|
EXC H-F-NK-SP B9+MARG >4 CM
|
Professional
|
Both
|
$915.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
9601142602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$253.51 |
| Max. Negotiated Rate |
$860.10 |
| Rate for Payer: Aetna of VT Commercial |
$860.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$819.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$261.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$819.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$354.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$452.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$452.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$291.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$452.64
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$283.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$511.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$511.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$310.69
|
| Rate for Payer: Multiplan Commercial |
$850.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$359.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$253.51
|
| Rate for Payer: United Healthcare Commercial |
$389.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$253.51
|
| Rate for Payer: United Healthcare VA CCN |
$253.51
|
|
|
EXC H-F-NK-SP B9+MARG >4 CM
|
Facility
|
OP
|
$915.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
9601142602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$405.25 |
| Max. Negotiated Rate |
$869.25 |
| Rate for Payer: Aetna of VT Commercial |
$869.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$819.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$405.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$819.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$550.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$777.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$741.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$411.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$727.42
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$732.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$732.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$732.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$411.75
|
| Rate for Payer: Multiplan Commercial |
$850.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$777.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$411.75
|
| Rate for Payer: United Healthcare Commercial |
$869.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$411.75
|
| Rate for Payer: United Healthcare VA CCN |
$411.75
|
|
|
EXC H-F-NK-SP B9+MARG >4 CM
|
Facility
|
IP
|
$915.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
9601142602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$677.19 |
| Max. Negotiated Rate |
$869.25 |
| Rate for Payer: Aetna of VT Commercial |
$869.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$677.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$677.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$777.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$768.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$732.00
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$732.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$732.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$732.00
|
| Rate for Payer: Multiplan Commercial |
$850.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$777.75
|
| Rate for Payer: United Healthcare Commercial |
$869.25
|
|
|
EXC H-F-NK-SP B9+MARG >4 CM
|
Facility
|
IP
|
$4,807.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
5101142601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,557.66 |
| Max. Negotiated Rate |
$4,566.65 |
| Rate for Payer: Aetna of VT Commercial |
$4,566.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,557.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,557.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,085.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,037.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,845.60
|
| Rate for Payer: Cash Price |
$2,403.50
|
| Rate for Payer: Cigna Commercial |
$3,845.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,845.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,845.60
|
| Rate for Payer: Multiplan Commercial |
$4,470.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,085.95
|
| Rate for Payer: United Healthcare Commercial |
$4,566.65
|
|
|
EXC H-F-NK-SP B9+MARG >4 CM
|
Facility
|
OP
|
$5,722.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
9601142601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,534.27 |
| Max. Negotiated Rate |
$5,435.90 |
| Rate for Payer: Aetna of VT Commercial |
$5,435.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,126.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,534.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,126.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,444.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,863.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,634.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,574.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,548.99
|
| Rate for Payer: Cash Price |
$2,861.00
|
| Rate for Payer: Cigna Commercial |
$4,577.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,577.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,577.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,574.90
|
| Rate for Payer: Multiplan Commercial |
$5,321.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,863.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,574.90
|
| Rate for Payer: United Healthcare Commercial |
$5,435.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,574.90
|
| Rate for Payer: United Healthcare VA CCN |
$2,574.90
|
|
|
EXC H-F-NK-SP B9+MARG >4 CM
|
Facility
|
OP
|
$4,807.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
5101142601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,129.02 |
| Max. Negotiated Rate |
$4,566.65 |
| Rate for Payer: Aetna of VT Commercial |
$4,566.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,306.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,129.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,306.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,893.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,085.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,893.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,163.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,821.57
|
| Rate for Payer: Cash Price |
$2,403.50
|
| Rate for Payer: Cigna Commercial |
$3,845.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,845.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,845.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,163.15
|
| Rate for Payer: Multiplan Commercial |
$4,470.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,085.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,163.15
|
| Rate for Payer: United Healthcare Commercial |
$4,566.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,163.15
|
| Rate for Payer: United Healthcare VA CCN |
$2,163.15
|
|
|
EXC H-F-NK-SP B9+MARG >4 CM
|
Professional
|
Both
|
$4,807.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
5101142601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$253.51 |
| Max. Negotiated Rate |
$4,518.58 |
| Rate for Payer: Aetna of VT Commercial |
