|
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
|
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
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
9825811001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$113.98 |
| 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 |
$113.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$123.20
|
| 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: Multiplan Commercial |
$143.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.90
|
| Rate for Payer: United Healthcare Commercial |
$146.30
|
|
|
BX OF CERVIX W/SCOPE LEEP
|
Professional
|
Both
|
$2,068.00
|
|
|
Service Code
|
CPT 57460
|
| Hospital Charge Code |
5105746001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$147.61 |
| Max. Negotiated Rate |
$1,943.92 |
| Rate for Payer: Aetna of VT Commercial |
$1,943.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,852.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$152.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,852.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$206.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$583.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$583.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$169.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$583.44
|
| Rate for Payer: Cash Price |
$1,034.00
|
| Rate for Payer: Cash Price |
$1,034.00
|
| Rate for Payer: Cigna Commercial |
$259.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$475.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$475.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$289.90
|
| Rate for Payer: Multiplan Commercial |
$1,923.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$147.61
|
| Rate for Payer: United Healthcare Commercial |
$227.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.61
|
| Rate for Payer: United Healthcare VA CCN |
$147.61
|
|
|
BX OF CERVIX W/SCOPE LEEP
|
Facility
|
OP
|
$2,068.00
|
|
|
Service Code
|
CPT 57460
|
| Hospital Charge Code |
5105746001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$915.92 |
| Max. Negotiated Rate |
$1,964.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,964.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,852.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$915.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,852.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,244.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,757.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,675.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$930.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,644.06
|
| Rate for Payer: Cash Price |
$1,034.00
|
| Rate for Payer: Cigna Commercial |
$1,654.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,654.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,654.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$930.60
|
| Rate for Payer: Multiplan Commercial |
$1,923.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,757.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$930.60
|
| Rate for Payer: United Healthcare Commercial |
$1,964.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$930.60
|
| Rate for Payer: United Healthcare VA CCN |
$930.60
|
|
|
BX OF CERVIX W/SCOPE LEEP
|
Professional
|
Both
|
$703.00
|
|
|
Service Code
|
CPT 57460
|
| Hospital Charge Code |
9605746002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$147.61 |
| Max. Negotiated Rate |
$660.82 |
| Rate for Payer: Aetna of VT Commercial |
$660.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$629.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$152.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$629.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$206.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$583.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$583.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$169.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$583.44
|
| Rate for Payer: Cash Price |
$351.50
|
| Rate for Payer: Cash Price |
$351.50
|
| Rate for Payer: Cigna Commercial |
$259.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$475.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$475.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$289.90
|
| Rate for Payer: Multiplan Commercial |
$653.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$147.61
|
| Rate for Payer: United Healthcare Commercial |
$227.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.61
|
| Rate for Payer: United Healthcare VA CCN |
$147.61
|
|
|
BX OF CERVIX W/SCOPE LEEP
|
Professional
|
Both
|
$2,771.00
|
|
|
Service Code
|
CPT 57460
|
| Hospital Charge Code |
9605746001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$147.61 |
| Max. Negotiated Rate |
$2,604.74 |
| Rate for Payer: Aetna of VT Commercial |
$2,604.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,482.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$152.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,482.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$206.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$583.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$583.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$169.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$583.44
|
| Rate for Payer: Cash Price |
$1,385.50
|
| Rate for Payer: Cash Price |
$1,385.50
|
| Rate for Payer: Cigna Commercial |
$259.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$475.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$475.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$289.90
|
| Rate for Payer: Multiplan Commercial |
$2,577.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$147.61
|
| Rate for Payer: United Healthcare Commercial |
$227.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.61
|
| Rate for Payer: United Healthcare VA CCN |
$147.61
|
|
|
BX OF CERVIX W/SCOPE LEEP
|
Facility
|
IP
|
$703.00
|
|
|
Service Code
|
CPT 57460
|
| Hospital Charge Code |
9605746002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$520.29 |
| Max. Negotiated Rate |
$667.85 |
| Rate for Payer: Aetna of VT Commercial |
