|
COLONOSCOPY W/DECOMPRESSION
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT 45393
|
| Hospital Charge Code |
9824539301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$363.62 |
| Max. Negotiated Rate |
$779.95 |
| Rate for Payer: Aetna of VT Commercial |
$779.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$735.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$363.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$735.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$494.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$697.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$665.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$369.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$652.70
|
| Rate for Payer: Cash Price |
$410.50
|
| Rate for Payer: Cigna Commercial |
$656.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$656.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$656.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$369.45
|
| Rate for Payer: Multiplan Commercial |
$763.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$697.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$369.45
|
| Rate for Payer: United Healthcare Commercial |
$779.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$369.45
|
| Rate for Payer: United Healthcare VA CCN |
$369.45
|
|
|
COLONOSCOPY W/DECOMPRESSION
|
Facility
|
IP
|
$821.00
|
|
|
Service Code
|
CPT 45393
|
| Hospital Charge Code |
9824539301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$607.62 |
| Max. Negotiated Rate |
$779.95 |
| Rate for Payer: Aetna of VT Commercial |
$779.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$607.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$607.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$697.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$689.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$656.80
|
| Rate for Payer: Cash Price |
$410.50
|
| Rate for Payer: Cigna Commercial |
$656.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$656.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$656.80
|
| Rate for Payer: Multiplan Commercial |
$763.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$697.85
|
| Rate for Payer: United Healthcare Commercial |
$779.95
|
|
|
COLONOSCOPY W/LESION REMOVAL
|
Facility
|
IP
|
$1,214.00
|
|
|
Service Code
|
CPT 45385
|
| Hospital Charge Code |
9824538501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$898.48 |
| Max. Negotiated Rate |
$1,153.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,153.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$898.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$898.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,031.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,019.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$971.20
|
| Rate for Payer: Cash Price |
$607.00
|
| Rate for Payer: Cigna Commercial |
$971.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$971.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$971.20
|
| Rate for Payer: Multiplan Commercial |
$1,129.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,031.90
|
| Rate for Payer: United Healthcare Commercial |
$1,153.30
|
|
|
COLONOSCOPY W/LESION REMOVAL
|
Professional
|
Both
|
$1,084.00
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
9824538401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$208.69 |
| Max. Negotiated Rate |
$1,018.96 |
| Rate for Payer: Aetna of VT Commercial |
$1,018.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$971.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$214.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$971.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$292.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$766.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$766.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$239.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$766.41
|
| Rate for Payer: Cash Price |
$542.00
|
| Rate for Payer: Cash Price |
$542.00
|
| Rate for Payer: Cigna Commercial |
$382.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$742.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$742.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$455.05
|
| Rate for Payer: Multiplan Commercial |
$1,008.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$296.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$208.69
|
| Rate for Payer: United Healthcare Commercial |
$321.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$208.69
|
| Rate for Payer: United Healthcare VA CCN |
$208.69
|
|
|
COLONOSCOPY W/LESION REMOVAL
|
Professional
|
Both
|
$1,214.00
|
|
|
Service Code
|
CPT 45385
|
| Hospital Charge Code |
9824538501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$233.65 |
| Max. Negotiated Rate |
$1,141.16 |
| Rate for Payer: Aetna of VT Commercial |
$1,141.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,087.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$240.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,087.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$327.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$864.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$864.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$268.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$864.10
|
| Rate for Payer: Cash Price |
$607.00
|
| Rate for Payer: Cash Price |
$607.00
|
| Rate for Payer: Cigna Commercial |
$638.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$692.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$692.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$424.76
|
| Rate for Payer: Multiplan Commercial |
$1,129.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$331.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$233.65
|
| Rate for Payer: United Healthcare Commercial |
$359.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.65
|
| Rate for Payer: United Healthcare VA CCN |
$233.65
|
|
|
COLONOSCOPY W/LESION REMOVAL
|
Facility
|
IP
|
$1,084.00
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
9824538401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$802.27 |
| Max. Negotiated Rate |
$1,029.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,029.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$802.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$802.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$921.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$910.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$867.20
|
| Rate for Payer: Cash Price |
$542.00
|
| Rate for Payer: Cigna Commercial |
$867.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$867.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$867.20
|
| Rate for Payer: Multiplan Commercial |
$1,008.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$921.40
|
| Rate for Payer: United Healthcare Commercial |
$1,029.80
|
|
|
COLONOSCOPY W/LESION REMOVAL
|
Facility
|
OP
|
$1,084.00
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
