|
EXC LEG/ANKLE LES SC 3 CM/>
|
Professional
|
Both
|
$1,471.00
|
|
|
Service Code
|
CPT 27632
|
| Hospital Charge Code |
9822763201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$384.58 |
| Max. Negotiated Rate |
$1,382.74 |
| Rate for Payer: Aetna of VT Commercial |
$1,382.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,317.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$396.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,317.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$538.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$487.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$487.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$442.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$487.76
|
| Rate for Payer: Cash Price |
$735.50
|
| Rate for Payer: Cash Price |
$735.50
|
| Rate for Payer: Cigna Commercial |
$726.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$643.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$643.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$384.58
|
| Rate for Payer: Multiplan Commercial |
$1,368.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$546.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$384.58
|
| Rate for Payer: United Healthcare Commercial |
$591.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$384.58
|
| Rate for Payer: United Healthcare VA CCN |
$384.58
|
|
|
EXC LEG/ANKLE LES SC 3 CM/>
|
Facility
|
IP
|
$1,471.00
|
|
|
Service Code
|
CPT 27632
|
| Hospital Charge Code |
9822763201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,088.69 |
| Max. Negotiated Rate |
$1,397.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,397.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,088.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,088.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,250.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,235.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,176.80
|
| Rate for Payer: Cash Price |
$735.50
|
| Rate for Payer: Cigna Commercial |
$1,176.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,176.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,176.80
|
| Rate for Payer: Multiplan Commercial |
$1,368.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,250.35
|
| Rate for Payer: United Healthcare Commercial |
$1,397.45
|
|
|
EXC LEG/ANKLE TUM < 3 CM
|
Facility
|
IP
|
$1,106.00
|
|
|
Service Code
|
CPT 27618
|
| Hospital Charge Code |
9602761802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$818.55 |
| Max. Negotiated Rate |
$1,050.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,050.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$818.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$818.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$940.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$929.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$884.80
|
| Rate for Payer: Cash Price |
$553.00
|
| Rate for Payer: Cigna Commercial |
$884.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$884.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$884.80
|
| Rate for Payer: Multiplan Commercial |
$1,028.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$940.10
|
| Rate for Payer: United Healthcare Commercial |
$1,050.70
|
|
|
EXC LEG/ANKLE TUM < 3 CM
|
Facility
|
OP
|
$1,106.00
|
|
|
Service Code
|
CPT 27618
|
| Hospital Charge Code |
9602761802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$489.85 |
| Max. Negotiated Rate |
$1,050.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,050.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$990.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$489.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$990.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$665.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$940.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$895.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$497.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$879.27
|
| Rate for Payer: Cash Price |
$553.00
|
| Rate for Payer: Cigna Commercial |
$884.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$884.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$884.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$497.70
|
| Rate for Payer: Multiplan Commercial |
$1,028.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$940.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$497.70
|
| Rate for Payer: United Healthcare Commercial |
$1,050.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$497.70
|
| Rate for Payer: United Healthcare VA CCN |
$497.70
|
|
|
EXC LEG/ANKLE TUM < 3 CM
|
Professional
|
Both
|
$1,106.00
|
|
|
Service Code
|
CPT 27618
|
| Hospital Charge Code |
9602761802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$290.35 |
| Max. Negotiated Rate |
$1,039.64 |
| Rate for Payer: Aetna of VT Commercial |
$1,039.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$990.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$299.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$990.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$406.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$812.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$812.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$333.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$812.47
|
| Rate for Payer: Cash Price |
$553.00
|
| Rate for Payer: Cash Price |
$553.00
|
| Rate for Payer: Cigna Commercial |
$551.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$747.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$747.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$455.77
|
| Rate for Payer: Multiplan Commercial |
$1,028.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$412.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$290.35
|
| Rate for Payer: United Healthcare Commercial |
$446.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$290.35
|
| Rate for Payer: United Healthcare VA CCN |
$290.35
|
|
|
EXC LEG/ANKLE TUM < 3 CM
|
Professional
