|
BX TONGUE POSTERIOR 1/3
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
CPT 41105
|
| Hospital Charge Code |
9604110502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$105.17 |
| Max. Negotiated Rate |
$360.96 |
| Rate for Payer: Aetna of VT Commercial |
$360.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$344.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$108.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$344.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$147.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$250.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$250.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$120.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$250.97
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$166.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$288.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$288.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$177.76
|
| Rate for Payer: Multiplan Commercial |
$357.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.17
|
| Rate for Payer: United Healthcare Commercial |
$161.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.17
|
| Rate for Payer: United Healthcare VA CCN |
$105.17
|
|
|
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
|
|
|
BX TONGUE POSTERIOR 1/3
|
Facility
|
IP
|
$2,153.00
|
|
|
Service Code
|
CPT 41105
|
| Hospital Charge Code |
9604110501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,593.44 |
| 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 |
$1,593.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,593.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,830.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,808.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,722.40
|
| 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: Multiplan Commercial |
$2,002.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,830.05
|
| Rate for Payer: United Healthcare Commercial |
$2,045.35
|
|
|
BX TONGUE POSTERIOR 1/3
|
Facility
|
OP
|
$384.00
|
|
|
Service Code
|
CPT 41105
|
| Hospital Charge Code |
9604110502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.07 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Aetna of VT Commercial |
$364.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$344.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$170.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$344.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$231.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$326.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$311.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$172.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$305.28
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$307.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$307.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$307.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$172.80
|
| Rate for Payer: Multiplan Commercial |
$357.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$326.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$172.80
|
| Rate for Payer: United Healthcare Commercial |
$364.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.80
|
| Rate for Payer: United Healthcare VA CCN |
$172.80
|
|
|
BX TONGUE POSTERIOR 1/3
|
Facility
|
OP
|
$384.00
|
|
|
Service Code
|
CPT 41105
|
| Hospital Charge Code |
9824110501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$170.07 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Aetna of VT Commercial |
$364.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$344.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$170.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$344.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$231.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$326.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$311.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$172.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$305.28
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$307.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$307.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$307.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$172.80
|
| Rate for Payer: Multiplan Commercial |
$357.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$326.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$172.80
|
| Rate for Payer: United Healthcare Commercial |
$364.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.80
|
| Rate for Payer: United Healthcare VA CCN |
$172.80
|
|
|
BX TONGUE POSTERIOR 1/3
|
Facility
|
IP
|
$384.00
|
|
|
Service Code
|
CPT 41105
|
| Hospital Charge Code |
9824110501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Aetna of VT Commercial |
$364.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$284.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$284.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$326.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$322.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$307.20
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$307.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$307.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$307.20
|
| Rate for Payer: Multiplan Commercial |
$357.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$326.40
|
| Rate for Payer: United Healthcare Commercial |
$364.80
|
|
|
BX TONGUE POSTERIOR 1/3
|
Professional
|
Both
|
$2,153.00
|
|
|
Service Code
|
CPT 41105
|
| Hospital Charge Code |
9604110501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$105.17 |
| Max. Negotiated Rate |
$2,023.82 |
| Rate for Payer: Aetna of VT Commercial |
$2,023.82
|
| 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 |
$108.33
|
| 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 |
$147.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$250.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$250.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$120.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$250.97
|
| Rate for Payer: Cash Price |
$1,076.50
|
| Rate for Payer: Cash Price |
$1,076.50
|
| Rate for Payer: Cigna Commercial |
$166.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$288.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$288.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$177.76
|
| Rate for Payer: Multiplan Commercial |
$2,002.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.17
|
| Rate for Payer: United Healthcare Commercial |
$161.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.17
|
| Rate for Payer: United Healthcare VA CCN |
$105.17
|
|
|
BX TONGUE POSTERIOR 1/3
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
CPT 41105
|
| Hospital Charge Code |
9824110501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$105.17 |
| Max. Negotiated Rate |
$360.96 |
| Rate for Payer: Aetna of VT Commercial |
$360.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$344.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$108.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$344.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$147.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$250.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$250.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$120.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$250.97
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$166.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$288.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$288.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$177.76
|
| Rate for Payer: Multiplan Commercial |
$357.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.17
|
| Rate for Payer: United Healthcare Commercial |
$161.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.17
|
| Rate for Payer: United Healthcare VA CCN |
$105.17
|
|
|
BX TONGUE POSTERIOR 1/3
|
Facility
|
OP
|
$1,770.00
|
|
|
Service Code
|
CPT 41105
|
| Hospital Charge Code |
5104110501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$783.93 |
| Max. Negotiated Rate |
$1,681.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,681.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,585.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$783.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,585.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,065.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,504.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,433.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$796.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,407.15
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$1,416.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,416.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,416.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$796.50
|
| Rate for Payer: Multiplan Commercial |
$1,646.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,504.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$796.50
|
| Rate for Payer: United Healthcare Commercial |
$1,681.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$796.50
|
| Rate for Payer: United Healthcare VA CCN |
$796.50
|
|
|
BX TONGUE POSTERIOR 1/3
|
Facility
|
IP
|
$1,770.00
|
|
|
Service Code
|
CPT 41105
|
| Hospital Charge Code |
5104110501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,309.98 |
| Max. Negotiated Rate |
$1,681.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,681.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,309.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,309.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,504.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,486.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,416.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$1,416.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,416.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,416.00