$667.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$520.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$520.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$597.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$590.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$562.40
|
| Rate for Payer: Cash Price |
$351.50
|
| Rate for Payer: Cigna Commercial |
$562.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$562.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$562.40
|
| Rate for Payer: Multiplan Commercial |
$653.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$597.55
|
| Rate for Payer: United Healthcare Commercial |
$667.85
|
|
|
BX OF CERVIX W/SCOPE LEEP
|
Facility
|
OP
|
$703.00
|
|
|
Service Code
|
CPT 57460
|
| Hospital Charge Code |
9605746002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$311.36 |
| Max. Negotiated Rate |
$667.85 |
| Rate for Payer: Aetna of VT Commercial |
$667.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$629.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$311.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$629.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$423.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$597.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$569.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$316.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$558.88
|
| Rate for Payer: Cash Price |
$351.50
|
| Rate for Payer: Cigna Commercial |
$562.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$562.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$562.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$316.35
|
| Rate for Payer: Multiplan Commercial |
$653.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$597.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$316.35
|
| Rate for Payer: United Healthcare Commercial |
$667.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$316.35
|
| Rate for Payer: United Healthcare VA CCN |
$316.35
|
|
|
BX OF CERVIX W/SCOPE LEEP
|
Facility
|
IP
|
$2,771.00
|
|
|
Service Code
|
CPT 57460
|
| Hospital Charge Code |
9605746001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,050.82 |
| Max. Negotiated Rate |
$2,632.45 |
| Rate for Payer: Aetna of VT Commercial |
$2,632.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,050.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,050.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,355.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,327.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,216.80
|
| Rate for Payer: Cash Price |
$1,385.50
|
| Rate for Payer: Cigna Commercial |
$2,216.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,216.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,216.80
|
| Rate for Payer: Multiplan Commercial |
$2,577.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,355.35
|
| Rate for Payer: United Healthcare Commercial |
$2,632.45
|
|
|
BX OF CERVIX W/SCOPE LEEP
|
Facility
|
OP
|
$2,771.00
|
|
|
Service Code
|
CPT 57460
|
| Hospital Charge Code |
9605746001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,227.28 |
| Max. Negotiated Rate |
$2,632.45 |
| Rate for Payer: Aetna of VT Commercial |
$2,632.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,482.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,227.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,482.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,668.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,355.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,244.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,246.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,202.95
|
| Rate for Payer: Cash Price |
$1,385.50
|
| Rate for Payer: Cigna Commercial |
$2,216.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,216.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,216.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,246.95
|
| Rate for Payer: Multiplan Commercial |
$2,577.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,355.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,246.95
|
| Rate for Payer: United Healthcare Commercial |
$2,632.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,246.95
|
| Rate for Payer: United Healthcare VA CCN |
$1,246.95
|
|
|
BX OF CERVIX W/SCOPE LEEP
|
Facility
|
IP
|
$2,068.00
|
|
|
Service Code
|
CPT 57460
|
| Hospital Charge Code |
5105746001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,530.53 |
| Max. Negotiated Rate |
$1,964.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,964.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,530.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,530.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,757.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,737.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,654.40
|
| Rate for Payer: Cash Price |
$1,034.00
|
| Rate for Payer: Cigna Commercial |
$1,654.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,654.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,654.40
|
| Rate for Payer: Multiplan Commercial |
$1,923.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,757.80
|
| Rate for Payer: United Healthcare Commercial |
$1,964.60
|
|
|
BX SKIN SUBQ/MM EA ADDL LESION
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 11101
|
| Hospital Charge Code |
9601110102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna of VT Commercial |
$79.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.78
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$78.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.80
|
| Rate for Payer: United Healthcare Commercial |
$79.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.80
|
| Rate for Payer: United Healthcare VA CCN |
$37.80
|
|
|
BX SKIN SUBQ/MM EA ADDL LESION
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 11101
|
| Hospital Charge Code |
9601110102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna of VT Commercial |
$79.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$67.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$78.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.40