$4,518.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,306.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$261.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,306.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$354.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$452.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$452.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$291.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$452.64
|
| Rate for Payer: Cash Price |
$2,403.50
|
| Rate for Payer: Cash Price |
$2,403.50
|
| Rate for Payer: Cigna Commercial |
$283.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$511.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$511.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$310.69
|
| Rate for Payer: Multiplan Commercial |
$4,470.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$359.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$253.51
|
| Rate for Payer: United Healthcare Commercial |
$389.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$253.51
|
| Rate for Payer: United Healthcare VA CCN |
$253.51
|
|
|
EXC H-F-NK-SP B9+MARG >4 CM
|
Professional
|
Both
|
$5,722.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
9601142601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$253.51 |
| Max. Negotiated Rate |
$5,378.68 |
| Rate for Payer: Aetna of VT Commercial |
$5,378.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,126.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$261.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,126.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$354.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$452.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$452.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$291.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$452.64
|
| Rate for Payer: Cash Price |
$2,861.00
|
| Rate for Payer: Cash Price |
$2,861.00
|
| Rate for Payer: Cigna Commercial |
$283.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$511.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$511.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$310.69
|
| Rate for Payer: Multiplan Commercial |
$5,321.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$359.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$253.51
|
| Rate for Payer: United Healthcare Commercial |
$389.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$253.51
|
| Rate for Payer: United Healthcare VA CCN |
$253.51
|
|
|
EXC H-F-NK-SP B9+MARG >4 CM
|
Facility
|
IP
|
$5,722.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
9601142601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4,234.85 |
| Max. Negotiated Rate |
$5,435.90 |
| Rate for Payer: Aetna of VT Commercial |
$5,435.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,234.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,234.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,863.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,806.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,577.60
|
| Rate for Payer: Cash Price |
$2,861.00
|
| Rate for Payer: Cigna Commercial |
$4,577.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,577.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,577.60
|
| Rate for Payer: Multiplan Commercial |
$5,321.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,863.70
|
| Rate for Payer: United Healthcare Commercial |
$5,435.90
|
|
|
EXC HIP/PELVIS LES SC < 3 CM
|
Professional
|
Both
|
$1,064.00
|
|
|
Service Code
|
CPT 27047
|
| Hospital Charge Code |
9602704702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$339.47 |
| Max. Negotiated Rate |
$1,000.16 |
| Rate for Payer: Aetna of VT Commercial |
$1,000.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$953.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$349.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$953.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$475.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$860.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$860.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$390.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$860.46
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cigna Commercial |
$645.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$765.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$765.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$462.17
|
| Rate for Payer: Multiplan Commercial |
$989.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$482.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$339.47
|
| Rate for Payer: United Healthcare Commercial |
$522.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.47
|
| Rate for Payer: United Healthcare VA CCN |
$339.47
|
|
|
EXC HIP/PELVIS LES SC < 3 CM
|
Facility
|
IP
|
$3,294.00
|
|
|
Service Code
|
CPT 27047
|
| Hospital Charge Code |
5102704701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,437.89 |
| Max. Negotiated Rate |
$3,129.30 |
| Rate for Payer: Aetna of VT Commercial |
$3,129.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,437.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,437.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,799.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,766.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,635.20
|
| Rate for Payer: Cash Price |
$1,647.00
|
| Rate for Payer: Cigna Commercial |
$2,635.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,635.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,635.20
|
| Rate for Payer: Multiplan Commercial |
$3,063.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,799.90
|
| Rate for Payer: United Healthcare Commercial |
$3,129.30
|
|
|
EXC HIP/PELVIS LES SC < 3 CM
|
Professional
|
Both
|
$3,294.00
|
|
|
Service Code
|
CPT 27047
|
| Hospital Charge Code |
5102704701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$339.47 |
| Max. Negotiated Rate |
$3,096.36 |
| Rate for Payer: Aetna of VT Commercial |
$3,096.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,951.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$349.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,951.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$475.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$860.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$860.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$390.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$860.46
|
| Rate for Payer: Cash Price |
$1,647.00
|
| Rate for Payer: Cash Price |
$1,647.00
|
| Rate for Payer: Cigna Commercial |
$645.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$765.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$765.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$462.17
|
| Rate for Payer: Multiplan Commercial |
$3,063.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$482.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$339.47
|
| Rate for Payer: United Healthcare Commercial |
$522.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.47
|
| Rate for Payer: United Healthcare VA CCN |
$339.47
|
|
|
EXC HIP/PELVIS LES SC < 3 CM
|
Facility
|
IP
|
$1,064.00
|
|
|
Service Code
|
CPT 27047
|
| Hospital Charge Code |
9602704702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$787.47 |
| Max. Negotiated Rate |
$1,010.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,010.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$787.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$787.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$904.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$893.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$851.20
