|
AMPUTATION OF FINGER/THUMB
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
9812695201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
9822695201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$871.63 |
| Max. Negotiated Rate |
$1,869.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,869.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,763.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$871.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,763.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,184.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,672.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,594.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$885.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,564.56
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cigna Commercial |
$1,574.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,574.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,574.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$885.60
|
| Rate for Payer: Multiplan Commercial |
$1,830.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,672.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$885.60
|
| Rate for Payer: United Healthcare Commercial |
$1,869.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$885.60
|
| Rate for Payer: United Healthcare VA CCN |
$885.60
|
|
|
AMPUTATION OF FINGER/THUMB
|
Professional
|
Both
|
$1,683.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
9602695102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$670.59 |
| Max. Negotiated Rate |
$1,582.02 |
| Rate for Payer: Aetna of VT Commercial |
$1,582.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,507.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$690.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,507.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$938.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$873.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$873.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$771.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$873.26
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna Commercial |
$1,280.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,100.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,100.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$670.59
|
| Rate for Payer: Multiplan Commercial |
$1,565.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$952.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$670.59
|
| Rate for Payer: United Healthcare Commercial |
$1,031.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$670.59
|
| Rate for Payer: United Healthcare VA CCN |
$670.59
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
9812695101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
9812695201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
OP
|
$1,683.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
9812695102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$745.40 |
| Max. Negotiated Rate |
$1,598.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,598.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,507.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$745.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,507.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,013.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,430.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,363.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$757.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,337.98
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna Commercial |
$1,346.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,346.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,346.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$757.35
|
| Rate for Payer: Multiplan Commercial |
$1,565.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,430.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$757.35
|
| Rate for Payer: United Healthcare Commercial |
$1,598.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$757.35
|
| Rate for Payer: United Healthcare VA CCN |
$757.35
|
|
|
AMPUTATION OF FINGER/THUMB
|
Professional
|
Both
|
$7,756.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
9602695101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$670.59 |
| Max. Negotiated Rate |
$7,290.64 |
| Rate for Payer: Aetna of VT Commercial |
$7,290.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,948.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$690.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,948.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$938.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$873.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$873.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$771.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$873.26
|
| Rate for Payer: Cash Price |
$3,878.00
|
| Rate for Payer: Cash Price |
$3,878.00
|
| Rate for Payer: Cigna Commercial |
$1,280.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,100.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,100.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$670.59
|
| Rate for Payer: Multiplan Commercial |
$7,213.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$952.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$670.59
|
| Rate for Payer: United Healthcare Commercial |
$1,031.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$670.59
|
| Rate for Payer: United Healthcare VA CCN |
$670.59
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
IP
|
$1,683.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
9602695102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,245.59 |
| Max. Negotiated Rate |
$1,598.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,598.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,245.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,245.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,430.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,413.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,346.40
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna Commercial |
$1,346.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,346.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,346.40
|
| Rate for Payer: Multiplan Commercial |
$1,565.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,430.55
|
| Rate for Payer: United Healthcare Commercial |
$1,598.85
|
|
|
AMPUTATION OF FINGER/THUMB
|
Professional
|
Both
|
$1,968.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
9822695201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$650.02 |
| Max. Negotiated Rate |
$1,849.92 |
| Rate for Payer: Aetna of VT Commercial |
$1,849.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,763.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$669.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,763.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$910.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,177.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,177.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$747.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,177.52
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cigna Commercial |
$1,243.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,068.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,068.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$650.02
|
| Rate for Payer: Multiplan Commercial |
$1,830.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$923.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$650.02
|
| Rate for Payer: United Healthcare Commercial |
$999.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$650.02
|
| Rate for Payer: United Healthcare VA CCN |
$650.02
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
OP
|
$6,073.41
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
4502695101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,689.91 |
| Max. Negotiated Rate |
$5,769.74 |
| Rate for Payer: Aetna of VT Commercial |
$5,769.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,441.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,689.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,441.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,656.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,162.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,919.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,733.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,828.36
|
| Rate for Payer: Cash Price |
$3,036.70
|
| Rate for Payer: Cigna Commercial |
$4,858.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,858.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,858.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,733.03
|
| Rate for Payer: Multiplan Commercial |
$5,648.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,162.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,733.03
