|
EXC FOREARM LES SC 3 CM/>
|
Facility
|
IP
|
$1,195.00
|
|
|
Service Code
|
CPT 25071
|
| Hospital Charge Code |
9822507101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$884.42 |
| Max. Negotiated Rate |
$1,135.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,135.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$884.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$884.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,015.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,003.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$956.00
|
| Rate for Payer: Cash Price |
$597.50
|
| Rate for Payer: Cigna Commercial |
$956.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$956.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$956.00
|
| Rate for Payer: Multiplan Commercial |
$1,111.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,015.75
|
| Rate for Payer: United Healthcare Commercial |
$1,135.25
|
|
|
EXC FOREARM LES SC 3 CM/>
|
Professional
|
Both
|
$1,195.00
|
|
|
Service Code
|
CPT 25071
|
| Hospital Charge Code |
9822507101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$400.03 |
| Max. Negotiated Rate |
$1,123.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,123.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,070.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$412.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,070.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$560.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$503.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$503.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$460.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$503.09
|
| Rate for Payer: Cash Price |
$597.50
|
| Rate for Payer: Cash Price |
$597.50
|
| Rate for Payer: Cigna Commercial |
$757.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$669.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$669.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$400.03
|
| Rate for Payer: Multiplan Commercial |
$1,111.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$568.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$400.03
|
| Rate for Payer: United Healthcare Commercial |
$615.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$400.03
|
| Rate for Payer: United Healthcare VA CCN |
$400.03
|
|
|
EXC FOREARM LES SC 3 CM/>
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
CPT 25071
|
| Hospital Charge Code |
9822507101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$529.27 |
| Max. Negotiated Rate |
$1,135.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,135.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,070.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$529.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,070.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$719.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,015.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$967.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$537.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$950.02
|
| Rate for Payer: Cash Price |
$597.50
|
| Rate for Payer: Cigna Commercial |
$956.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$956.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$956.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$537.75
|
| Rate for Payer: Multiplan Commercial |
$1,111.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,015.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$537.75
|
| Rate for Payer: United Healthcare Commercial |
$1,135.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$537.75
|
| Rate for Payer: United Healthcare VA CCN |
$537.75
|
|
|
EXC FOREARM TUM DEEP < 3 CM
|
Professional
|
Both
|
$1,436.23
|
|
|
Service Code
|
CPT 25076
|
| Hospital Charge Code |
9822507601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$495.79 |
| Max. Negotiated Rate |
$1,350.06 |
| Rate for Payer: Aetna of VT Commercial |
$1,350.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,286.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$510.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,286.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$694.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$917.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$917.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$570.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$917.78
|
| Rate for Payer: Cash Price |
$718.12
|
| Rate for Payer: Cash Price |
$718.12
|
| Rate for Payer: Cigna Commercial |
$936.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$823.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$823.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$495.80
|
| Rate for Payer: Multiplan Commercial |
$1,335.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$704.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$495.79
|
| Rate for Payer: United Healthcare Commercial |
$762.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$495.79
|
| Rate for Payer: United Healthcare VA CCN |
$495.79
|
|
|
EXC FOREARM TUM DEEP < 3 CM
|
Facility
|
OP
|
$1,436.23
|
|
|
Service Code
|
CPT 25076
|
| Hospital Charge Code |
9822507601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$636.11 |
| Max. Negotiated Rate |
$1,364.42 |
| Rate for Payer: Aetna of VT Commercial |
$1,364.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,286.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$636.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,286.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$864.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,220.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,163.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$646.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,141.80
|
| Rate for Payer: Cash Price |
$718.12
|
| Rate for Payer: Cigna Commercial |
$1,148.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,148.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,148.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$646.30
|
| Rate for Payer: Multiplan Commercial |
$1,335.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,220.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$646.30
|
| Rate for Payer: United Healthcare Commercial |
$1,364.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$646.30
|
| Rate for Payer: United Healthcare VA CCN |
$646.30
|
|
|
EXC FOREARM TUM DEEP < 3 CM
|
Facility
|
IP
|
$1,436.23
|
|
|
Service Code
|
CPT 25076
|
| Hospital Charge Code |
9822507601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,062.95 |
| Max. Negotiated Rate |
$1,364.42 |
| Rate for Payer: Aetna of VT Commercial |
$1,364.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,062.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,062.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,220.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,206.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,148.98
|
| Rate for Payer: Cash Price |
$718.12
|
| Rate for Payer: Cigna Commercial |
$1,148.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,148.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,148.98
|
| Rate for Payer: Multiplan Commercial |
$1,335.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,220.80
|
| Rate for Payer: United Healthcare Commercial |
$1,364.42
|
|
|
EXC FOREARM TUM DEEP 3 CM/>
|
Facility
|
IP
|
$1,666.00
|
|
|
Service Code
|
CPT 25073
|
| Hospital Charge Code |
9822507301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,233.01 |
| Max. Negotiated Rate |
