|
CHROMOSOME ANALYSIS 15-20
|
Facility
|
OP
|
$508.73
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
6368826201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$225.32 |
| Max. Negotiated Rate |
$483.29 |
| Rate for Payer: Aetna of VT Commercial |
$483.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$455.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$225.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$455.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$306.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$432.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$412.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$228.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$404.44
|
| Rate for Payer: Cash Price |
$254.36
|
| Rate for Payer: Cigna Commercial |
$406.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$406.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$406.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$228.93
|
| Rate for Payer: Multiplan Commercial |
$473.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$432.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$228.93
|
| Rate for Payer: United Healthcare Commercial |
$483.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$228.93
|
| Rate for Payer: United Healthcare VA CCN |
$228.93
|
|
|
CILOSTAZOL 100 MG TAB
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 5026817715
|
| Hospital Charge Code |
2500000554
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
CILOSTAZOL 100 MG TAB
|
Facility
|
IP
|
$0.01
|
|
| Hospital Charge Code |
2500000554
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
CILOSTAZOL 100 MG TAB
|
Facility
|
OP
|
$0.01
|
|
| Hospital Charge Code |
2500000554
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
CILOSTAZOL 100 MG TAB
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 5026817715
|
| Hospital Charge Code |
2500000554
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
CIPROFLOXACIN 500 MG TAB
|
Professional
|
Both
|
$0.28
|
|
| Hospital Charge Code |
2500000355
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of VT Commercial |
$0.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.25
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: United Healthcare Commercial |
$0.24
|
| Rate for Payer: United Healthcare VA CCN |
$0.11
|
|
|
CIPROFLOXACIN 500 MG TAB
|
Professional
|
Both
|
$0.28
|
|
|
Service Code
|
NDC 904724361
|
| Hospital Charge Code |
2500000355
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of VT Commercial |
$0.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.25
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: United Healthcare Commercial |
$0.24
|
| Rate for Payer: United Healthcare VA CCN |
$0.11
|
|
|
CIRCUM 28 DAYS OR OLDER
|
Professional
|
Both
|
$523.00
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
9825416101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$186.36 |
| Max. Negotiated Rate |
$491.62 |
| Rate for Payer: Aetna of VT Commercial |
$491.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$468.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$191.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$468.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$260.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$329.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$329.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$214.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$329.38
|
| Rate for Payer: Cash Price |
$261.50
|
| Rate for Payer: Cash Price |
$261.50
|
| Rate for Payer: Cigna Commercial |
$323.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$307.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$307.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$186.36
|
| Rate for Payer: Multiplan Commercial |
$486.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$186.36
|
| Rate for Payer: United Healthcare Commercial |
$286.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.36
|
| Rate for Payer: United Healthcare VA CCN |
$186.36
|
|
|
CIRCUM 28 DAYS OR OLDER
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
9825416101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$231.64 |
| Max. Negotiated Rate |
$496.85 |
| Rate for Payer: Aetna of VT Commercial |
$496.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$468.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$231.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$468.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$314.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$444.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$423.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$235.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$415.79
|
| Rate for Payer: Cash Price |
$261.50
|
| Rate for Payer: Cigna Commercial |
$418.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$418.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$418.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$235.35
|
| Rate for Payer: Multiplan Commercial |
$486.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$444.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$235.35
|
| Rate for Payer: United Healthcare Commercial |
$496.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$235.35
|
| Rate for Payer: United Healthcare VA CCN |
$235.35
|
|
|
CIRCUM 28 DAYS OR OLDER
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
9825416101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$387.07 |
| Max. Negotiated Rate |
$496.85 |
| Rate for Payer: Aetna of VT Commercial |
$496.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$387.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$387.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$444.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$439.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$418.40
|
| Rate for Payer: Cash Price |
$261.50
|
| Rate for Payer: Cigna Commercial |
$418.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$418.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$418.40
|
| Rate for Payer: Multiplan Commercial |
$486.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$444.55
|
| Rate for Payer: United Healthcare Commercial |
$496.85
|
|
|
CIRCUMCISION NEONATE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
5215416001
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$172.73 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Aetna of VT Commercial |
$370.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$349.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$172.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$349.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$234.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$315.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$175.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$310.05
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$312.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$312.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$312.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$175.50
|
| Rate for Payer: Multiplan Commercial |
$362.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$331.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$175.50
|
| Rate for Payer: United Healthcare Commercial |
$370.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$175.50
|
| Rate for Payer: United Healthcare VA CCN |
$175.50
|
|
|
CIRCUMCISION NEONATE
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
5215416001
