|
CORRECTION HALLUX VALGUS
|
Facility
|
IP
|
$1,677.00
|
|
|
Service Code
|
CPT 28292
|
| Hospital Charge Code |
9822829201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,241.15 |
| Max. Negotiated Rate |
$1,593.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,593.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,241.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,241.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,425.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,408.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,341.60
|
| Rate for Payer: Cash Price |
$838.50
|
| Rate for Payer: Cigna Commercial |
$1,341.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,341.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,341.60
|
| Rate for Payer: Multiplan Commercial |
$1,559.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,425.45
|
| Rate for Payer: United Healthcare Commercial |
$1,593.15
|
|
|
CORRECTION HALLUX VALGUS
|
Facility
|
OP
|
$2,189.00
|
|
|
Service Code
|
CPT 28299
|
| Hospital Charge Code |
9822829901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$969.51 |
| Max. Negotiated Rate |
$2,079.55 |
| Rate for Payer: Aetna of VT Commercial |
$2,079.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,961.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$969.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,961.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,317.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,860.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,773.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$985.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,740.26
|
| Rate for Payer: Cash Price |
$1,094.50
|
| Rate for Payer: Cigna Commercial |
$1,751.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,751.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,751.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$985.05
|
| Rate for Payer: Multiplan Commercial |
$2,035.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,860.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$985.05
|
| Rate for Payer: United Healthcare Commercial |
$2,079.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$985.05
|
| Rate for Payer: United Healthcare VA CCN |
$985.05
|
|
|
CORRECTION HALLUX VALGUS
|
Facility
|
IP
|
$2,522.00
|
|
|
Service Code
|
CPT 28295
|
| Hospital Charge Code |
9822829501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,866.53 |
| Max. Negotiated Rate |
$2,395.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,395.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,866.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,866.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,143.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,118.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,017.60
|
| Rate for Payer: Cash Price |
$1,261.00
|
| Rate for Payer: Cigna Commercial |
$2,017.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,017.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,017.60
|
| Rate for Payer: Multiplan Commercial |
$2,345.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,143.70
|
| Rate for Payer: United Healthcare Commercial |
$2,395.90
|
|
|
CORRECTION HALLUX VALGUS
|
Facility
|
OP
|
$1,758.00
|
|
|
Service Code
|
CPT 28296
|
| Hospital Charge Code |
9822829601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$778.62 |
| Max. Negotiated Rate |
$1,670.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,670.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,574.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$778.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,574.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,058.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,494.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,423.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$791.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,397.61
|
| Rate for Payer: Cash Price |
$879.00
|
| Rate for Payer: Cigna Commercial |
$1,406.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,406.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,406.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$791.10
|
| Rate for Payer: Multiplan Commercial |
$1,634.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,494.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$791.10
|
| Rate for Payer: United Healthcare Commercial |
$1,670.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$791.10
|
| Rate for Payer: United Healthcare VA CCN |
$791.10
|
|
|
CORRECTION HALLUX VALGUS
|
Facility
|
IP
|
$1,758.00
|
|
|
Service Code
|
CPT 28296
|
| Hospital Charge Code |
9822829601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,301.10 |
| Max. Negotiated Rate |
$1,670.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,670.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,301.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,301.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,494.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,476.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,406.40
|
| Rate for Payer: Cash Price |
$879.00
|
| Rate for Payer: Cigna Commercial |
$1,406.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,406.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,406.40
|
| Rate for Payer: Multiplan Commercial |
$1,634.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,494.30
|
| Rate for Payer: United Healthcare Commercial |
$1,670.10
|
|
|
CORRECTION HALLUX VALGUS
|
Professional
|
Both
|
$1,677.00
|
|
|
Service Code
|
CPT 28292
|
| Hospital Charge Code |
9822829201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$467.77 |
| Max. Negotiated Rate |
$1,576.38 |
| Rate for Payer: Aetna of VT Commercial |
$1,576.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,502.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$481.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,502.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$654.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$990.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$990.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$537.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$990.24