$1,582.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,582.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,233.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,233.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,416.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,399.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,332.80
|
| Rate for Payer: Cash Price |
$833.00
|
| Rate for Payer: Cigna Commercial |
$1,332.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,332.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,332.80
|
| Rate for Payer: Multiplan Commercial |
$1,549.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,416.10
|
| Rate for Payer: United Healthcare Commercial |
$1,582.70
|
|
|
EXC FOREARM TUM DEEP 3 CM/>
|
Facility
|
OP
|
$1,666.00
|
|
|
Service Code
|
CPT 25073
|
| Hospital Charge Code |
9822507301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$737.87 |
| Max. Negotiated Rate |
$1,582.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,582.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,492.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$737.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,492.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,002.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,416.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,349.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$749.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,324.47
|
| Rate for Payer: Cash Price |
$833.00
|
| Rate for Payer: Cigna Commercial |
$1,332.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,332.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,332.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$749.70
|
| Rate for Payer: Multiplan Commercial |
$1,549.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,416.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$749.70
|
| Rate for Payer: United Healthcare Commercial |
$1,582.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$749.70
|
| Rate for Payer: United Healthcare VA CCN |
$749.70
|
|
|
EXC FOREARM TUM DEEP 3 CM/>
|
Professional
|
Both
|
$1,666.00
|
|
|
Service Code
|
CPT 25073
|
| Hospital Charge Code |
9822507301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$509.33 |
| Max. Negotiated Rate |
$1,566.04 |
| Rate for Payer: Aetna of VT Commercial |
$1,566.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,492.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$524.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,492.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$713.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$637.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$637.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$585.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$637.31
|
| Rate for Payer: Cash Price |
$833.00
|
| Rate for Payer: Cash Price |
$833.00
|
| Rate for Payer: Cigna Commercial |
$962.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$849.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$849.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$509.33
|
| Rate for Payer: Multiplan Commercial |
$1,549.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$723.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$509.33
|
| Rate for Payer: United Healthcare Commercial |
$783.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$509.33
|
| Rate for Payer: United Healthcare VA CCN |
$509.33
|
|
|
EXC HAND LES SC < 1.5 CM
|
Professional
|
Both
|
$4,122.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
9602611501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$321.33 |
| Max. Negotiated Rate |
$3,874.68 |
| Rate for Payer: Aetna of VT Commercial |
$3,874.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,692.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$330.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,692.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$449.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$872.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$872.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$369.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$872.07
|
| Rate for Payer: Cash Price |
$2,061.00
|
| Rate for Payer: Cash Price |
$2,061.00
|
| Rate for Payer: Cigna Commercial |
$605.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$851.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$851.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$521.11
|
| Rate for Payer: Multiplan Commercial |
$3,833.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$456.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$321.33
|
| Rate for Payer: United Healthcare Commercial |
$494.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$321.33
|
| Rate for Payer: United Healthcare VA CCN |
$321.33
|
|
|
EXC HAND LES SC < 1.5 CM
|
Facility
|
IP
|
$1,327.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
9602611502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$982.11 |
| Max. Negotiated Rate |
$1,260.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,260.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$982.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$982.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,127.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,114.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,061.60
|
| Rate for Payer: Cash Price |
$663.50
|
| Rate for Payer: Cigna Commercial |
$1,061.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,061.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,061.60
|
| Rate for Payer: Multiplan Commercial |
$1,234.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,127.95
|
| Rate for Payer: United Healthcare Commercial |
$1,260.65
|
|
|
EXC HAND LES SC < 1.5 CM
|
Facility
|
IP
|
$4,122.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
9602611501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,050.69 |
| Max. Negotiated Rate |
$3,915.90 |
| Rate for Payer: Aetna of VT Commercial |
$3,915.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,050.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,050.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,503.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,462.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,297.60
|
| Rate for Payer: Cash Price |
$2,061.00
|
| Rate for Payer: Cigna Commercial |
$3,297.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,297.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,297.60
|
| Rate for Payer: Multiplan Commercial |
$3,833.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,503.70
|
| Rate for Payer: United Healthcare Commercial |
$3,915.90
|
|
|
EXC HAND LES SC < 1.5 CM
|
Professional
|
Both
|
$1,327.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
9602611502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$321.33 |
| Max. Negotiated Rate |
$1,247.38 |
| Rate for Payer: Aetna of VT Commercial |
$1,247.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,188.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$330.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,188.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$449.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$872.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$872.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$369.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$872.07
|
| Rate for Payer: Cash Price |
$663.50
|
| Rate for Payer: Cash Price |
$663.50
|
| Rate for Payer: Cigna Commercial |
$605.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$851.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$851.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$521.11