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cigna Commercial |
$851.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$851.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$851.20
|
| Rate for Payer: Multiplan Commercial |
$989.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$904.40
|
| Rate for Payer: United Healthcare Commercial |
$1,010.80
|
|
|
EXC HIP/PELVIS LES SC < 3 CM
|
Facility
|
OP
|
$4,358.00
|
|
|
Service Code
|
CPT 27047
|
| Hospital Charge Code |
9602704701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,930.16 |
| Max. Negotiated Rate |
$4,140.10 |
| Rate for Payer: Aetna of VT Commercial |
$4,140.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,904.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,930.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,904.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,623.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,704.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,529.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,961.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,464.61
|
| Rate for Payer: Cash Price |
$2,179.00
|
| Rate for Payer: Cigna Commercial |
$3,486.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,486.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,486.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,961.10
|
| Rate for Payer: Multiplan Commercial |
$4,052.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,704.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,961.10
|
| Rate for Payer: United Healthcare Commercial |
$4,140.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,961.10
|
| Rate for Payer: United Healthcare VA CCN |
$1,961.10
|
|
|
EXC HIP/PELVIS LES SC < 3 CM
|
Facility
|
OP
|
$3,294.00
|
|
|
Service Code
|
CPT 27047
|
| Hospital Charge Code |
5102704701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,458.91 |
| Max. Negotiated Rate |
$3,129.30 |
| Rate for Payer: Aetna of VT Commercial |
$3,129.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,951.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,458.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,951.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,982.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,799.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,668.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,482.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,618.73
|
| Rate for Payer: Cash Price |
$1,647.00
|
| Rate for Payer: Cigna Commercial |
$2,635.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,635.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,635.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,482.30
|
| Rate for Payer: Multiplan Commercial |
$3,063.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,799.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,482.30
|
| Rate for Payer: United Healthcare Commercial |
$3,129.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,482.30
|
| Rate for Payer: United Healthcare VA CCN |
$1,482.30
|
|
|
EXC HIP/PELVIS LES SC < 3 CM
|
Facility
|
OP
|
$1,064.00
|
|
|
Service Code
|
CPT 27047
|
| Hospital Charge Code |
9602704702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$471.25 |
| Max. Negotiated Rate |
$1,010.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,010.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$953.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$471.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$953.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$640.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$904.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$861.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$478.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$845.88
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cigna Commercial |
$851.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$851.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$851.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$478.80
|
| Rate for Payer: Multiplan Commercial |
$989.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$904.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$478.80
|
| Rate for Payer: United Healthcare Commercial |
$1,010.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$478.80
|
| Rate for Payer: United Healthcare VA CCN |
$478.80
|
|
|
EXC HIP/PELVIS LES SC < 3 CM
|
Facility
|
IP
|
$4,358.00
|
|
|
Service Code
|
CPT 27047
|
| Hospital Charge Code |
9602704701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,225.36 |
| Max. Negotiated Rate |
$4,140.10 |
| Rate for Payer: Aetna of VT Commercial |
$4,140.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,225.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,225.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,704.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,660.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,486.40
|
| Rate for Payer: Cash Price |
$2,179.00
|
| Rate for Payer: Cigna Commercial |
$3,486.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,486.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,486.40
|
| Rate for Payer: Multiplan Commercial |
$4,052.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,704.30
|
| Rate for Payer: United Healthcare Commercial |
$4,140.10
|
|
|
EXC HIP/PELVIS LES SC < 3 CM
|
Professional
|
Both
|
$4,358.00
|
|
|
Service Code
|
CPT 27047
|
| Hospital Charge Code |
9602704701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$339.47 |
| Max. Negotiated Rate |
$4,096.52 |
| Rate for Payer: Aetna of VT Commercial |
$4,096.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,904.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$349.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,904.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$475.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$860.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$860.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$390.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$860.46
|
| Rate for Payer: Cash Price |
$2,179.00
|
| Rate for Payer: Cash Price |
$2,179.00
|
| Rate for Payer: Cigna Commercial |
$645.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$765.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$765.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$462.17
|
| Rate for Payer: Multiplan Commercial |
$4,052.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$482.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$339.47
|
| Rate for Payer: United Healthcare Commercial |
$522.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.47
|
| Rate for Payer: United Healthcare VA CCN |
$339.47
|
|
|
EXC HIP/PELV TUM DEEP < 5 CM
|
Facility
|
IP
|
$1,697.00
|
|
|
Service Code
|
CPT 27048
|
| Hospital Charge Code |
9822704801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,255.95 |
| Max. Negotiated Rate |
$1,612.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,612.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,255.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,255.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,442.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,425.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,357.60
|
| Rate for Payer: Cash Price |
$848.50
|
| Rate for Payer: Cigna Commercial |
$1,357.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,357.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,357.60