9824538401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$480.10 |
| Max. Negotiated Rate |
$1,029.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,029.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$971.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$480.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$971.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$652.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$921.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$878.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$487.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$861.78
|
| Rate for Payer: Cash Price |
$542.00
|
| Rate for Payer: Cigna Commercial |
$867.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$867.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$867.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$487.80
|
| Rate for Payer: Multiplan Commercial |
$1,008.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$921.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$487.80
|
| Rate for Payer: United Healthcare Commercial |
$1,029.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$487.80
|
| Rate for Payer: United Healthcare VA CCN |
$487.80
|
|
|
COLONOSCOPY W/LESION REMOVAL
|
Facility
|
OP
|
$1,214.00
|
|
|
Service Code
|
CPT 45385
|
| Hospital Charge Code |
9824538501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$537.68 |
| Max. Negotiated Rate |
$1,153.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,153.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,087.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$537.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,087.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$730.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,031.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$983.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$546.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$965.13
|
| Rate for Payer: Cash Price |
$607.00
|
| Rate for Payer: Cigna Commercial |
$971.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$971.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$971.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$546.30
|
| Rate for Payer: Multiplan Commercial |
$1,129.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,031.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$546.30
|
| Rate for Payer: United Healthcare Commercial |
$1,153.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$546.30
|
| Rate for Payer: United Healthcare VA CCN |
$546.30
|
|
|
COLORECTAL SCRN; HI RISK IND
|
Professional
|
Both
|
$1,072.00
|
|
|
Service Code
|
HCPCS G0105
|
| Hospital Charge Code |
982G010501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$170.15 |
| Max. Negotiated Rate |
$1,007.68 |
| Rate for Payer: Aetna of VT Commercial |
$1,007.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$960.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$175.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$960.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$238.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$578.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$578.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$195.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$578.55
|
| Rate for Payer: Cash Price |
$536.00
|
| Rate for Payer: Cash Price |
$536.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$520.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$520.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$319.51
|
| Rate for Payer: Multiplan Commercial |
$996.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$241.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$170.15
|
| Rate for Payer: United Healthcare Commercial |
$261.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$170.15
|
| Rate for Payer: United Healthcare VA CCN |
$170.15
|
|
|
COLORECTAL SCRN; HI RISK IND
|
Facility
|
IP
|
$1,072.00
|
|
|
Service Code
|
HCPCS G0105
|
| Hospital Charge Code |
982G010501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$793.39 |
| Max. Negotiated Rate |
$1,018.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,018.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$793.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$793.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$911.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$900.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$857.60
|
| Rate for Payer: Cash Price |
$536.00
|
| Rate for Payer: Cigna Commercial |
$857.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$857.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$857.60
|
| Rate for Payer: Multiplan Commercial |
$996.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$911.20
|
| Rate for Payer: United Healthcare Commercial |
$1,018.40
|
|
|
COLORECTAL SCRN; HI RISK IND
|
Facility
|
OP
|
$1,072.00
|
|
|
Service Code
|
HCPCS G0105
|
| Hospital Charge Code |
982G010501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$474.79 |
| Max. Negotiated Rate |
$1,018.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,018.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$960.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$474.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$960.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$645.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$911.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$868.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$482.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$852.24
|
| Rate for Payer: Cash Price |
$536.00
|
| Rate for Payer: Cigna Commercial |
$857.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$857.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$857.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$482.40
|
| Rate for Payer: Multiplan Commercial |
$996.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$911.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$482.40
|
| Rate for Payer: United Healthcare Commercial |
$1,018.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$482.40
|
| Rate for Payer: United Healthcare VA CCN |
$482.40
|
|
|
COLPOPEXY EXTRAPERITONEAL
|
Professional
|
Both
|
$1,522.00
|
|
|
Service Code
|
CPT 57282
|
| Hospital Charge Code |
9825728201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$645.97 |
| Max. Negotiated Rate |
$1,430.68 |
| Rate for Payer: Aetna of VT Commercial |
$1,430.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,363.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$665.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,363.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$904.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$994.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$994.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$742.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$994.45
|
| Rate for Payer: Cash Price |
$761.00
|
| Rate for Payer: Cash Price |
$761.00
|
| Rate for Payer: Cigna Commercial |