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$88.93 |
| Max. Negotiated Rate |
$375.96 |
| Rate for Payer: Aetna of VT Commercial |
$366.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$349.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$91.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$349.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$124.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$375.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$375.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$102.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$375.96
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$154.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$228.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$228.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$139.68
|
| Rate for Payer: Multiplan Commercial |
$362.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$88.93
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.93
|
| Rate for Payer: United Healthcare VA CCN |
$88.93
|
|
|
CIRCUMCISION NEONATE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
5215416001
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$288.64 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Aetna of VT Commercial |
$370.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$288.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$288.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$327.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$312.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$312.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$312.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$312.00
|
| Rate for Payer: Multiplan Commercial |
$362.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$331.50
|
| Rate for Payer: United Healthcare Commercial |
$370.50
|
|
|
CIRCUMCISION W/REGIONL BLOCK
|
Professional
|
Both
|
$7,393.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
5105415001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.93 |
| Max. Negotiated Rate |
$6,949.42 |
| Rate for Payer: Aetna of VT Commercial |
$6,949.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,623.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$91.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,623.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$124.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$375.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$375.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$102.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$375.96
|
| Rate for Payer: Cash Price |
$3,696.50
|
| Rate for Payer: Cash Price |
$3,696.50
|
| Rate for Payer: Cigna Commercial |
$154.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$228.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$228.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$139.68
|
| Rate for Payer: Multiplan Commercial |
$6,875.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$88.93
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.93
|
| Rate for Payer: United Healthcare VA CCN |
$88.93
|
|
|
CIRCUMCISION W/REGIONL BLOCK
|
Facility
|
IP
|
$7,393.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
5105415001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,471.56 |
| Max. Negotiated Rate |
$7,023.35 |
| Rate for Payer: Aetna of VT Commercial |
$7,023.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,471.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,471.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,284.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,210.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,914.40
|
| Rate for Payer: Cash Price |
$3,696.50
|
| Rate for Payer: Cigna Commercial |
$5,914.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,914.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,914.40
|
| Rate for Payer: Multiplan Commercial |
$6,875.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,284.05
|
| Rate for Payer: United Healthcare Commercial |
$7,023.35
|
|
|
CIRCUMCISION W/REGIONL BLOCK
|
Facility
|
OP
|
$7,392.07
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
7235415001
|
|
Hospital Revenue Code
|
723
|
| Min. Negotiated Rate |
$3,273.95 |
| Max. Negotiated Rate |
$7,022.47 |
| Rate for Payer: Aetna of VT Commercial |
$7,022.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,622.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,273.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,622.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,450.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,283.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,987.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,326.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,876.70
|
| Rate for Payer: Cash Price |
$3,696.03
|
| Rate for Payer: Cigna Commercial |
$5,913.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,913.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,913.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,326.43
|
| Rate for Payer: Multiplan Commercial |
$6,874.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,283.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,326.43
|
| Rate for Payer: United Healthcare Commercial |
$7,022.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,326.43
|
| Rate for Payer: United Healthcare VA CCN |
$3,326.43
|
|
|
CIRCUMCISION W/REGIONL BLOCK
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
5215415002
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$288.64 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Aetna of VT Commercial |
$370.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$288.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$288.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$327.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$312.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$312.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$312.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$312.00
|
| Rate for Payer: Multiplan Commercial |
$362.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$331.50
|
| Rate for Payer: United Healthcare Commercial |
$370.50
|
|
|
CIRCUMCISION W/REGIONL BLOCK
|
Facility
|
IP
|
$7,392.07
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
7235415001
|
|
Hospital Revenue Code
|
723
|
| Min. Negotiated Rate |
$5,470.87 |
| Max. Negotiated Rate |
$7,022.47 |
| Rate for Payer: Aetna of VT Commercial |
$7,022.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,470.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,470.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,283.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,209.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,913.66
|
| Rate for Payer: Cash Price |
$3,696.03
|
| Rate for Payer: Cigna Commercial |
$5,913.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,913.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,913.66
|
| Rate for Payer: Multiplan Commercial |
$6,874.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,283.26
|
| Rate for Payer: United Healthcare Commercial |
$7,022.47
|
|
|
CIRCUMCISION W/REGIONL BLOCK
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
5215415002
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$172.73 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Aetna of VT Commercial |