|
Both
|
$5,679.00
|
|
|
Service Code
|
CPT 27618
|
| Hospital Charge Code |
9602761801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$290.35 |
| Max. Negotiated Rate |
$5,338.26 |
| Rate for Payer: Aetna of VT Commercial |
$5,338.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,087.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$299.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,087.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$406.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$812.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$812.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$333.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$812.47
|
| Rate for Payer: Cash Price |
$2,839.50
|
| Rate for Payer: Cash Price |
$2,839.50
|
| Rate for Payer: Cigna Commercial |
$551.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$747.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$747.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$455.77
|
| Rate for Payer: Multiplan Commercial |
$5,281.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$412.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$290.35
|
| Rate for Payer: United Healthcare Commercial |
$446.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$290.35
|
| Rate for Payer: United Healthcare VA CCN |
$290.35
|
|
|
EXC LEG/ANKLE TUM < 3 CM
|
Facility
|
OP
|
$4,573.00
|
|
|
Service Code
|
CPT 27618
|
| Hospital Charge Code |
5102761801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,025.38 |
| Max. Negotiated Rate |
$4,344.35 |
| Rate for Payer: Aetna of VT Commercial |
$4,344.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,096.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,025.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,096.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,752.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,887.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,704.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,057.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,635.53
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cigna Commercial |
$3,658.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,658.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,658.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,057.85
|
| Rate for Payer: Multiplan Commercial |
$4,252.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,887.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,057.85
|
| Rate for Payer: United Healthcare Commercial |
$4,344.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,057.85
|
| Rate for Payer: United Healthcare VA CCN |
$2,057.85
|
|
|
EXC LEG/ANKLE TUM < 3 CM
|
Professional
|
Both
|
$4,573.00
|
|
|
Service Code
|
CPT 27618
|
| Hospital Charge Code |
5102761801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$290.35 |
| Max. Negotiated Rate |
$4,298.62 |
| Rate for Payer: Aetna of VT Commercial |
$4,298.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,096.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$299.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,096.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$406.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$812.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$812.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$333.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$812.47
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cigna Commercial |
$551.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$747.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$747.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$455.77
|
| Rate for Payer: Multiplan Commercial |
$4,252.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$412.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$290.35
|
| Rate for Payer: United Healthcare Commercial |
$446.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$290.35
|
| Rate for Payer: United Healthcare VA CCN |
$290.35
|
|
|
EXC LEG/ANKLE TUM < 3 CM
|
Facility
|
OP
|
$5,679.00
|
|
|
Service Code
|
CPT 27618
|
| Hospital Charge Code |
9602761801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,515.23 |
| Max. Negotiated Rate |
$5,395.05 |
| Rate for Payer: Aetna of VT Commercial |
$5,395.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,087.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,515.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,087.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,418.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,827.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,599.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,555.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,514.81
|
| Rate for Payer: Cash Price |
$2,839.50
|
| Rate for Payer: Cigna Commercial |
$4,543.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,543.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,543.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,555.55
|
| Rate for Payer: Multiplan Commercial |
$5,281.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,827.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,555.55
|
| Rate for Payer: United Healthcare Commercial |
$5,395.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,555.55
|
| Rate for Payer: United Healthcare VA CCN |
$2,555.55
|
|
|
EXC LEG/ANKLE TUM < 3 CM
|
Facility
|
IP
|
$5,679.00
|
|
|
Service Code
|
CPT 27618
|
| Hospital Charge Code |
9602761801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4,203.03 |
| Max. Negotiated Rate |
$5,395.05 |
| Rate for Payer: Aetna of VT Commercial |
$5,395.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,203.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,203.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,827.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,770.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,543.20
|
| Rate for Payer: Cash Price |
$2,839.50
|
| Rate for Payer: Cigna Commercial |