$1,140.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,074.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,074.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$645.97
|
| Rate for Payer: Multiplan Commercial |
$1,415.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$917.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$645.97
|
| Rate for Payer: United Healthcare Commercial |
$993.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$645.97
|
| Rate for Payer: United Healthcare VA CCN |
$645.97
|
|
|
COLPOPEXY EXTRAPERITONEAL
|
Facility
|
OP
|
$1,522.00
|
|
|
Service Code
|
CPT 57282
|
| Hospital Charge Code |
9825728201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$674.09 |
| Max. Negotiated Rate |
$1,445.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,445.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,363.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$674.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,363.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$916.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,293.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,232.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$684.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,209.99
|
| Rate for Payer: Cash Price |
$761.00
|
| Rate for Payer: Cigna Commercial |
$1,217.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,217.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,217.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$684.90
|
| Rate for Payer: Multiplan Commercial |
$1,415.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,293.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$684.90
|
| Rate for Payer: United Healthcare Commercial |
$1,445.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$684.90
|
| Rate for Payer: United Healthcare VA CCN |
$684.90
|
|
|
COLPOPEXY EXTRAPERITONEAL
|
Facility
|
IP
|
$1,522.00
|
|
|
Service Code
|
CPT 57282
|
| Hospital Charge Code |
9825728201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,126.43 |
| Max. Negotiated Rate |
$1,445.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,445.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,126.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,126.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,293.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,278.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,217.60
|
| Rate for Payer: Cash Price |
$761.00
|
| Rate for Payer: Cigna Commercial |
$1,217.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,217.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,217.60
|
| Rate for Payer: Multiplan Commercial |
$1,415.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,293.70
|
| Rate for Payer: United Healthcare Commercial |
$1,445.90
|
|
|
COLPOPEXY INTRAPERITONEAL
|
Facility
|
IP
|
$1,709.00
|
|
|
Service Code
|
CPT 57283
|
| Hospital Charge Code |
9825728301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,264.83 |
| Max. Negotiated Rate |
$1,623.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,264.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,264.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,452.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,435.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,367.20
|
| Rate for Payer: Cash Price |
$854.50
|
| Rate for Payer: Cigna Commercial |
$1,367.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,367.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,367.20
|
| Rate for Payer: Multiplan Commercial |
$1,589.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,452.65
|
| Rate for Payer: United Healthcare Commercial |
$1,623.55
|
|
|
COLPOPEXY INTRAPERITONEAL
|
Facility
|
OP
|
$1,709.00
|
|
|
Service Code
|
CPT 57283
|
| Hospital Charge Code |
9825728301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$756.92 |
| Max. Negotiated Rate |
$1,623.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,531.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$756.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,531.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,028.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,452.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,384.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$769.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,358.65
|
| Rate for Payer: Cash Price |
$854.50
|
| Rate for Payer: Cigna Commercial |
$1,367.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,367.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,367.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$769.05
|
| Rate for Payer: Multiplan Commercial |
$1,589.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,452.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$769.05
|
| Rate for Payer: United Healthcare Commercial |
$1,623.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$769.05
|
| Rate for Payer: United Healthcare VA CCN |
$769.05
|
|
|
COLPOPEXY INTRAPERITONEAL
|
Professional
|
Both
|
$1,709.00
|
|
|
Service Code
|
CPT 57283
|
| Hospital Charge Code |
9825728301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$649.90 |
| Max. Negotiated Rate |
$1,606.46 |
| Rate for Payer: Aetna of VT Commercial |
$1,606.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,531.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$669.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,531.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$909.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,147.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,147.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$747.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,147.97
|
| Rate for Payer: Cash Price |
$854.50
|
| Rate for Payer: Cash Price |
$854.50
|
| Rate for Payer: Cigna Commercial |
$1,147.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,083.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,083.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$649.90
|
| Rate for Payer: Multiplan Commercial |
$1,589.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$922.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$649.90
|
| Rate for Payer: United Healthcare Commercial |
$999.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$649.90
|
| Rate for Payer: United Healthcare VA CCN |
$649.90
|
|
|
COLPOSCOPY VAG W/VAG/CERVIX BX
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
5105742101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.39 |
| Max. Negotiated Rate |
$276.73 |
| Rate for Payer: Aetna of VT Commercial |
$213.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$203.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$115.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$203.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$276.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$276.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$129.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$276.73