$370.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$349.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$172.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$349.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$234.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$315.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$175.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$310.05
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$312.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$312.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$312.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$175.50
|
| Rate for Payer: Multiplan Commercial |
$362.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$331.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$175.50
|
| Rate for Payer: United Healthcare Commercial |
$370.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$175.50
|
| Rate for Payer: United Healthcare VA CCN |
$175.50
|
|
|
CIRCUMCISION W/REGIONL BLOCK
|
Facility
|
OP
|
$7,393.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
5105415001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,274.36 |
| Max. Negotiated Rate |
$7,023.35 |
| Rate for Payer: Aetna of VT Commercial |
$7,023.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,623.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,274.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,623.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,450.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,284.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,988.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,326.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,877.44
|
| Rate for Payer: Cash Price |
$3,696.50
|
| Rate for Payer: Cigna Commercial |
$5,914.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,914.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,914.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,326.85
|
| Rate for Payer: Multiplan Commercial |
$6,875.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,284.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,326.85
|
| Rate for Payer: United Healthcare Commercial |
$7,023.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,326.85
|
| Rate for Payer: United Healthcare VA CCN |
$3,326.85
|
|
|
CIRCUMCISION W/REGIONL BLOCK
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
9605415002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$88.93 |
| Max. Negotiated Rate |
$375.96 |
| Rate for Payer: Aetna of VT Commercial |
$366.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$349.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$91.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$349.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$124.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$375.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$375.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$102.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$375.96
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$154.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$228.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$228.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$139.68
|
| Rate for Payer: Multiplan Commercial |
$362.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$88.93
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.93
|
| Rate for Payer: United Healthcare VA CCN |
$88.93
|
|
|
CIRCUMCISION W/REGIONL BLOCK
|
Facility
|
IP
|
$7,782.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
9605415001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$5,759.46 |
| Max. Negotiated Rate |
$7,392.90 |
| Rate for Payer: Aetna of VT Commercial |
$7,392.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,759.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,759.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,614.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,536.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,225.60
|
| Rate for Payer: Cash Price |
$3,891.00
|
| Rate for Payer: Cigna Commercial |
$6,225.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,225.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,225.60
|
| Rate for Payer: Multiplan Commercial |
$7,237.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,614.70
|
| Rate for Payer: United Healthcare Commercial |
$7,392.90
|
|
|
CIRCUMCISION W/REGIONL BLOCK
|
Facility
|
OP
|
$7,782.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
9605415001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,446.65 |
| Max. Negotiated Rate |
$7,392.90 |
| Rate for Payer: Aetna of VT Commercial |
$7,392.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,971.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,446.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,971.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,684.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,614.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,303.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,501.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,186.69
|
| Rate for Payer: Cash Price |
$3,891.00
|
| Rate for Payer: Cigna Commercial |
$6,225.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,225.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,225.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,501.90
|
| Rate for Payer: Multiplan Commercial |
$7,237.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,614.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,501.90
|
| Rate for Payer: United Healthcare Commercial |
$7,392.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,501.90
|
| Rate for Payer: United Healthcare VA CCN |
$3,501.90
|
|
|
CIRCUMCISION W/REGIONL BLOCK
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
5215415002
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$88.93 |
| Max. Negotiated Rate |
$375.96 |
| Rate for Payer: Aetna of VT Commercial |
$366.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$349.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$91.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$349.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$124.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$375.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$375.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$102.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$375.96
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$154.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$228.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$228.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$139.68
|
| Rate for Payer: Multiplan Commercial |
$362.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$88.93
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.93
|
| Rate for Payer: United Healthcare VA CCN |
$88.93
|
|
|
CIRCUMCISION W/REGIONL BLOCK
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
9605415002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$288.64 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Aetna of VT Commercial |
$370.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$288.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$288.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$327.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$312.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$312.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$312.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$312.00
|
| Rate for Payer: Multiplan Commercial |
$362.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$331.50
|
| Rate for Payer: United Healthcare Commercial |
$370.50
|
|
