|
AMPUTATION OF FINGER/THUMB
|
Facility
|
IP
|
$6,074.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
5102695101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,495.37 |
| Max. Negotiated Rate |
$5,770.30 |
| Rate for Payer: Aetna of VT Commercial |
$5,770.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,495.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,495.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,162.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,102.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,859.20
|
| Rate for Payer: Cash Price |
$3,037.00
|
| Rate for Payer: Cigna Commercial |
$4,859.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,859.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,859.20
|
| Rate for Payer: Multiplan Commercial |
$5,648.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,162.90
|
| Rate for Payer: United Healthcare Commercial |
$5,770.30
|
|
|
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
|
|
|
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
|
$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 TOE
|
Facility
|
OP
|
$1,277.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
9822882001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$565.58 |
| Max. Negotiated Rate |
$1,213.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,213.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,144.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$565.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,144.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$768.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,085.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,034.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$574.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,015.22
|
| Rate for Payer: Cash Price |
$638.50
|
| Rate for Payer: Cigna Commercial |
$1,021.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,021.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,021.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$574.65
|
| Rate for Payer: Multiplan Commercial |
$1,187.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,085.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$574.65
|
| Rate for Payer: United Healthcare Commercial |
$1,213.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$574.65
|
| Rate for Payer: United Healthcare VA CCN |
$574.65
|
|
|
AMPUTATION OF TOE
|
Professional
|
Both
|
$1,277.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
9822882001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$165.85 |
| Max. Negotiated Rate |
$1,200.38 |
| Rate for Payer: Aetna of VT Commercial |
$1,200.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,144.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$170.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,144.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$232.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$725.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$725.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$190.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$725.17
|
| Rate for Payer: Cash Price |
$638.50
|
| Rate for Payer: Cash Price |
$638.50
|
| Rate for Payer: Cigna Commercial |
$314.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$453.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$453.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$277.95
|
| Rate for Payer: Multiplan Commercial |
$1,187.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$235.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$165.85
|
| Rate for Payer: United Healthcare Commercial |
$255.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.85
|
| Rate for Payer: United Healthcare VA CCN |
$165.85
|
|
|
AMPUTATION OF TOE
|
Facility
|
IP
|
$1,277.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
9822882001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$945.11 |
| Max. Negotiated Rate |
$1,213.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,213.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$945.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$945.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,085.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,072.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,021.60
|
| Rate for Payer: Cash Price |
$638.50
|
| Rate for Payer: Cigna Commercial |
$1,021.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,021.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,021.60
|
| Rate for Payer: Multiplan Commercial |
$1,187.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,085.45
|
| Rate for Payer: United Healthcare Commercial |
$1,213.15
|
|
|
AMPUTATION THRU METATARSAL
|
Professional
|
Both
|
$1,833.00
|
|
|
Service Code
|
CPT 28805
|
| Hospital Charge Code |
9822880501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$662.88 |
| Max. Negotiated Rate |
$1,723.02 |
| Rate for Payer: Aetna of VT Commercial |
$1,723.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,642.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$682.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,642.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$928.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$993.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$993.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$762.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$993.04
|
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Cigna Commercial |
$1,258.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,094.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,094.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$662.88
|
| Rate for Payer: Multiplan Commercial |
$1,704.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$941.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$662.89
|
| Rate for Payer: United Healthcare Commercial |
$1,019.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$662.89
|
| Rate for Payer: United Healthcare VA CCN |
$662.89
|
|
|
AMPUTATION THRU METATARSAL
|
Facility
|
IP
|
$1,833.00
|
|
|
Service Code
|
CPT 28805
|
| Hospital Charge Code |
9822880501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,356.60 |
| Max. Negotiated Rate |
$1,741.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,741.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,356.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,356.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,558.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,539.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,466.40
|
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Cigna Commercial |
$1,466.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,466.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,466.40
|
| Rate for Payer: Multiplan Commercial |
$1,704.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,558.05
|
| Rate for Payer: United Healthcare Commercial |
$1,741.35
|
|
|
AMPUTATION THRU METATARSAL
|
Facility
|
OP
|
$1,833.00
|
|
|
Service Code
|
CPT 28805
|
| Hospital Charge Code |
9822880501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$811.84 |
| Max. Negotiated Rate |