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$197.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$275.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$275.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$166.34
|
| Rate for Payer: Multiplan Commercial |
$211.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$159.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.39
|
| Rate for Payer: United Healthcare Commercial |
$172.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.39
|
| Rate for Payer: United Healthcare VA CCN |
$112.39
|
|
|
COLPOSCOPY VAG W/VAG/CERVIX BX
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
5105742101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Aetna of VT Commercial |
$215.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$192.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$190.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$181.60
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$181.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$181.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$211.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$192.95
|
| Rate for Payer: United Healthcare Commercial |
$215.65
|
|
|
COLPOSCOPY VAG W/VAG/CERVIX BX
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
9825742101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$168.74 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Aetna of VT Commercial |
$361.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$168.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$229.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$308.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$171.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$302.89
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$304.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$171.45
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$323.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$171.45
|
| Rate for Payer: United Healthcare Commercial |
$361.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.45
|
| Rate for Payer: United Healthcare VA CCN |
$171.45
|
|
|
COLPOSCOPY VAG W/VAG/CERVIX BX
|
Professional
|
Both
|
$608.00
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
9605742101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$112.39 |
| Max. Negotiated Rate |
$571.52 |
| Rate for Payer: Aetna of VT Commercial |
$571.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$544.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$115.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$544.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$276.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$276.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$129.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$276.73
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cigna Commercial |
$197.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$275.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$275.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$166.34
|
| Rate for Payer: Multiplan Commercial |
$565.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$159.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.39
|
| Rate for Payer: United Healthcare Commercial |
$172.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.39
|
| Rate for Payer: United Healthcare VA CCN |
$112.39
|
|
|
COLPOSCOPY VAG W/VAG/CERVIX BX
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
9605742102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$281.98 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Aetna of VT Commercial |
$361.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$281.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$281.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$320.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$304.80
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$304.80
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$323.85
|
| Rate for Payer: United Healthcare Commercial |
$361.95
|
|
|
COLPOSCOPY VAG W/VAG/CERVIX BX
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
9825742101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$112.39 |
| Max. Negotiated Rate |
$358.14 |
| Rate for Payer: Aetna of VT Commercial |
$358.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$115.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$276.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$276.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$129.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$276.73
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$197.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$275.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$275.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$166.34
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$159.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.39
|
| Rate for Payer: United Healthcare Commercial |
$172.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.39
|
| Rate for Payer: United Healthcare VA CCN |
$112.39
|
|
|
COLPOSCOPY VAG W/VAG/CERVIX BX
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
9605742101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$449.98 |
| Max. Negotiated Rate |
$577.60 |
| Rate for Payer: Aetna of VT Commercial |
$577.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$449.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$449.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$516.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$510.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$486.40
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cigna Commercial |
$486.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$486.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$486.40
|
| Rate for Payer: Multiplan Commercial |
$565.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$516.80
|
| Rate for Payer: United Healthcare Commercial |
$577.60
|
|
|
COLPOSCOPY VAG W/VAG/CERVIX BX
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
9605742102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$112.39 |
| Max. Negotiated Rate |
$358.14 |
| Rate for Payer: Aetna of VT Commercial |
$358.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$115.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$276.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$276.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$129.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$276.73
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$197.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$275.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$275.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$166.34
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$159.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.39
|
| Rate for Payer: United Healthcare Commercial |
$172.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.39
|
| Rate for Payer: United Healthcare VA CCN |
$112.39
|
|