|
| Rate for Payer: Cash Price |
$838.50
|
| Rate for Payer: Cash Price |
$838.50
|
| Rate for Payer: Cigna Commercial |
$885.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,077.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,077.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$663.38
|
| Rate for Payer: Multiplan Commercial |
$1,559.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$664.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$467.77
|
| Rate for Payer: United Healthcare Commercial |
$719.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$467.77
|
| Rate for Payer: United Healthcare VA CCN |
$467.77
|
|
|
CORRECTION HALLUX VALGUS
|
Professional
|
Both
|
$2,522.00
|
|
|
Service Code
|
CPT 28295
|
| Hospital Charge Code |
9822829501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$570.00 |
| Max. Negotiated Rate |
$2,370.68 |
| Rate for Payer: Aetna of VT Commercial |
$2,370.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,259.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$587.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,259.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$798.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,398.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,398.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$655.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,398.83
|
| Rate for Payer: Cash Price |
$1,261.00
|
| Rate for Payer: Cash Price |
$1,261.00
|
| Rate for Payer: Cigna Commercial |
$1,086.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,587.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,587.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$975.36
|
| Rate for Payer: Multiplan Commercial |
$2,345.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$809.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$570.00
|
| Rate for Payer: United Healthcare Commercial |
$876.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$570.00
|
| Rate for Payer: United Healthcare VA CCN |
$570.00
|
|
|
CORRECTION HALLUX VALGUS
|
Facility
|
IP
|
$1,774.00
|
|
|
Service Code
|
CPT 28298
|
| Hospital Charge Code |
9822829801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,312.94 |
| Max. Negotiated Rate |
$1,685.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,685.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,312.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,312.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,507.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,490.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,419.20
|
| Rate for Payer: Cash Price |
$887.00
|
| Rate for Payer: Cigna Commercial |
$1,419.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,419.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,419.20
|
| Rate for Payer: Multiplan Commercial |
$1,649.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,507.90
|
| Rate for Payer: United Healthcare Commercial |
$1,685.30
|
|
|
CORRECTION HALLUX VALGUS
|
Facility
|
OP
|
$2,522.00
|
|
|
Service Code
|
CPT 28295
|
| Hospital Charge Code |
9822829501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,116.99 |
| Max. Negotiated Rate |
$2,395.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,395.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,259.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,116.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,259.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,518.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,143.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,042.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,134.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,004.99
|
| Rate for Payer: Cash Price |
$1,261.00
|
| Rate for Payer: Cigna Commercial |
$2,017.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,017.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,017.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,134.90
|
| Rate for Payer: Multiplan Commercial |
$2,345.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,143.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,134.90
|
| Rate for Payer: United Healthcare Commercial |
$2,395.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,134.90
|
| Rate for Payer: United Healthcare VA CCN |
$1,134.90
|
|
|
CORRECTION HALLUX VALGUS
|
Facility
|
OP
|
$2,098.00
|
|
|
Service Code
|
CPT 28297
|
| Hospital Charge Code |
9822829701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$929.20 |
| Max. Negotiated Rate |
$1,993.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,993.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,879.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$929.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,879.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,263.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,783.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,699.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$944.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,667.91
|
| Rate for Payer: Cash Price |
$1,049.00
|
| Rate for Payer: Cigna Commercial |
$1,678.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,678.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,678.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$944.10
|
| Rate for Payer: Multiplan Commercial |
$1,951.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,783.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$944.10
|
| Rate for Payer: United Healthcare Commercial |
$1,993.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$944.10
|
| Rate for Payer: United Healthcare VA CCN |
$944.10
|
|
|
CORRECTION HALLUX VALGUS
|
Facility
|
IP
|
$2,098.00
|
|
|
Service Code
|
CPT 28297
|
| Hospital Charge Code |
9822829701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,552.73 |
| Max. Negotiated Rate |