$1,741.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,741.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,642.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$811.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,642.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,103.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,558.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,484.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$824.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,457.23
|
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Cigna Commercial |
$1,466.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,466.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,466.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$824.85
|
| Rate for Payer: Multiplan Commercial |
$1,704.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,558.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$824.85
|
| Rate for Payer: United Healthcare Commercial |
$1,741.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$824.85
|
| Rate for Payer: United Healthcare VA CCN |
$824.85
|
|
|
AMPUTATION TOE & METATARSAL
|
Facility
|
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 28810
|
| Hospital Charge Code |
9822881001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$535.91 |
| Max. Negotiated Rate |
$1,149.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,149.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,084.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$535.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,084.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$728.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,028.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$980.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$544.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$961.95
|
| Rate for Payer: Cash Price |
$605.00
|
| Rate for Payer: Cigna Commercial |
$968.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$968.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$968.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$544.50
|
| Rate for Payer: Multiplan Commercial |
$1,125.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,028.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$544.50
|
| Rate for Payer: United Healthcare Commercial |
$1,149.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$544.50
|
| Rate for Payer: United Healthcare VA CCN |
$544.50
|
|
|
AMPUTATION TOE & METATARSAL
|
Facility
|
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 28810
|
| Hospital Charge Code |
9822881001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$895.52 |
| Max. Negotiated Rate |
$1,149.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,149.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$895.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$895.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,028.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,016.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$968.00
|
| Rate for Payer: Cash Price |
$605.00
|
| Rate for Payer: Cigna Commercial |
$968.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$968.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$968.00
|
| Rate for Payer: Multiplan Commercial |
$1,125.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,028.50
|
| Rate for Payer: United Healthcare Commercial |
$1,149.50
|
|
|
AMPUTATION TOE & METATARSAL
|
Professional
|
Both
|
$1,210.00
|
|
|
Service Code
|
CPT 28810
|
| Hospital Charge Code |
9822881001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$397.56 |
| Max. Negotiated Rate |
$1,137.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,137.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,084.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$409.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,084.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$556.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$759.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$759.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$457.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$759.11
|
| Rate for Payer: Cash Price |
$605.00
|
| Rate for Payer: Cash Price |
$605.00
|
| Rate for Payer: Cigna Commercial |
$755.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$657.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$657.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$397.56
|
| Rate for Payer: Multiplan Commercial |
$1,125.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$564.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$397.56
|
| Rate for Payer: United Healthcare Commercial |
$611.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$397.56
|
| Rate for Payer: United Healthcare VA CCN |
$397.56
|
|
|
ANAPLSMA PHGCYTOPHLM AMP PRB
|
Facility
|
IP
|
$86.86
|
|
|
Service Code
|
CPT 87468
|
| Hospital Charge Code |
3008746801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.29 |
| Max. Negotiated Rate |
$82.52 |
| Rate for Payer: Aetna of VT Commercial |
$82.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.49
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cigna Commercial |
$69.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.49
|
| Rate for Payer: Multiplan Commercial |
$80.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.83
|
| Rate for Payer: United Healthcare Commercial |
$82.52
|
|
|
ANAPLSMA PHGCYTOPHLM AMP PRB
|
Facility
|
OP
|
$86.86
|
|
|
Service Code
|
CPT 87468
|
| Hospital Charge Code |
3008746801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$82.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.05
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cigna Commercial |
$69.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$39.09
|
| Rate for Payer: Multiplan Commercial |
$80.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.09
|
| Rate for Payer: United Healthcare Commercial |
$82.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$39.09
|
|
|
ANAPLSMA PHGCYTOPHLM AMP PRB
|
Professional
|
Both
|
$86.86
|
|
|
Service Code
|
CPT 87468
|
| Hospital Charge Code |
3008746801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$81.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.35
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cigna Commercial |
$42.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$48.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$48.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.60
|
| Rate for Payer: Multiplan Commercial |
$80.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$53.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$35.09
|
|
|
ANATOM FEM COMP CEMENT S4RM
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780054501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.54 |
| Max. Negotiated Rate |
$2,470.00 |
| Rate for Payer: Aetna of VT Commercial |
$2,470.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,329.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,151.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,329.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,565.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,210.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,106.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,170.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,067.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,080.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,080.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,080.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,170.00