|
| Rate for Payer: Multiplan Commercial |
$1,578.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,442.45
|
| Rate for Payer: United Healthcare Commercial |
$1,612.15
|
|
|
EXC HIP/PELV TUM DEEP < 5 CM
|
Facility
|
OP
|
$1,697.00
|
|
|
Service Code
|
CPT 27048
|
| Hospital Charge Code |
9822704801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$751.60 |
| Max. Negotiated Rate |
$1,612.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,612.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,520.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$751.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,520.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,021.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,442.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,374.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$763.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,349.12
|
| Rate for Payer: Cash Price |
$848.50
|
| Rate for Payer: Cigna Commercial |
$1,357.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,357.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,357.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$763.65
|
| Rate for Payer: Multiplan Commercial |
$1,578.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,442.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$763.65
|
| Rate for Payer: United Healthcare Commercial |
$1,612.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$763.65
|
| Rate for Payer: United Healthcare VA CCN |
$763.65
|
|
|
EXC HIP/PELV TUM DEEP < 5 CM
|
Professional
|
Both
|
$1,697.00
|
|
|
Service Code
|
CPT 27048
|
| Hospital Charge Code |
9822704801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$574.93 |
| Max. Negotiated Rate |
$1,595.18 |
| Rate for Payer: Aetna of VT Commercial |
$1,595.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,520.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$592.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,520.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$804.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$818.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$818.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$661.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$818.62
|
| Rate for Payer: Cash Price |
$848.50
|
| Rate for Payer: Cash Price |
$848.50
|
| Rate for Payer: Cigna Commercial |
$1,084.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$965.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$965.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$574.93
|
| Rate for Payer: Multiplan Commercial |
$1,578.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$816.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$574.94
|
| Rate for Payer: United Healthcare Commercial |
$884.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$574.94
|
| Rate for Payer: United Healthcare VA CCN |
$574.94
|
|
|
EXCISE ANAL EXT TAG/PAPILLA
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 46220
|
| Hospital Charge Code |
9824622001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$145.80 |
| Max. Negotiated Rate |
$187.15 |
| Rate for Payer: Aetna of VT Commercial |
$187.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$167.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$165.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$157.60
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cigna Commercial |
$157.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$157.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$157.60
|
| Rate for Payer: Multiplan Commercial |
$183.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$167.45
|
| Rate for Payer: United Healthcare Commercial |
$187.15
|
|
|
EXCISE ANAL EXT TAG/PAPILLA
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
CPT 46220
|
| Hospital Charge Code |
9824622001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$384.18 |
| Rate for Payer: Aetna of VT Commercial |
$185.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$176.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$118.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$176.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$311.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$311.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$131.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$311.92
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cigna Commercial |
$209.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$384.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$384.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$235.85
|
| Rate for Payer: Multiplan Commercial |
$183.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$162.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$114.75
|
| Rate for Payer: United Healthcare Commercial |
$176.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.75
|
| Rate for Payer: United Healthcare VA CCN |
$114.75
|
|
|
EXCISE ANAL EXT TAG/PAPILLA
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 46220
|
| Hospital Charge Code |
9824622001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$87.25 |
| Max. Negotiated Rate |
$187.15 |
| Rate for Payer: Aetna of VT Commercial |
$187.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$176.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$176.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$118.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$167.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$156.62
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cigna Commercial |
$157.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$157.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$157.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$88.65
|
| Rate for Payer: Multiplan Commercial |
$183.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$167.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$88.65
|
| Rate for Payer: United Healthcare Commercial |
$187.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.65
|
| Rate for Payer: United Healthcare VA CCN |
$88.65
|
|
|
EXCISION BREAST LESION
|
Professional
|
Both
|
$8,449.00
|
|
|
Service Code
|
CPT 19125
|
| Hospital Charge Code |
9601912501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$428.76 |
| Max. Negotiated Rate |
$7,942.06 |
| Rate for Payer: Aetna of VT Commercial |
$7,942.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7,569.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$441.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7,569.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$600.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$719.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$719.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$493.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$719.68
|
| Rate for Payer: Cash Price |
$4,224.50
|
| Rate for Payer: Cash Price |
$4,224.50
|
| Rate for Payer: Cigna Commercial |
$782.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$894.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$894.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$534.44
|
| Rate for Payer: Multiplan Commercial |
$7,857.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$608.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$428.76
|
| Rate for Payer: United Healthcare Commercial |
$659.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$428.76
|
| Rate for Payer: United Healthcare VA CCN |
$428.76
|
|