$4,543.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,543.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,543.20
|
| Rate for Payer: Multiplan Commercial |
$5,281.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,827.15
|
| Rate for Payer: United Healthcare Commercial |
$5,395.05
|
|
|
EXC LEG/ANKLE TUM < 3 CM
|
Facility
|
IP
|
$4,573.00
|
|
|
Service Code
|
CPT 27618
|
| Hospital Charge Code |
5102761801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,384.48 |
| Max. Negotiated Rate |
$4,344.35 |
| Rate for Payer: Aetna of VT Commercial |
$4,344.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,384.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,384.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,887.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,841.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,658.40
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cigna Commercial |
$3,658.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,658.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,658.40
|
| Rate for Payer: Multiplan Commercial |
$4,252.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,887.05
|
| Rate for Payer: United Healthcare Commercial |
$4,344.35
|
|
|
EXC LEG/ANKLE TUM DEEP <5 CM
|
Facility
|
IP
|
$1,716.00
|
|
|
Service Code
|
CPT 27619
|
| Hospital Charge Code |
9822761901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,270.01 |
| Max. Negotiated Rate |
$1,630.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,630.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,270.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,270.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,458.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,441.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,372.80
|
| Rate for Payer: Cash Price |
$858.00
|
| Rate for Payer: Cigna Commercial |
$1,372.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,372.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,372.80
|
| Rate for Payer: Multiplan Commercial |
$1,595.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,458.60
|
| Rate for Payer: United Healthcare Commercial |
$1,630.20
|
|
|
EXC LEG/ANKLE TUM DEEP <5 CM
|
Professional
|
Both
|
$1,716.00
|
|
|
Service Code
|
CPT 27619
|
| Hospital Charge Code |
9822761901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$441.45 |
| Max. Negotiated Rate |
$1,613.04 |
| Rate for Payer: Aetna of VT Commercial |
$1,613.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,537.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$454.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,537.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$618.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$820.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$820.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$507.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$820.10
|
| Rate for Payer: Cash Price |
$858.00
|
| Rate for Payer: Cash Price |
$858.00
|
| Rate for Payer: Cigna Commercial |
$845.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$732.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$732.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$441.45
|
| Rate for Payer: Multiplan Commercial |
$1,595.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$626.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$441.45
|
| Rate for Payer: United Healthcare Commercial |
$679.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$441.45
|
| Rate for Payer: United Healthcare VA CCN |
$441.45
|
|
|
EXC LEG/ANKLE TUM DEEP <5 CM
|
Facility
|
OP
|
$1,716.00
|
|
|
Service Code
|
CPT 27619
|
| Hospital Charge Code |
9822761901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$760.02 |
| Max. Negotiated Rate |
$1,630.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,630.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,537.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$760.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,537.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,033.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,458.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,389.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$772.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,364.22
|
| Rate for Payer: Cash Price |
$858.00
|
| Rate for Payer: Cigna Commercial |
$1,372.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,372.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,372.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$772.20
|
| Rate for Payer: Multiplan Commercial |
$1,595.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,458.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$772.20
|
| Rate for Payer: United Healthcare Commercial |
$1,630.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$772.20
|
| Rate for Payer: United Healthcare VA CCN |
$772.20
|
|
|
EXC NECK LES SC 3 CM/>
|
Facility
|
IP
|
$7,305.00
|
|
|
Service Code
|
CPT 21552
|
| Hospital Charge Code |
9602155201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$5,406.43 |
| Max. Negotiated Rate |
$6,939.75 |
| Rate for Payer: Aetna of VT Commercial |
$6,939.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,406.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,406.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,209.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,136.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,844.00
|
| Rate for Payer: Cash Price |
$3,652.50
|
| Rate for Payer: Cigna Commercial |
$5,844.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,844.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,844.00
|
| Rate for Payer: Multiplan Commercial |
$6,793.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,209.25
|
| Rate for Payer: United Healthcare Commercial |
$6,939.75
|
|
|
EXC NECK LES SC 3 CM/>
|
Facility
|
OP
|
$7,305.00
|
|
|
Service Code
|
CPT 21552
|
| Hospital Charge Code |
9602155201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,235.38 |
| Max. Negotiated Rate |
$6,939.75 |