$1,993.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,993.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,552.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,552.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,783.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,762.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,678.40
|
| Rate for Payer: Cash Price |
$1,049.00
|
| Rate for Payer: Cigna Commercial |
$1,678.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,678.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,678.40
|
| Rate for Payer: Multiplan Commercial |
$1,951.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,783.30
|
| Rate for Payer: United Healthcare Commercial |
$1,993.10
|
|
|
CORRECTION HALLUX VALGUS
|
Professional
|
Both
|
$1,758.00
|
|
|
Service Code
|
CPT 28296
|
| Hospital Charge Code |
9822829601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$494.34 |
| Max. Negotiated Rate |
$1,652.52 |
| Rate for Payer: Aetna of VT Commercial |
$1,652.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,574.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$509.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,574.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$692.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,220.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,220.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$568.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,220.41
|
| Rate for Payer: Cash Price |
$879.00
|
| Rate for Payer: Cash Price |
$879.00
|
| Rate for Payer: Cigna Commercial |
$934.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,353.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,353.13
|
| Rate for Payer: Martins Point Health Care Commercial |
$834.81
|
| Rate for Payer: Multiplan Commercial |
$1,634.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$701.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$494.34
|
| Rate for Payer: United Healthcare Commercial |
$760.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$494.34
|
| Rate for Payer: United Healthcare VA CCN |
$494.34
|
|
|
CORRECTION HALLUX VALGUS
|
Facility
|
OP
|
$1,677.00
|
|
|
Service Code
|
CPT 28292
|
| Hospital Charge Code |
9822829201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$742.74 |
| Max. Negotiated Rate |
$1,593.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,593.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,502.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$742.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,502.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,009.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,425.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,358.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$754.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,333.21
|
| Rate for Payer: Cash Price |
$838.50
|
| Rate for Payer: Cigna Commercial |
$1,341.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,341.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,341.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$754.65
|
| Rate for Payer: Multiplan Commercial |
$1,559.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,425.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$754.65
|
| Rate for Payer: United Healthcare Commercial |
$1,593.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$754.65
|
| Rate for Payer: United Healthcare VA CCN |
$754.65
|
|
|
CORRECTION HALLUX VALGUS
|
Professional
|
Both
|
$2,098.00
|
|
|
Service Code
|
CPT 28297
|
| Hospital Charge Code |
9822829701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$571.06 |
| Max. Negotiated Rate |
$1,972.12 |
| Rate for Payer: Aetna of VT Commercial |
$1,972.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,879.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$588.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,879.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$799.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,348.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,348.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$656.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,348.30
|
| Rate for Payer: Cash Price |
$1,049.00
|
| Rate for Payer: Cash Price |
$1,049.00
|
| Rate for Payer: Cigna Commercial |
$1,087.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,552.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,552.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$954.90
|
| Rate for Payer: Multiplan Commercial |
$1,951.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$810.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$571.06
|
| Rate for Payer: United Healthcare Commercial |
$878.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$571.06
|
| Rate for Payer: United Healthcare VA CCN |
$571.06
|
|
|
CORRECTION HAMMERTOE
|
Professional
|
Both
|
$3,496.00
|
|
|
Service Code
|
CPT 28285
|
| Hospital Charge Code |
9602828501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$373.64 |
| Max. Negotiated Rate |
$3,286.24 |
| Rate for Payer: Aetna of VT Commercial |
$3,286.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,132.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$384.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,132.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$523.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$688.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$688.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$429.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$688.57
|
| Rate for Payer: Cash Price |
$1,748.00
|
| Rate for Payer: Cash Price |
$1,748.00
|
| Rate for Payer: Cigna Commercial |
$705.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$835.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$835.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$513.69
|
| Rate for Payer: Multiplan Commercial |
$3,251.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$530.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$373.64
|
| Rate for Payer: United Healthcare Commercial |
$574.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$373.64
|
| Rate for Payer: United Healthcare VA CCN |
$373.64
|
|
|
CORRECTION HAMMERTOE
|
Professional