|
| Rate for Payer: Multiplan Commercial |
$2,418.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,210.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,170.00
|
| Rate for Payer: United Healthcare Commercial |
$2,470.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,170.00
|
| Rate for Payer: United Healthcare VA CCN |
$1,170.00
|
|
|
ANATOM FEM COMP CEMENT S4RM
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780054501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,924.26 |
| Max. Negotiated Rate |
$2,470.00 |
| Rate for Payer: Aetna of VT Commercial |
$2,470.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,924.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,924.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,210.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,184.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,080.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,080.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,080.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,080.00
|
| Rate for Payer: Multiplan Commercial |
$2,418.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,210.00
|
| Rate for Payer: United Healthcare Commercial |
$2,470.00
|
|
|
ANCA SCREEN EACH ANTIBODY
|
Professional
|
Both
|
$195.57
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
3008603601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$183.84 |
| Rate for Payer: Aetna of VT Commercial |
$183.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$14.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$14.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.20
|
| Rate for Payer: Cash Price |
$97.78
|
| Rate for Payer: Cash Price |
$97.78
|
| Rate for Payer: Cigna Commercial |
$14.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.88
|
| Rate for Payer: Multiplan Commercial |
$181.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare Commercial |
$18.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare VA CCN |
$12.05
|
|
|
ANCA SCREEN EACH ANTIBODY
|
Facility
|
OP
|
$195.57
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
3008603601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$185.79 |
| Rate for Payer: Aetna of VT Commercial |
$185.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$86.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$117.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$158.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.48
|
| Rate for Payer: Cash Price |
$97.78
|
| Rate for Payer: Cash Price |
$97.78
|
| Rate for Payer: Cigna Commercial |
$156.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$156.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$156.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$88.01
|
| Rate for Payer: Multiplan Commercial |
$181.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$166.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$88.01
|
| Rate for Payer: United Healthcare Commercial |
$185.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare VA CCN |
$88.01
|
|
|
ANCA SCREEN EACH ANTIBODY
|
Facility
|
IP
|
$195.57
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
3008603601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$144.74 |
| Max. Negotiated Rate |
$185.79 |
| Rate for Payer: Aetna of VT Commercial |
$185.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$144.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$144.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$164.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$156.46
|
| Rate for Payer: Cash Price |
$97.78
|
| Rate for Payer: Cigna Commercial |
$156.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$156.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$156.46
|
| Rate for Payer: Multiplan Commercial |
$181.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$166.23
|
| Rate for Payer: United Healthcare Commercial |
$185.79
|
|
|
ANESTHESIA: PER MINUTE
|
Facility
|
OP
|
$23.78
|
|
| Hospital Charge Code |
3700000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$22.59 |
| Rate for Payer: Aetna of VT Commercial |
$22.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$14.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$10.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$18.91
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cigna Commercial |
$19.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.70
|
| Rate for Payer: Multiplan Commercial |
$22.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.70
|
| Rate for Payer: United Healthcare Commercial |
$22.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.70
|
| Rate for Payer: United Healthcare VA CCN |
$10.70
|
|
|
ANESTHESIA: PER MINUTE
|
Facility
|
IP
|
$23.78
|
|
| Hospital Charge Code |
3700000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$22.59 |
| Rate for Payer: Aetna of VT Commercial |
$22.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$17.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$17.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.02
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cigna Commercial |
$19.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.02
|
| Rate for Payer: Multiplan Commercial |
$22.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.21
|
| Rate for Payer: United Healthcare Commercial |
$22.59
|
|
|
ANESTH N BLOCK/INJ PRONE
|
Professional
|
Both
|
$210.77
|
|
| Hospital Charge Code |
9630199202
|
|
Hospital Revenue Code
|
963
|
| Min. Negotiated Rate |
$84.31 |
| Max. Negotiated Rate |
$198.12 |
| Rate for Payer: Aetna of VT Commercial |
$198.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$188.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$188.83
|
| Rate for Payer: Cash Price |
$105.39
|
| Rate for Payer: Multiplan Commercial |
$196.02
|
| Rate for Payer: United Healthcare Commercial |
$179.15
|
| Rate for Payer: United Healthcare VA CCN |
$84.31
|
|
|
ANESTH N BLOCK/INJ PRONE
|
Facility
|
OP
|
$210.77
|
|
| Hospital Charge Code |
3700199201
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$93.35 |
| Max. Negotiated Rate |
$200.23 |
| Rate for Payer: Aetna of VT Commercial |
$200.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$188.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$93.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$188.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$126.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$170.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$94.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$167.56
|
| Rate for Payer: Cash Price |
$105.39
|
| Rate for Payer: Cigna Commercial |
$168.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.85
|
| Rate for Payer: Multiplan Commercial |
$196.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$94.85
|
| Rate for Payer: United Healthcare Commercial |
$200.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.85
|
| Rate for Payer: United Healthcare VA CCN |
$94.85
|
|