| Rate for Payer: Aetna of VT Commercial |
$6,939.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,544.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,235.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,544.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,397.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,209.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,917.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,287.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,807.48
|
| Rate for Payer: Cash Price |
$3,652.50
|
| Rate for Payer: Cigna Commercial |
$5,844.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,844.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,844.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,287.25
|
| Rate for Payer: Multiplan Commercial |
$6,793.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,209.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,287.25
|
| Rate for Payer: United Healthcare Commercial |
$6,939.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,287.25
|
| Rate for Payer: United Healthcare VA CCN |
$3,287.25
|
|
|
EXC NECK LES SC 3 CM/>
|
Facility
|
IP
|
$1,009.00
|
|
|
Service Code
|
CPT 21552
|
| Hospital Charge Code |
9602155202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$746.76 |
| Max. Negotiated Rate |
$958.55 |
| Rate for Payer: Aetna of VT Commercial |
$958.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$746.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$746.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$857.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$847.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$807.20
|
| Rate for Payer: Cash Price |
$504.50
|
| Rate for Payer: Cigna Commercial |
$807.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$807.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$807.20
|
| Rate for Payer: Multiplan Commercial |
$938.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$857.65
|
| Rate for Payer: United Healthcare Commercial |
$958.55
|
|
|
EXC NECK LES SC 3 CM/>
|
Facility
|
OP
|
$6,297.00
|
|
|
Service Code
|
CPT 21552
|
| Hospital Charge Code |
5102155201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,788.94 |
| Max. Negotiated Rate |
$5,982.15 |
| Rate for Payer: Aetna of VT Commercial |
$5,982.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,641.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,788.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,641.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,790.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,352.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,100.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,833.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,006.11
|
| Rate for Payer: Cash Price |
$3,148.50
|
| Rate for Payer: Cigna Commercial |
$5,037.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,037.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,037.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,833.65
|
| Rate for Payer: Multiplan Commercial |
$5,856.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,352.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,833.65
|
| Rate for Payer: United Healthcare Commercial |
$5,982.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,833.65
|
| Rate for Payer: United Healthcare VA CCN |
$2,833.65
|
|
|
EXC NECK LES SC 3 CM/>
|
Professional
|
Both
|
$1,242.00
|
|
|
Service Code
|
CPT 21552
|
| Hospital Charge Code |
9822155201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$417.18 |
| Max. Negotiated Rate |
$1,167.48 |
| Rate for Payer: Aetna of VT Commercial |
$1,167.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,112.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$429.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,112.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$584.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$528.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$528.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$479.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$528.02
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cigna Commercial |
$790.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$702.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$702.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$417.18
|
| Rate for Payer: Multiplan Commercial |
$1,155.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$592.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$417.18
|
| Rate for Payer: United Healthcare Commercial |
$641.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$417.18
|
| Rate for Payer: United Healthcare VA CCN |
$417.18
|
|
|
EXC NECK LES SC 3 CM/>
|
Professional
|
Both
|
$7,305.00
|
|
|
Service Code
|
CPT 21552
|
| Hospital Charge Code |
9602155201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$417.18 |
| Max. Negotiated Rate |
$6,866.70 |
| Rate for Payer: Aetna of VT Commercial |
$6,866.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,544.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$429.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,544.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$584.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$528.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$528.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$479.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$528.02
|
| Rate for Payer: Cash Price |
$3,652.50
|
| Rate for Payer: Cash Price |
$3,652.50
|
| Rate for Payer: Cigna Commercial |
$790.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$702.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$702.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$417.18
|
| Rate for Payer: Multiplan Commercial |
$6,793.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$592.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$417.18
|
| Rate for Payer: United Healthcare Commercial |
$641.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$417.18
