|
CORRECTION HAMMERTOE
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 28285
|
| Hospital Charge Code |
5102828501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,573.45 |
| 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 |
$1,573.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,573.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,807.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,785.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,700.80
|
| 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: Multiplan Commercial |
$1,977.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,807.10
|
| Rate for Payer: United Healthcare Commercial |
$2,019.70
|
|
|
CORRJ HALUX RIGDUS W/IMPLT
|
Professional
|
Both
|
$2,082.00
|
|
|
Service Code
|
CPT 28291
|
| Hospital Charge Code |
9822829101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$456.97 |
| Max. Negotiated Rate |
$1,957.08 |
| Rate for Payer: Aetna of VT Commercial |
$1,957.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,865.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$470.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,865.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$639.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,065.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,065.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$525.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,065.35
|
| Rate for Payer: Cash Price |
$1,041.00
|
| Rate for Payer: Cash Price |
$1,041.00
|
| Rate for Payer: Cigna Commercial |
$873.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,048.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,048.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$645.84
|
| Rate for Payer: Multiplan Commercial |
$1,936.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$648.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$456.97
|
| Rate for Payer: United Healthcare Commercial |
$702.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$456.97
|
| Rate for Payer: United Healthcare VA CCN |
$456.97
|
|
|
CORRJ HALUX RIGDUS W/IMPLT
|
Facility
|
OP
|
$2,082.00
|
|
|
Service Code
|
CPT 28291
|
| Hospital Charge Code |
9822829101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$922.12 |
| Max. Negotiated Rate |
$1,977.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,977.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,865.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$922.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,865.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,253.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,769.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,686.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$936.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,655.19
|
| Rate for Payer: Cash Price |
$1,041.00
|
| Rate for Payer: Cigna Commercial |
$1,665.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,665.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,665.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$936.90
|
| Rate for Payer: Multiplan Commercial |
$1,936.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,769.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$936.90
|
| Rate for Payer: United Healthcare Commercial |
$1,977.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$936.90
|
| Rate for Payer: United Healthcare VA CCN |
$936.90
|
|
|
CORRJ HALUX RIGDUS W/IMPLT
|
Facility
|
IP
|
$2,082.00
|
|
|
Service Code
|
CPT 28291
|
| Hospital Charge Code |
9822829101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,540.89 |
| Max. Negotiated Rate |
$1,977.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,977.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,540.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,540.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,769.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,748.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,665.60
|
| Rate for Payer: Cash Price |
$1,041.00
|
| Rate for Payer: Cigna Commercial |
$1,665.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,665.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,665.60
|
| Rate for Payer: Multiplan Commercial |
$1,936.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,769.70
|
| Rate for Payer: United Healthcare Commercial |
$1,977.90
|
|
|
CORRJ HALUX RIGDUS W/O IMPLT
|
Facility
|
IP
|
$1,654.00
|
|
|
Service Code
|
CPT 28289
|
| Hospital Charge Code |
9822828901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,224.13 |
| Max. Negotiated Rate |
$1,571.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,571.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,224.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,224.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,405.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,389.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,323.20
|
| Rate for Payer: Cash Price |
$827.00
|
| Rate for Payer: Cigna Commercial |
$1,323.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,323.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,323.20
|
| Rate for Payer: Multiplan Commercial |
$1,538.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,405.90
|
| Rate for Payer: United Healthcare Commercial |
$1,571.30
|
|
|
CORRJ HALUX RIGDUS W/O IMPLT
|
Professional
|
Both
|
$1,654.00
|
|
|
Service Code
|
CPT 28289
|
| Hospital Charge Code |
9822828901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$442.65 |
| Max. Negotiated Rate |
$1,554.76 |
| Rate for Payer: Aetna of VT Commercial |
$1,554.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,481.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$455.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,481.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$619.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$998.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$998.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$509.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$998.59
|
| Rate for Payer: Cash Price |
$827.00
|
| Rate for Payer: Cash Price |
$827.00
|
| Rate for Payer: Cigna Commercial |
$837.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,059.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,059.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$650.79
|
| Rate for Payer: Multiplan Commercial |
$1,538.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$628.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$442.65