|
| Rate for Payer: United Healthcare Commercial |
$5,769.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,733.03
|
| Rate for Payer: United Healthcare VA CCN |
$2,733.03
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
9812695202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$871.63 |
| Max. Negotiated Rate |
$1,869.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,869.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,763.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$871.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,763.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,184.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,672.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,594.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$885.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,564.56
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cigna Commercial |
$1,574.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,574.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,574.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$885.60
|
| Rate for Payer: Multiplan Commercial |
$1,830.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,672.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$885.60
|
| Rate for Payer: United Healthcare Commercial |
$1,869.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$885.60
|
| Rate for Payer: United Healthcare VA CCN |
$885.60
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
OP
|
$1,683.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
9822695101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$745.40 |
| Max. Negotiated Rate |
$1,598.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,598.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,507.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$745.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,507.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,013.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,430.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,363.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$757.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,337.98
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna Commercial |
$1,346.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,346.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,346.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$757.35
|
| Rate for Payer: Multiplan Commercial |
$1,565.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,430.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$757.35
|
| Rate for Payer: United Healthcare Commercial |
$1,598.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$757.35
|
| Rate for Payer: United Healthcare VA CCN |
$757.35
|
|
|
AMPUTATION OF FINGER/THUMB
|
Professional
|
Both
|
$1,968.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
9812695202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$650.02 |
| Max. Negotiated Rate |
$1,849.92 |
| Rate for Payer: Aetna of VT Commercial |
$1,849.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,763.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$669.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,763.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$910.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,177.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,177.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$747.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,177.52
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cigna Commercial |
$1,243.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,068.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,068.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$650.02
|
| Rate for Payer: Multiplan Commercial |
$1,830.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$923.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$650.02
|
| Rate for Payer: United Healthcare Commercial |
$999.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$650.02
|
| Rate for Payer: United Healthcare VA CCN |
$650.02
|
|
|
AMPUTATION OF FINGER/THUMB
|
Professional
|
Both
|
$1,683.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
9812695102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$670.59 |
| Max. Negotiated Rate |
$1,582.02 |
| Rate for Payer: Aetna of VT Commercial |
$1,582.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,507.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$690.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,507.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$938.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$873.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$873.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$771.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$873.26
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna Commercial |
$1,280.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,100.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,100.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$670.59
|
| Rate for Payer: Multiplan Commercial |
$1,565.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$952.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$670.59
|
| Rate for Payer: United Healthcare Commercial |
$1,031.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$670.59
|
| Rate for Payer: United Healthcare VA CCN |
$670.59
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
IP
|
$3,486.13
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
4502695201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,580.08 |
| Max. Negotiated Rate |
$3,311.82 |
| Rate for Payer: Aetna of VT Commercial |
$3,311.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,580.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,580.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,963.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,928.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,788.90
|
| Rate for Payer: Cash Price |
$1,743.07
|
| Rate for Payer: Cigna Commercial |
$2,788.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,788.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,788.90
|
| Rate for Payer: Multiplan Commercial |
$3,242.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,963.21
|
| Rate for Payer: United Healthcare Commercial |
$3,311.82
|
|
|
AMPUTATION OF FINGER/THUMB
|
Professional
|
Both
|
$6,074.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
5102695101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$670.59 |
| Max. Negotiated Rate |
$5,709.56 |
| Rate for Payer: Aetna of VT Commercial |
$5,709.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,441.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$690.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,441.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$938.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$873.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$873.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$771.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$873.26
|
| Rate for Payer: Cash Price |
$3,037.00
|
| Rate for Payer: Cash Price |
$3,037.00
|
| Rate for Payer: Cigna Commercial |
$1,280.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,100.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,100.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$670.59
|
| Rate for Payer: Multiplan Commercial |
$5,648.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$952.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$670.59
|
| Rate for Payer: United Healthcare Commercial |
$1,031.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$670.59
|
| Rate for Payer: United Healthcare VA CCN |
$670.59
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
IP
|
$6,073.41
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
4502695101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,494.93 |
| Max. Negotiated Rate |
$5,769.74 |
| Rate for Payer: Aetna of VT Commercial |
$5,769.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,494.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,494.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,162.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,101.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,858.73
|
| Rate for Payer: Cash Price |
$3,036.70
|
| Rate for Payer: Cigna Commercial |
$4,858.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,858.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,858.73
|
| Rate for Payer: Multiplan Commercial |
$5,648.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,162.40
|
| Rate for Payer: United Healthcare Commercial |
$5,769.74
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
OP
|
$7,756.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
