|
|
|
BX/CURETT OF CERVIX W/SCOPE
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
9605745402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$197.09 |
| Max. Negotiated Rate |
$422.75 |
| Rate for Payer: Aetna of VT Commercial |
$422.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$398.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$197.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$398.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$267.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$378.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$360.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$200.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$353.77
|
| Rate for Payer: Cash Price |
$222.50
|
| Rate for Payer: Cigna Commercial |
$356.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$356.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$356.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$200.25
|
| Rate for Payer: Multiplan Commercial |
$413.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$378.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$200.25
|
| Rate for Payer: United Healthcare Commercial |
$422.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.25
|
| Rate for Payer: United Healthcare VA CCN |
$200.25
|
|
|
BX DONE W/COLPOSCOPY ADD-ON
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
9605811002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$68.21 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna of VT Commercial |
$146.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.43
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$123.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$123.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$123.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.30
|
| Rate for Payer: Multiplan Commercial |
$143.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$146.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.30
|
| Rate for Payer: United Healthcare VA CCN |
$69.30
|
|
|
BX DONE W/COLPOSCOPY ADD-ON
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
9825811001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$37.04 |
| Max. Negotiated Rate |
$144.76 |
| Rate for Payer: Aetna of VT Commercial |
$144.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$51.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$76.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$76.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.27
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$64.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$77.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$77.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.36
|
| Rate for Payer: Multiplan Commercial |
$143.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.04
|
| Rate for Payer: United Healthcare Commercial |
$56.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.04
|
| Rate for Payer: United Healthcare VA CCN |
$37.04
|
|
|
BX DONE W/COLPOSCOPY ADD-ON
|
Facility
|
OP
|
$557.00
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
5105811001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$246.70 |
| Max. Negotiated Rate |
$529.15 |
| Rate for Payer: Aetna of VT Commercial |
$529.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$499.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$246.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$499.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$335.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$473.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$451.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$250.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$442.81
|
| Rate for Payer: Cash Price |
$278.50
|
| Rate for Payer: Cigna Commercial |
$445.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$445.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$445.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$250.65
|
| Rate for Payer: Multiplan Commercial |
$518.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$473.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$250.65
|
| Rate for Payer: United Healthcare Commercial |
$529.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$250.65
|
| Rate for Payer: United Healthcare VA CCN |
$250.65
|
|
|
BX DONE W/COLPOSCOPY ADD-ON
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
9825811001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$68.21 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna of VT Commercial |
$146.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.43
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$123.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$123.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$123.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.30
|
| Rate for Payer: Multiplan Commercial |
$143.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$146.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.30
|
| Rate for Payer: United Healthcare VA CCN |
$69.30
|
|
|
BX DONE W/COLPOSCOPY ADD-ON
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
9605811001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$314.90 |
| Max. Negotiated Rate |
$675.45 |
| Rate for Payer: Aetna of VT Commercial |
$675.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$636.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$314.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$636.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$428.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$604.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$575.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$319.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$565.25
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cigna Commercial |
$568.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$568.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$568.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$319.95
|
| Rate for Payer: Multiplan Commercial |
$661.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$604.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$319.95
|
| Rate for Payer: United Healthcare Commercial |
$675.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$319.95
|
| Rate for Payer: United Healthcare VA CCN |
$319.95
|
|
|
BX DONE W/COLPOSCOPY ADD-ON
|
Professional
|
Both
|
$557.00
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
5105811001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.04 |
| Max. Negotiated Rate |
$523.58 |
| Rate for Payer: Aetna of VT Commercial |
$523.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$499.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$499.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$51.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$76.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$76.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.27
|
| Rate for Payer: Cash Price |
$278.50
|
| Rate for Payer: Cash Price |
$278.50
|
| Rate for Payer: Cigna Commercial |
$64.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$77.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$77.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.36
|
| Rate for Payer: Multiplan Commercial |
$518.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.04
|
| Rate for Payer: United Healthcare Commercial |
$56.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.04
|
| Rate for Payer: United Healthcare VA CCN |
$37.04
|
|
|
BX DONE W/COLPOSCOPY ADD-ON
|
Facility
|
IP
|
$557.00
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
5105811001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$412.24 |
| Max. Negotiated Rate |
$529.15 |
| Rate for Payer: Aetna of VT Commercial |
$529.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$412.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$412.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$473.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$467.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$445.60
|
| Rate for Payer: Cash Price |
$278.50
|
| Rate for Payer: Cigna Commercial |
$445.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$445.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$445.60
|
| Rate for Payer: Multiplan Commercial |
$518.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$473.45
|
| Rate for Payer: United Healthcare Commercial |
$529.15
|
|
|
BX DONE W/COLPOSCOPY ADD-ON
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
9605811001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$526.21 |
| Max. Negotiated Rate |
$675.45 |
| Rate for Payer: Aetna of VT Commercial |
$675.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$526.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$526.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$604.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$597.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$568.80
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cigna Commercial |
$568.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$568.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$568.80
|
| Rate for Payer: Multiplan Commercial |
$661.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$604.35
|
| Rate for Payer: United Healthcare Commercial |
$675.45
|
|
|
BX DONE W/COLPOSCOPY ADD-ON
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
9605811002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$37.04 |
| Max. Negotiated Rate |
$144.76 |
| Rate for Payer: Aetna of VT Commercial |
$144.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$51.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$76.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$76.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.27
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$64.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$77.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$77.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.36
|
| Rate for Payer: Multiplan Commercial |
$143.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.04
|
| Rate for Payer: United Healthcare Commercial |
$56.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.04
|
| Rate for Payer: United Healthcare VA CCN |
$37.04
|
|