|
Both
|
$1,371.00
|
|
|
Service Code
|
CPT 28285
|
| Hospital Charge Code |
9822828501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$373.64 |
| Max. Negotiated Rate |
$1,288.74 |
| Rate for Payer: Aetna of VT Commercial |
$1,288.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,228.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$384.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,228.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$523.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$688.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$688.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$429.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$688.57
|
| Rate for Payer: Cash Price |
$685.50
|
| Rate for Payer: Cash Price |
$685.50
|
| Rate for Payer: Cigna Commercial |
$705.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$835.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$835.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$513.69
|
| Rate for Payer: Multiplan Commercial |
$1,275.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$530.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$373.64
|
| Rate for Payer: United Healthcare Commercial |
$574.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$373.64
|
| Rate for Payer: United Healthcare VA CCN |
$373.64
|
|
|
CORRECTION HAMMERTOE
|
Facility
|
IP
|
$1,371.00
|
|
|
Service Code
|
CPT 28285
|
| Hospital Charge Code |
9822828501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,014.68 |
| Max. Negotiated Rate |
$1,302.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,302.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,014.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,014.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,165.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,151.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,096.80
|
| Rate for Payer: Cash Price |
$685.50
|
| Rate for Payer: Cigna Commercial |
$1,096.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,096.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,096.80
|
| Rate for Payer: Multiplan Commercial |
$1,275.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,165.35
|
| Rate for Payer: United Healthcare Commercial |
$1,302.45
|
|
|
CORRECTION HAMMERTOE
|
Facility
|
IP
|
$1,371.00
|
|
|
Service Code
|
CPT 28285
|
| Hospital Charge Code |
9602828502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,014.68 |
| Max. Negotiated Rate |
$1,302.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,302.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,014.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,014.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,165.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,151.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,096.80
|
| Rate for Payer: Cash Price |
$685.50
|
| Rate for Payer: Cigna Commercial |
$1,096.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,096.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,096.80
|
| Rate for Payer: Multiplan Commercial |
$1,275.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,165.35
|
| Rate for Payer: United Healthcare Commercial |
$1,302.45
|
|
|
CORRECTION HAMMERTOE
|
Facility
|
OP
|
$1,371.00
|
|
|
Service Code
|
CPT 28285
|
| Hospital Charge Code |
9602828502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$607.22 |
| Max. Negotiated Rate |
$1,302.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,302.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,228.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$607.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,228.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$825.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,165.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,110.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$616.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,089.94
|
| Rate for Payer: Cash Price |
$685.50
|
| Rate for Payer: Cigna Commercial |
$1,096.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,096.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,096.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$616.95
|
| Rate for Payer: Multiplan Commercial |
$1,275.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,165.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$616.95
|
| Rate for Payer: United Healthcare Commercial |
$1,302.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$616.95
|
| Rate for Payer: United Healthcare VA CCN |
$616.95
|
|
|
CORRECTION HAMMERTOE
|
Professional
|
Both
|
$2,126.00
|
|
|
Service Code
|
CPT 28285
|
| Hospital Charge Code |
5102828501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$373.64 |
| Max. Negotiated Rate |
$1,998.44 |
| Rate for Payer: Aetna of VT Commercial |
$1,998.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,904.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$384.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,904.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$523.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$688.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$688.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$429.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$688.57
|
| Rate for Payer: Cash Price |
$1,063.00
|
| Rate for Payer: Cash Price |
$1,063.00
|
| Rate for Payer: Cigna Commercial |
$705.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$835.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$835.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$513.69
|
| Rate for Payer: Multiplan Commercial |
$1,977.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$530.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$373.64
|
| Rate for Payer: United Healthcare Commercial |
$574.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$373.64
|
| Rate for Payer: United Healthcare VA CCN |
$373.64
|
|
|
CORRECTION HAMMERTOE
|
Facility
|
OP
|
$3,496.00
|
|
|
Service Code
|
CPT 28285
|
| Hospital Charge Code |
9602828501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,548.38 |
| Max. Negotiated Rate |