|
| Rate for Payer: United Healthcare Commercial |
$79.80
|
|
|
BX SKIN SUBQ/MM EA ADDL LESION
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 11101
|
| Hospital Charge Code |
9601110102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Aetna of VT Commercial |
$78.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$75.26
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$78.12
|
| Rate for Payer: United Healthcare Commercial |
$71.40
|
| Rate for Payer: United Healthcare VA CCN |
$33.60
|
|
|
BX SKIN SUBQ/MM EA ADDL LESION
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 11101
|
| Hospital Charge Code |
5101110101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna of VT Commercial |
$79.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.78
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$78.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.80
|
| Rate for Payer: United Healthcare Commercial |
$79.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.80
|
| Rate for Payer: United Healthcare VA CCN |
$37.80
|
|
|
BX SKIN SUBQ/MM EA ADDL LESION
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
CPT 11101
|
| Hospital Charge Code |
9601110101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$157.92 |
| Rate for Payer: Aetna of VT Commercial |
$157.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$150.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$150.51
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$156.24
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare VA CCN |
$67.20
|
|
|
BX SKIN SUBQ/MM EA ADDL LESION
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 11101
|
| Hospital Charge Code |
9601110101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Aetna of VT Commercial |
$159.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$141.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$134.40
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$134.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$156.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.80
|
| Rate for Payer: United Healthcare Commercial |
$159.60
|
|
|
BX SKIN SUBQ/MM EA ADDL LESION
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 11101
|
| Hospital Charge Code |
9601110101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$74.41 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Aetna of VT Commercial |
$159.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$150.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$74.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$150.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$101.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$136.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.56
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$134.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$156.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$75.60
|
| Rate for Payer: United Healthcare Commercial |
$159.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.60
|
| Rate for Payer: United Healthcare VA CCN |
$75.60
|
|
|
BX SKIN SUBQ/MM EA ADDL LESION
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 11101
|
| Hospital Charge Code |
5101110101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Aetna of VT Commercial |
$78.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$75.26
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$78.12
|
| Rate for Payer: United Healthcare Commercial |
$71.40
|
| Rate for Payer: United Healthcare VA CCN |
$33.60
|
|
|
BX SKIN SUBQ/MM EA ADDL LESION
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 11101
|
| Hospital Charge Code |
5101110101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna of VT Commercial |
$79.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$67.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$78.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.40
|
| Rate for Payer: United Healthcare Commercial |
$79.80
|
|
|
BX SKIN SUBQ/MM SINGLE LESION
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 11100
|
| Hospital Charge Code |
9821110001
|
|
Hospital Revenue Code
|
982
|
| 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
|
|
|
BX SKIN SUBQ/MM SINGLE LESION
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 11100
|
| Hospital Charge Code |
9821110001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.94 |
| 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 SHOP Off Exchange |
$0.90
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$0.85
|
| Rate for Payer: United Healthcare VA CCN |
$0.40
|
|
|
BX SKIN SUBQ/MM SINGLE LESION
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 11100
|
| Hospital Charge Code |
9821110001
|
|
Hospital Revenue Code
|
982
|
| 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
|
|
|
BX TONGUE POSTERIOR 1/3
|
Facility
|
OP
|
$2,153.00
|
|
|
Service Code
|
CPT 41105
|
| Hospital Charge Code |
9604110501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$953.56 |
| Max. Negotiated Rate |
$2,045.35 |
| Rate for Payer: Aetna of VT Commercial |
$2,045.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,928.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$953.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,928.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,296.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,830.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,743.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$968.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,711.63
|
| Rate for Payer: Cash Price |
$1,076.50
|
| Rate for Payer: Cigna Commercial |
$1,722.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,722.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,722.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$968.85
|
| Rate for Payer: Multiplan Commercial |
$2,002.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,830.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$968.85
|
| Rate for Payer: United Healthcare Commercial |
$2,045.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$968.85
|
| Rate for Payer: United Healthcare VA CCN |
$968.85
|
|