|
| Rate for Payer: Multiplan Commercial |
$1,646.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,504.50
|
| Rate for Payer: United Healthcare Commercial |
$1,681.50
|
|
|
BX TONGUE POSTERIOR 1/3
|
Facility
|
IP
|
$384.00
|
|
|
Service Code
|
CPT 41105
|
| Hospital Charge Code |
9604110502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Aetna of VT Commercial |
$364.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$284.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$284.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$326.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$322.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$307.20
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$307.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$307.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$307.20
|
| Rate for Payer: Multiplan Commercial |
$357.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$326.40
|
| Rate for Payer: United Healthcare Commercial |
$364.80
|
|
|
BX VULVA/PERINEUM EA ADDL LES
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
9825660601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$97.69 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna of VT Commercial |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$105.60
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.60
|
| Rate for Payer: Multiplan Commercial |
$122.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.20
|
| Rate for Payer: United Healthcare Commercial |
$125.40
|
|
|
BX VULVA/PERINEUM EA ADDL LES
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
9605660601
|
|
Hospital Revenue Code
|
960
|
| 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 VULVA/PERINEUM EA ADDL LES
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
9605660602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$58.46 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna of VT Commercial |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.94
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$59.40
|
| Rate for Payer: Multiplan Commercial |
$122.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.40
|
| Rate for Payer: United Healthcare Commercial |
$125.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.40
|
| Rate for Payer: United Healthcare VA CCN |
$59.40
|
|
|
BX VULVA/PERINEUM EA ADDL LES
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
9605660601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$199.28 |
| 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 |
$27.32
|
| 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 |
$37.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$68.36
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna Commercial |
$47.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.19
|
| Rate for Payer: Multiplan Commercial |
$197.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.66
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.52
|
| Rate for Payer: United Healthcare Commercial |
$40.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.52
|
| Rate for Payer: United Healthcare VA CCN |
$26.52
|
|
|
BX VULVA/PERINEUM EA ADDL LES
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
9605660602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$97.69 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna of VT Commercial |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$105.60
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.60
|
| Rate for Payer: Multiplan Commercial |
$122.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.20
|
| Rate for Payer: United Healthcare Commercial |
$125.40
|
|
|
BX VULVA/PERINEUM EA ADDL LES
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
9825660601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$124.08 |
| Rate for Payer: Aetna of VT Commercial |
$124.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$68.36
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$47.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.19
|
| Rate for Payer: Multiplan Commercial |
$122.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.66
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.52
|
| Rate for Payer: United Healthcare Commercial |
$40.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.52
|
| Rate for Payer: United Healthcare VA CCN |
$26.52
|
|
|
BX VULVA/PERINEUM EA ADDL LES
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
5105660601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.87 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Aetna of VT Commercial |
$76.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$48.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.39
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$64.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.45
|
| Rate for Payer: Multiplan Commercial |
$75.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.45
|
| Rate for Payer: United Healthcare Commercial |
$76.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.45
|
| Rate for Payer: United Healthcare VA CCN |
$36.45
|
|
|
BX VULVA/PERINEUM EA ADDL LES
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
5105660601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$76.14 |
| Rate for Payer: Aetna of VT Commercial |
$76.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$68.36
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$47.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.19
|
| Rate for Payer: Multiplan Commercial |
$75.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.66
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.52
|
| Rate for Payer: United Healthcare Commercial |
$40.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.52
|
| Rate for Payer: United Healthcare VA CCN |
$26.52
|
|
|
BX VULVA/PERINEUM EA ADDL LES
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
9825660601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$58.46 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna of VT Commercial |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.94
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$59.40
|
| Rate for Payer: Multiplan Commercial |
$122.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.40
|
| Rate for Payer: United Healthcare Commercial |
$125.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.40
|
| Rate for Payer: United Healthcare VA CCN |
$59.40
|
|
|
BX VULVA/PERINEUM EA ADDL LES
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
9605660602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$124.08 |
| Rate for Payer: Aetna of VT Commercial |
$124.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$68.36
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$47.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.19
|
| Rate for Payer: Multiplan Commercial |
$122.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.66
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.52
|
| Rate for Payer: United Healthcare Commercial |
$40.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.52
|
| Rate for Payer: United Healthcare VA CCN |
$26.52
|
|
|
BX VULVA/PERINEUM EA ADDL LES
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
9605660601
|
|
Hospital Revenue Code
|
960
|
| 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 VULVA/PERINEUM EA ADDL LES
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
5105660601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.95 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Aetna of VT Commercial |
$76.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.80
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$64.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$75.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.85
|
| Rate for Payer: United Healthcare Commercial |
$76.95
|
|
|
CALCIUM IONIZED
|
Professional
|
Both
|
$225.72
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
3008233001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.49 |
| Max. Negotiated Rate |
$212.18 |
| Rate for Payer: Aetna of VT Commercial |
$212.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$23.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$23.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$23.39
|
| Rate for Payer: Cash Price |
$112.86
|
| Rate for Payer: Cash Price |
$112.86
|
| Rate for Payer: Cigna Commercial |
$16.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.49
|
| Rate for Payer: Multiplan Commercial |
$209.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.68
|
| Rate for Payer: United Healthcare Commercial |
$21.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.68
|
| Rate for Payer: United Healthcare VA CCN |
$13.68
|
|
|
CALCIUM IONIZED
|
Facility
|
OP
|
$225.72
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
3008233001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$214.43 |
| Rate for Payer: Aetna of VT Commercial |
$214.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$99.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$135.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$191.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$182.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$101.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$179.45
|
| Rate for Payer: Cash Price |
$112.86
|
| Rate for Payer: Cash Price |
$112.86
|
| Rate for Payer: Cigna Commercial |
$180.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$180.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$180.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$101.57
|
| Rate for Payer: Multiplan Commercial |
$209.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$191.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$101.57
|
| Rate for Payer: United Healthcare Commercial |
$214.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.68
|
| Rate for Payer: United Healthcare VA CCN |
$101.57
|
|