|
| Rate for Payer: Multiplan Commercial |
$1,234.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$456.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$321.33
|
| Rate for Payer: United Healthcare Commercial |
$494.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$321.33
|
| Rate for Payer: United Healthcare VA CCN |
$321.33
|
|
|
EXC HAND LES SC < 1.5 CM
|
Facility
|
IP
|
$2,796.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
5102611501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,069.32 |
| Max. Negotiated Rate |
$2,656.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,656.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,069.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,069.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,376.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,348.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,236.80
|
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: Cigna Commercial |
$2,236.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,236.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,236.80
|
| Rate for Payer: Multiplan Commercial |
$2,600.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,376.60
|
| Rate for Payer: United Healthcare Commercial |
$2,656.20
|
|
|
EXC HAND LES SC < 1.5 CM
|
Facility
|
IP
|
$1,327.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
9822611501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$982.11 |
| Max. Negotiated Rate |
$1,260.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,260.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$982.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$982.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,127.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,114.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,061.60
|
| Rate for Payer: Cash Price |
$663.50
|
| Rate for Payer: Cigna Commercial |
$1,061.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,061.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,061.60
|
| Rate for Payer: Multiplan Commercial |
$1,234.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,127.95
|
| Rate for Payer: United Healthcare Commercial |
$1,260.65
|
|
|
EXC HAND LES SC < 1.5 CM
|
Facility
|
OP
|
$2,796.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
5102611501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,238.35 |
| Max. Negotiated Rate |
$2,656.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,656.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,504.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,238.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,504.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,683.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,376.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,264.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,258.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,222.82
|
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: Cigna Commercial |
$2,236.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,236.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,236.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,258.20
|
| Rate for Payer: Multiplan Commercial |
$2,600.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,376.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,258.20
|
| Rate for Payer: United Healthcare Commercial |
$2,656.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,258.20
|
| Rate for Payer: United Healthcare VA CCN |
$1,258.20
|
|
|
EXC HAND LES SC < 1.5 CM
|
Facility
|
OP
|
$1,327.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
9602611502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$587.73 |
| Max. Negotiated Rate |
$1,260.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,260.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,188.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$587.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,188.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$798.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,127.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,074.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$597.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,054.96
|
| Rate for Payer: Cash Price |
$663.50
|
| Rate for Payer: Cigna Commercial |
$1,061.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,061.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,061.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$597.15
|
| Rate for Payer: Multiplan Commercial |
$1,234.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,127.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$597.15
|
| Rate for Payer: United Healthcare Commercial |
$1,260.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$597.15
|
| Rate for Payer: United Healthcare VA CCN |
$597.15
|
|
|
EXC HAND LES SC < 1.5 CM
|
Professional
|
Both
|
$2,796.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
5102611501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$321.33 |
| Max. Negotiated Rate |
$2,628.24 |
| Rate for Payer: Aetna of VT Commercial |
$2,628.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,504.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$330.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,504.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$449.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$872.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$872.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$369.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$872.07
|
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: Cigna Commercial |
$605.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$851.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$851.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$521.11
|
| Rate for Payer: Multiplan Commercial |
$2,600.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$456.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$321.33
|
| Rate for Payer: United Healthcare Commercial |
$494.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$321.33
|
| Rate for Payer: United Healthcare VA CCN |
$321.33
|
|
|
EXC HAND LES SC < 1.5 CM
|
Professional
|
Both
|
$1,327.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
9822611501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$321.33 |
| Max. Negotiated Rate |
$1,247.38 |
| Rate for Payer: Aetna of VT Commercial |
$1,247.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,188.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$330.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,188.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$449.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$872.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$872.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$369.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$872.07
|
| Rate for Payer: Cash Price |
$663.50
|
| Rate for Payer: Cash Price |
$663.50
|
| Rate for Payer: Cigna Commercial |
$605.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$851.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$851.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$521.11
|
| Rate for Payer: Multiplan Commercial |
$1,234.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$456.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$321.33
|
| Rate for Payer: United Healthcare Commercial |
$494.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$321.33
|
| Rate for Payer: United Healthcare VA CCN |
$321.33
|
|
|
EXC HAND LES SC < 1.5 CM
|
Facility
|
OP
|