9602695101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,435.13 |
| Max. Negotiated Rate |
$7,368.20 |
| Rate for Payer: Aetna of VT Commercial |
$7,368.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,948.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,435.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,948.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,669.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,592.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,282.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,490.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,166.02
|
| Rate for Payer: Cash Price |
$3,878.00
|
| Rate for Payer: Cigna Commercial |
$6,204.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,204.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,204.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,490.20
|
| Rate for Payer: Multiplan Commercial |
$7,213.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,592.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,490.20
|
| Rate for Payer: United Healthcare Commercial |
$7,368.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,490.20
|
| Rate for Payer: United Healthcare VA CCN |
$3,490.20
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
IP
|
$7,756.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
9602695101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$5,740.22 |
| Max. Negotiated Rate |
$7,368.20 |
| Rate for Payer: Aetna of VT Commercial |
$7,368.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,740.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,740.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,592.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,515.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,204.80
|
| Rate for Payer: Cash Price |
$3,878.00
|
| Rate for Payer: Cigna Commercial |
$6,204.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,204.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,204.80
|
| Rate for Payer: Multiplan Commercial |
$7,213.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,592.60
|
| Rate for Payer: United Healthcare Commercial |
$7,368.20
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
IP
|
$1,683.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
9822695101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,245.59 |
| Max. Negotiated Rate |
$1,598.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,598.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,245.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,245.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,430.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,413.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,346.40
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna Commercial |
$1,346.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,346.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,346.40
|
| Rate for Payer: Multiplan Commercial |
$1,565.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,430.55
|
| Rate for Payer: United Healthcare Commercial |
$1,598.85
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
OP
|
$1,683.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
9602695102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$745.40 |
| Max. Negotiated Rate |
$1,598.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,598.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,507.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$745.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,507.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,013.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,430.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,363.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$757.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,337.98
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna Commercial |
$1,346.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,346.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,346.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$757.35
|
| Rate for Payer: Multiplan Commercial |
$1,565.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,430.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$757.35
|
| Rate for Payer: United Healthcare Commercial |
$1,598.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$757.35
|
| Rate for Payer: United Healthcare VA CCN |
$757.35
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
OP
|
$3,486.13
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
4502695201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,544.01 |
| Max. Negotiated Rate |
$3,311.82 |
| Rate for Payer: Aetna of VT Commercial |
$3,311.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,123.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,544.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,123.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,098.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,963.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,823.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,568.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,771.47
|
| Rate for Payer: Cash Price |
$1,743.07
|
| Rate for Payer: Cigna Commercial |
$2,788.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,788.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,788.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,568.76
|
| Rate for Payer: Multiplan Commercial |
$3,242.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,963.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,568.76
|
| Rate for Payer: United Healthcare Commercial |
$3,311.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,568.76
|
| Rate for Payer: United Healthcare VA CCN |
$1,568.76
|
|
|
AMPUTATION OF FINGER/THUMB
|
Professional
|
Both
|
$1,683.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
9822695101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$670.59 |
| Max. Negotiated Rate |
$1,582.02 |
| Rate for Payer: Aetna of VT Commercial |
$1,582.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,507.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$690.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,507.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$938.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$873.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$873.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$771.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$873.26
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna Commercial |
$1,280.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,100.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,100.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$670.59
|
| Rate for Payer: Multiplan Commercial |
$1,565.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$952.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$670.59
|
| Rate for Payer: United Healthcare Commercial |
$1,031.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$670.59
|
| Rate for Payer: United Healthcare VA CCN |
$670.59
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
9822695201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,456.52 |
| Max. Negotiated Rate |
$1,869.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,869.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,456.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,456.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,672.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,653.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,574.40
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cigna Commercial |
$1,574.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,574.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,574.40
|
| Rate for Payer: Multiplan Commercial |
$1,830.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,672.80
|
| Rate for Payer: United Healthcare Commercial |
$1,869.60
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
IP
|
$1,683.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
9812695102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,245.59 |
| Max. Negotiated Rate |
$1,598.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,598.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,245.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,245.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,430.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,413.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,346.40
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna Commercial |
$1,346.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,346.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,346.40
|
| Rate for Payer: Multiplan Commercial |
$1,565.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,430.55
|
| Rate for Payer: United Healthcare Commercial |
$1,598.85
|
|