|
| Rate for Payer: United Healthcare Commercial |
$680.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$442.65
|
| Rate for Payer: United Healthcare VA CCN |
$442.65
|
|
|
CORRJ HALUX RIGDUS W/O IMPLT
|
Facility
|
OP
|
$1,654.00
|
|
|
Service Code
|
CPT 28289
|
| Hospital Charge Code |
9822828901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$732.56 |
| Max. Negotiated Rate |
$1,571.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,571.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,481.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$732.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,481.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$995.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,405.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,339.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$744.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,314.93
|
| Rate for Payer: Cash Price |
$827.00
|
| Rate for Payer: Cigna Commercial |
$1,323.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,323.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,323.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$744.30
|
| Rate for Payer: Multiplan Commercial |
$1,538.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,405.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$744.30
|
| Rate for Payer: United Healthcare Commercial |
$1,571.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$744.30
|
| Rate for Payer: United Healthcare VA CCN |
$744.30
|
|
|
CORTISOL FREE
|
Facility
|
IP
|
$248.16
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
3008253001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$183.66 |
| Max. Negotiated Rate |
$235.75 |
| Rate for Payer: Aetna of VT Commercial |
$235.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$183.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$183.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$210.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$208.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$198.53
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cigna Commercial |
$198.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$198.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$198.53
|
| Rate for Payer: Multiplan Commercial |
$230.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$210.94
|
| Rate for Payer: United Healthcare Commercial |
$235.75
|
|
|
CORTISOL FREE
|
Professional
|
Both
|
$248.16
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
3008253001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.48 |
| Max. Negotiated Rate |
$233.27 |
| Rate for Payer: Aetna of VT Commercial |
$233.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$17.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$23.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.99
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cigna Commercial |
$20.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.48
|
| Rate for Payer: Multiplan Commercial |
$230.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.71
|
| Rate for Payer: United Healthcare Commercial |
$25.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.71
|
| Rate for Payer: United Healthcare VA CCN |
$16.71
|
|
|
CORTISOL FREE
|
Facility
|
OP
|
$248.16
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
3008253001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$235.75 |
| Rate for Payer: Aetna of VT Commercial |
$235.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$109.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$149.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$210.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$201.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$111.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$197.29
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cigna Commercial |
$198.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$198.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$198.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$111.67
|
| Rate for Payer: Multiplan Commercial |
$230.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$210.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$111.67
|
| Rate for Payer: United Healthcare Commercial |
$235.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.71
|
| Rate for Payer: United Healthcare VA CCN |
$111.67
|
|
|
CORTISOL TOTAL
|
Facility
|
IP
|
$118.81
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
3008253301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.93 |
| Max. Negotiated Rate |
$112.87 |
| Rate for Payer: Aetna of VT Commercial |
$112.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$87.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$87.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$100.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$99.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$95.05
|
| Rate for Payer: Cash Price |
$59.41
|
| Rate for Payer: Cigna Commercial |
$95.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$95.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$95.05
|
| Rate for Payer: Multiplan Commercial |
$110.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.99
|
| Rate for Payer: United Healthcare Commercial |
$112.87
|
|
|
CORTISOL TOTAL
|
Professional
|
Both
|
$118.81
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
3008253301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$111.68 |
| Rate for Payer: Aetna of VT Commercial |
$111.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$80.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$16.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$80.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$22.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$27.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$27.87
|
| Rate for Payer: Cash Price |
$59.41
|
| Rate for Payer: Cash Price |
$59.41
|
| Rate for Payer: Cigna Commercial |
$19.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.07
|
| Rate for Payer: Multiplan Commercial |
$110.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.30
|
| Rate for Payer: United Healthcare Commercial |
$25.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.30
|
| Rate for Payer: United Healthcare VA CCN |
$16.30
|
|
|
CORTISOL TOTAL
|
Facility
|
OP
|
$118.81
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
3008253301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$112.87 |