$3,321.20 |
| Rate for Payer: Aetna of VT Commercial |
$3,321.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,132.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,548.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,132.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,104.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,971.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,831.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,573.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,779.32
|
| Rate for Payer: Cash Price |
$1,748.00
|
| Rate for Payer: Cigna Commercial |
$2,796.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,796.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,796.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,573.20
|
| Rate for Payer: Multiplan Commercial |
$3,251.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,971.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,573.20
|
| Rate for Payer: United Healthcare Commercial |
$3,321.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,573.20
|
| Rate for Payer: United Healthcare VA CCN |
$1,573.20
|
|
|
CORRECTION HAMMERTOE
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 28285
|
| Hospital Charge Code |
5102828501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$941.61 |
| Max. Negotiated Rate |
$2,019.70 |
| Rate for Payer: Aetna of VT Commercial |
$2,019.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,904.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$941.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,904.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,279.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,807.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,722.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$956.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,690.17
|
| Rate for Payer: Cash Price |
$1,063.00
|
| Rate for Payer: Cigna Commercial |
$1,700.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,700.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,700.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$956.70
|
| Rate for Payer: Multiplan Commercial |
$1,977.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,807.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$956.70
|
| Rate for Payer: United Healthcare Commercial |
$2,019.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$956.70
|
| Rate for Payer: United Healthcare VA CCN |
$956.70
|
|
|
CORRECTION HAMMERTOE
|
Professional
|
Both
|
$1,371.00
|
|
|
Service Code
|
CPT 28285
|
| Hospital Charge Code |
9602828502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$373.64 |
| Max. Negotiated Rate |
$1,288.74 |
| Rate for Payer: Aetna of VT Commercial |
$1,288.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,228.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$384.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,228.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$523.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$688.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$688.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$429.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$688.57
|
| Rate for Payer: Cash Price |
$685.50
|
| Rate for Payer: Cash Price |
$685.50
|
| Rate for Payer: Cigna Commercial |
$705.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$835.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$835.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$513.69
|
| Rate for Payer: Multiplan Commercial |
$1,275.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$530.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$373.64
|
| Rate for Payer: United Healthcare Commercial |
$574.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$373.64
|
| Rate for Payer: United Healthcare VA CCN |
$373.64
|
|
|
CORRECTION HAMMERTOE
|
Facility
|
OP
|
$1,371.00
|
|
|
Service Code
|
CPT 28285
|
| Hospital Charge Code |
9822828501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$607.22 |
| Max. Negotiated Rate |
$1,302.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,302.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,228.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$607.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,228.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$825.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,165.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,110.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$616.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,089.94
|
| Rate for Payer: Cash Price |
$685.50
|
| Rate for Payer: Cigna Commercial |
$1,096.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,096.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,096.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$616.95
|
| Rate for Payer: Multiplan Commercial |
$1,275.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,165.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$616.95
|
| Rate for Payer: United Healthcare Commercial |
$1,302.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$616.95
|
| Rate for Payer: United Healthcare VA CCN |
$616.95
|
|
|
CORRECTION HAMMERTOE
|
Facility
|
IP
|
$3,496.00
|
|
|
Service Code
|
CPT 28285
|
| Hospital Charge Code |
9602828501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,587.39 |
| Max. Negotiated Rate |
$3,321.20 |
| Rate for Payer: Aetna of VT Commercial |
$3,321.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,587.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,587.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,971.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,936.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,796.80
|
| Rate for Payer: Cash Price |
$1,748.00
|
| Rate for Payer: Cigna Commercial |
$2,796.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,796.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,796.80
|
| Rate for Payer: Multiplan Commercial |
$3,251.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,971.60
|
| Rate for Payer: United Healthcare Commercial |
$3,321.20
|
|