$1,327.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
9822611501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$587.73 |
| Max. Negotiated Rate |
$1,260.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,260.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,188.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$587.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,188.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$798.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,127.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,074.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$597.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,054.96
|
| Rate for Payer: Cash Price |
$663.50
|
| Rate for Payer: Cigna Commercial |
$1,061.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,061.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,061.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$597.15
|
| Rate for Payer: Multiplan Commercial |
$1,234.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,127.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$597.15
|
| Rate for Payer: United Healthcare Commercial |
$1,260.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$597.15
|
| Rate for Payer: United Healthcare VA CCN |
$597.15
|
|
|
EXC HAND LES SC < 1.5 CM
|
Facility
|
OP
|
$4,122.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
9602611501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,825.63 |
| Max. Negotiated Rate |
$3,915.90 |
| Rate for Payer: Aetna of VT Commercial |
$3,915.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,692.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,825.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,692.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,481.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,503.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,338.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,854.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,276.99
|
| Rate for Payer: Cash Price |
$2,061.00
|
| Rate for Payer: Cigna Commercial |
$3,297.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,297.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,297.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,854.90
|
| Rate for Payer: Multiplan Commercial |
$3,833.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,503.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,854.90
|
| Rate for Payer: United Healthcare Commercial |
$3,915.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.90
|
| Rate for Payer: United Healthcare VA CCN |
$1,854.90
|
|
|
EXC HAND LES SC 1.5 CM/>
|
Professional
|
Both
|
$1,313.00
|
|
|
Service Code
|
CPT 26111
|
| Hospital Charge Code |
9822611101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$398.14 |
| Max. Negotiated Rate |
$1,234.22 |
| Rate for Payer: Aetna of VT Commercial |
$1,234.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,176.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$410.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,176.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$557.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$495.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$495.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$457.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$495.55
|
| Rate for Payer: Cash Price |
$656.50
|
| Rate for Payer: Cash Price |
$656.50
|
| Rate for Payer: Cigna Commercial |
$751.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$660.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$660.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$398.14
|
| Rate for Payer: Multiplan Commercial |
$1,221.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$565.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$398.14
|
| Rate for Payer: United Healthcare Commercial |
$612.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$398.14
|
| Rate for Payer: United Healthcare VA CCN |
$398.14
|
|
|
EXC HAND LES SC 1.5 CM/>
|
Facility
|
IP
|
$1,313.00
|
|
|
Service Code
|
CPT 26111
|
| Hospital Charge Code |
9822611101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$971.75 |
| Max. Negotiated Rate |
$1,247.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,247.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$971.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$971.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,116.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,102.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,050.40
|
| Rate for Payer: Cash Price |
$656.50
|
| Rate for Payer: Cigna Commercial |
$1,050.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,050.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,050.40
|
| Rate for Payer: Multiplan Commercial |
$1,221.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,116.05
|
| Rate for Payer: United Healthcare Commercial |
$1,247.35
|
|
|
EXC HAND LES SC 1.5 CM/>
|
Facility
|
OP
|
$1,313.00
|
|
|
Service Code
|
CPT 26111
|
| Hospital Charge Code |
9822611101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$581.53 |
| Max. Negotiated Rate |
$1,247.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,247.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,176.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$581.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,176.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$790.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,116.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,063.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$590.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,043.84
|
| Rate for Payer: Cash Price |
$656.50
|
| Rate for Payer: Cigna Commercial |
$1,050.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,050.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,050.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$590.85
|
| Rate for Payer: Multiplan Commercial |
$1,221.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,116.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$590.85
|
| Rate for Payer: United Healthcare Commercial |
$1,247.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$590.85
|
| Rate for Payer: United Healthcare VA CCN |
$590.85
|
|
|
EXC HAND TUM DEEP < 1.5 CM
|
Professional
|
Both
|
$1,604.00
|
|
|
Service Code
|
CPT 26116
|
| Hospital Charge Code |
9822611601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$504.12 |
| Max. Negotiated Rate |
$1,507.76 |
| Rate for Payer: Aetna of VT Commercial |
$1,507.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,437.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$519.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,437.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$705.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$933.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$933.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$579.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$933.02
|
| Rate for Payer: Cash Price |
$802.00
|
| Rate for Payer: Cash Price |
$802.00
|
| Rate for Payer: Cigna Commercial |
$951.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$835.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$835.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$504.12
|
| Rate for Payer: Multiplan Commercial |
$1,491.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$715.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$504.12
|
| Rate for Payer: United Healthcare Commercial |
$775.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$504.12
|
| Rate for Payer: United Healthcare VA CCN |
$504.12
|
|