|
| Rate for Payer: United Healthcare VA CCN |
$417.18
|
|
|
EXC NECK LES SC 3 CM/>
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
CPT 21552
|
| Hospital Charge Code |
9822155201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$919.20 |
| Max. Negotiated Rate |
$1,179.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,179.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$919.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$919.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,055.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,043.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$993.60
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cigna Commercial |
$993.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$993.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$993.60
|
| Rate for Payer: Multiplan Commercial |
$1,155.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,055.70
|
| Rate for Payer: United Healthcare Commercial |
$1,179.90
|
|
|
EXC NECK LES SC 3 CM/>
|
Facility
|
OP
|
$1,009.00
|
|
|
Service Code
|
CPT 21552
|
| Hospital Charge Code |
9602155202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$446.89 |
| Max. Negotiated Rate |
$958.55 |
| Rate for Payer: Aetna of VT Commercial |
$958.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$903.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$446.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$903.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$607.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$857.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$817.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$454.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$802.15
|
| Rate for Payer: Cash Price |
$504.50
|
| Rate for Payer: Cigna Commercial |
$807.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$807.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$807.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$454.05
|
| Rate for Payer: Multiplan Commercial |
$938.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$857.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$454.05
|
| Rate for Payer: United Healthcare Commercial |
$958.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$454.05
|
| Rate for Payer: United Healthcare VA CCN |
$454.05
|
|
|
EXC NECK LES SC 3 CM/>
|
Professional
|
Both
|
$1,009.00
|
|
|
Service Code
|
CPT 21552
|
| Hospital Charge Code |
9602155202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$417.18 |
| Max. Negotiated Rate |
$948.46 |
| Rate for Payer: Aetna of VT Commercial |
$948.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$903.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$429.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$903.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$584.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$528.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$528.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$479.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$528.02
|
| Rate for Payer: Cash Price |
$504.50
|
| Rate for Payer: Cash Price |
$504.50
|
| Rate for Payer: Cigna Commercial |
$790.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$702.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$702.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$417.18
|
| Rate for Payer: Multiplan Commercial |
$938.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$592.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$417.18
|
| Rate for Payer: United Healthcare Commercial |
$641.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$417.18
|
| Rate for Payer: United Healthcare VA CCN |
$417.18
|
|
|
EXC NECK LES SC 3 CM/>
|
Facility
|
IP
|
$6,297.00
|
|
|
Service Code
|
CPT 21552
|
| Hospital Charge Code |
5102155201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,660.41 |
| Max. Negotiated Rate |
$5,982.15 |
| Rate for Payer: Aetna of VT Commercial |
$5,982.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,660.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,660.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,352.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,289.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,037.60
|
| Rate for Payer: Cash Price |
$3,148.50
|
| Rate for Payer: Cigna Commercial |
$5,037.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,037.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,037.60
|
| Rate for Payer: Multiplan Commercial |
$5,856.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,352.45
|
| Rate for Payer: United Healthcare Commercial |
$5,982.15
|
|
|
EXC NECK LES SC 3 CM/>
|
Professional
|
Both
|
$6,297.00
|
|
|
Service Code
|
CPT 21552
|
| Hospital Charge Code |
5102155201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$417.18 |
| Max. Negotiated Rate |
$5,919.18 |
| Rate for Payer: Aetna of VT Commercial |
$5,919.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,641.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$429.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,641.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$584.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$528.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$528.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$479.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$528.02
|
| Rate for Payer: Cash Price |
$3,148.50
|
| Rate for Payer: Cash Price |
$3,148.50
|
| Rate for Payer: Cigna Commercial |
$790.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$702.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$702.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$417.18
|
| Rate for Payer: Multiplan Commercial |
$5,856.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$592.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$417.18
|
| Rate for Payer: United Healthcare Commercial |
$641.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$417.18
|
| Rate for Payer: United Healthcare VA CCN |
$417.18
|
|