| Rate for Payer: Aetna of VT Commercial |
$112.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$80.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$52.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$80.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$71.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$100.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$96.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$53.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$94.45
|
| Rate for Payer: Cash Price |
$59.41
|
| Rate for Payer: Cash Price |
$59.41
|
| Rate for Payer: Cigna Commercial |
$95.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$95.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$95.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$53.46
|
| Rate for Payer: Multiplan Commercial |
$110.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.46
|
| Rate for Payer: United Healthcare Commercial |
$112.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.30
|
| Rate for Payer: United Healthcare VA CCN |
$53.46
|
|
|
COUNTERSINK, 3.0MM, HEADLESS
|
Facility
|
OP
|
$256.43
|
|
| Hospital Charge Code |
2720073061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.57 |
| Max. Negotiated Rate |
$243.61 |
| Rate for Payer: Aetna of VT Commercial |
$243.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$229.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$113.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$229.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$154.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$217.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$207.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$115.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$203.86
|
| Rate for Payer: Cash Price |
$128.22
|
| Rate for Payer: Cigna Commercial |
$205.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$205.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$205.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$115.39
|
| Rate for Payer: Multiplan Commercial |
$238.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$115.39
|
| Rate for Payer: United Healthcare Commercial |
$243.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.39
|
| Rate for Payer: United Healthcare VA CCN |
$115.39
|
|
|
COUNTERSINK, 3.0MM, HEADLESS
|
Facility
|
IP
|
$256.43
|
|
| Hospital Charge Code |
2720073061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.78 |
| Max. Negotiated Rate |
$243.61 |
| Rate for Payer: Aetna of VT Commercial |
$243.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$189.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$189.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$217.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$215.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$205.14
|
| Rate for Payer: Cash Price |
$128.22
|
| Rate for Payer: Cigna Commercial |
$205.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$205.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$205.14
|
| Rate for Payer: Multiplan Commercial |
$238.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.97
|
| Rate for Payer: United Healthcare Commercial |
$243.61
|
|
|
COUNTERSINK, 3.5MM, HDLS
|
Facility
|
OP
|
$256.43
|
|
| Hospital Charge Code |
2720069521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.57 |
| Max. Negotiated Rate |
$243.61 |
| Rate for Payer: Aetna of VT Commercial |
$243.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$229.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$113.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$229.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$154.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$217.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$207.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$115.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$203.86
|
| Rate for Payer: Cash Price |
$128.22
|
| Rate for Payer: Cigna Commercial |
$205.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$205.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$205.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$115.39
|
| Rate for Payer: Multiplan Commercial |
$238.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$115.39
|
| Rate for Payer: United Healthcare Commercial |
$243.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.39
|
| Rate for Payer: United Healthcare VA CCN |
$115.39
|
|
|
COUNTERSINK, 3.5MM, HDLS
|
Facility
|
IP
|
$256.43
|
|
| Hospital Charge Code |
2720069521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.78 |
| Max. Negotiated Rate |
$243.61 |
| Rate for Payer: Aetna of VT Commercial |
$243.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$189.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$189.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$217.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$215.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$205.14
|
| Rate for Payer: Cash Price |
$128.22
|
| Rate for Payer: Cigna Commercial |
$205.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$205.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$205.14
|
| Rate for Payer: Multiplan Commercial |
$238.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.97
|
| Rate for Payer: United Healthcare Commercial |
$243.61
|
|
|
COUNTERSINK, 4.0MM, HD
|
Facility
|
IP
|
$259.00
|
|
| Hospital Charge Code |
2720073791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.69 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Aetna of VT Commercial |
$246.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.20
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.20
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.15
|
| Rate for Payer: United Healthcare Commercial |
$246.05
|
|
|
COUNTERSINK, 4.0MM, HD
|
Facility
|
OP
|
$259.00
|
|
| Hospital Charge Code |
2720073791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.71 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Aetna of VT Commercial |
$246.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$114.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$155.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$209.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$205.91
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$116.55
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$116.55
|
| Rate for Payer: United Healthcare Commercial |
$246.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.55
|
| Rate for Payer: United Healthcare VA CCN |
$116.55
|
|
|
COUNTERSINK, 4.0MM, HEADLESS
|
Facility
|
OP
|
$256.43
|
|
| Hospital Charge Code |
2720073081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.57 |
| Max. Negotiated Rate |
$243.61 |
| Rate for Payer: Aetna of VT Commercial |
$243.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$229.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$113.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$229.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$154.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$217.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$207.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$115.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$203.86
|
| Rate for Payer: Cash Price |
$128.22
|
| Rate for Payer: Cigna Commercial |
$205.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$205.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$205.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$115.39
|
| Rate for Payer: Multiplan Commercial |
$238.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$115.39
|
| Rate for Payer: United Healthcare Commercial |
$243.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.39
|
| Rate for Payer: United Healthcare VA CCN |
$115.39
|
|
|
COUNTERSINK, 4.0MM, HEADLESS
|
Facility
|
IP
|
$256.43
|
|
| Hospital Charge Code |
2720073081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.78 |
| Max. Negotiated Rate |
$243.61 |
| Rate for Payer: Aetna of VT Commercial |
$243.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$189.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$189.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$217.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$215.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$205.14
|
| Rate for Payer: Cash Price |
$128.22
|
| Rate for Payer: Cigna Commercial |
$205.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$205.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$205.14
|
| Rate for Payer: Multiplan Commercial |
$238.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.97
|
| Rate for Payer: United Healthcare Commercial |
$243.61
|
|
|
CPLX CHRNC CARE 1ST 60 MIN
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 99487
|
| Hospital Charge Code |
9609948702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$93.89 |
| Max. Negotiated Rate |
$201.40 |
| Rate for Payer: Aetna of VT Commercial |
$201.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$189.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$93.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$189.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$127.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$180.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$95.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$168.54
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna Commercial |
$169.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$169.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$169.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$95.40
|
| Rate for Payer: Multiplan Commercial |
$197.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$95.40
|
| Rate for Payer: United Healthcare Commercial |
$201.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.40
|
| Rate for Payer: United Healthcare VA CCN |
$95.40
|
|
|
CPLX CHRNC CARE 1ST 60 MIN
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
CPT 99487
|
| Hospital Charge Code |
9609948702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$84.82 |
| Max. Negotiated Rate |
$209.32 |
| Rate for Payer: Aetna of VT Commercial |
$199.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$195.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$195.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$118.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$159.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.47
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna Commercial |
$92.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$209.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$209.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$129.14
|
| Rate for Payer: Multiplan Commercial |
$197.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$84.82
|
| Rate for Payer: United Healthcare Commercial |
$130.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.82
|
| Rate for Payer: United Healthcare VA CCN |
$84.82
|
|
|
CPLX CHRNC CARE 1ST 60 MIN
|
Professional
|
Both
|
$424.00
|
|
|
Service Code
|
CPT 99487
|
| Hospital Charge Code |
9609948701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$84.82 |
| Max. Negotiated Rate |
$398.56 |
| Rate for Payer: Aetna of VT Commercial |
$398.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$195.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$195.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$118.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$159.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.47
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cigna Commercial |
$92.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$209.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$209.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$129.14
|
| Rate for Payer: Multiplan Commercial |
$394.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$84.82
|
| Rate for Payer: United Healthcare Commercial |
$130.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.82
|
| Rate for Payer: United Healthcare VA CCN |
$84.82
|
|
|
CPLX CHRNC CARE 1ST 60 MIN
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT 99487
|
| Hospital Charge Code |
9609948701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$313.80 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Aetna of VT Commercial |
$402.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$313.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$313.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$360.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$356.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$339.20
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cigna Commercial |
$339.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$339.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$339.20
|
| Rate for Payer: Multiplan Commercial |
$394.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$360.40
|
| Rate for Payer: United Healthcare Commercial |
$402.80
|
|
