|
EXC TR-EXT MAL+MARG >4 CM
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
CPT 11606
|
| Hospital Charge Code |
5101160601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,065.74 |
| Max. Negotiated Rate |
$1,368.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,368.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,065.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,065.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,224.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,209.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,152.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$1,152.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,152.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,152.00
|
| Rate for Payer: Multiplan Commercial |
$1,339.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare Commercial |
$1,368.00
|
|
|
EXC TR-EXT MAL+MARG >4 CM
|
Facility
|
IP
|
$1,524.00
|
|
|
Service Code
|
CPT 11606
|
| Hospital Charge Code |
9821160601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,127.91 |
| Max. Negotiated Rate |
$1,447.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,447.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,127.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,127.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,295.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,280.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,219.20
|
| Rate for Payer: Cash Price |
$762.00
|
| Rate for Payer: Cigna Commercial |
$1,219.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,219.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,219.20
|
| Rate for Payer: Multiplan Commercial |
$1,417.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,295.40
|
| Rate for Payer: United Healthcare Commercial |
$1,447.80
|
|
|
EXC TR-EXT MAL+MARG >4 CM
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
CPT 11606
|
| Hospital Charge Code |
5101160601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$637.78 |
| Max. Negotiated Rate |
$1,368.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,368.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,290.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$637.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,290.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$866.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,224.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,166.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$648.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,144.80
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$1,152.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,152.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,152.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$648.00
|
| Rate for Payer: Multiplan Commercial |
$1,339.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,224.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$648.00
|
| Rate for Payer: United Healthcare Commercial |
$1,368.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$648.00
|
| Rate for Payer: United Healthcare VA CCN |
$648.00
|
|
|
EXPLORATION OF ABDOMEN
|
Facility
|
IP
|
$2,218.00
|
|
|
Service Code
|
CPT 49000
|
| Hospital Charge Code |
9824900001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,641.54 |
| Max. Negotiated Rate |
$2,107.10 |
| Rate for Payer: Aetna of VT Commercial |
$2,107.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,641.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,641.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,885.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,863.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,774.40
|
| Rate for Payer: Cash Price |
$1,109.00
|
| Rate for Payer: Cigna Commercial |
$1,774.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,774.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,774.40
|
| Rate for Payer: Multiplan Commercial |
$2,062.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,885.30
|
| Rate for Payer: United Healthcare Commercial |
$2,107.10
|
|
|
EXPLORATION OF ABDOMEN
|
Facility
|
OP
|
$2,218.00
|
|
|
Service Code
|
CPT 49000
|
| Hospital Charge Code |
9824900001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$982.35 |
| Max. Negotiated Rate |
$2,107.10 |
| Rate for Payer: Aetna of VT Commercial |
$2,107.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,987.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$982.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,987.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,335.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,885.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,796.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$998.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,763.31
|
| Rate for Payer: Cash Price |
$1,109.00
|
| Rate for Payer: Cigna Commercial |
$1,774.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,774.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,774.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$998.10
|
| Rate for Payer: Multiplan Commercial |
$2,062.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,885.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$998.10
|
| Rate for Payer: United Healthcare Commercial |
$2,107.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$998.10
|
| Rate for Payer: United Healthcare VA CCN |
$998.10
|
|
|
EXPLORATION OF ABDOMEN
|
Professional
|
Both
|
$2,218.00
|
|
|
Service Code
|
CPT 49000
|
| Hospital Charge Code |
9824900001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$704.78 |
| Max. Negotiated Rate |
$2,084.92 |
| Rate for Payer: Aetna of VT Commercial |
$2,084.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,987.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$725.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,987.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$986.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,187.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,187.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$810.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,187.41
|
| Rate for Payer: Cash Price |
$1,109.00
|
| Rate for Payer: Cash Price |
$1,109.00
|
| Rate for Payer: Cigna Commercial |
$1,287.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,196.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,196.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$704.78
|
| Rate for Payer: Multiplan Commercial |
$2,062.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,000.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$704.78
|
| Rate for Payer: United Healthcare Commercial |
$1,084.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$704.78
|
| Rate for Payer: United Healthcare VA CCN |
$704.78
|
|
|
EXPLORE SMALL INTESTINE
|
Facility
|
OP
|
$2,762.00
|
|
|
Service Code
|
CPT 44020
|
| Hospital Charge Code |
9824402001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,223.29 |
| Max. Negotiated Rate |
$2,623.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,623.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,474.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,223.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,474.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,662.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,347.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,237.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,242.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,195.79
|
| Rate for Payer: Cash Price |
$1,381.00
|
| Rate for Payer: Cigna Commercial |
$2,209.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,209.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,209.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,242.90
|
| Rate for Payer: Multiplan Commercial |
$2,568.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,347.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,242.90
|
| Rate for Payer: United Healthcare Commercial |
$2,623.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,242.90
|
| Rate for Payer: United Healthcare VA CCN |
$1,242.90
|
|
|
EXPLORE SMALL INTESTINE
|
Facility
|
IP
|
$2,762.00
|
|
|
Service Code
|
CPT 44020
|
| Hospital Charge Code |
9824402001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,044.16 |
| Max. Negotiated Rate |
$2,623.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,623.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,044.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,044.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,347.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,320.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,209.60
|
| Rate for Payer: Cash Price |
$1,381.00
|
| Rate for Payer: Cigna Commercial |
$2,209.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,209.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,209.60
|
| Rate for Payer: Multiplan Commercial |
$2,568.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,347.70
|
| Rate for Payer: United Healthcare Commercial |
$2,623.90
|
|
|
EXPLORE SMALL INTESTINE
|
Professional
|
Both
|
$2,762.00
|
|
|
Service Code
|
CPT 44020
|
| Hospital Charge Code |
9824402001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$888.14 |
| Max. Negotiated Rate |
$2,596.28 |
| Rate for Payer: Aetna of VT Commercial |
$2,596.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,474.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$914.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,474.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,243.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,390.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,390.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,021.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,390.15
|
| Rate for Payer: Cash Price |
$1,381.00
|
| Rate for Payer: Cash Price |
$1,381.00
|
| Rate for Payer: Cigna Commercial |
$1,621.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,514.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,514.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$888.14
|
| Rate for Payer: Multiplan Commercial |
$2,568.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,261.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$888.14
|
| Rate for Payer: United Healthcare Commercial |
$1,366.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$888.14
|
| Rate for Payer: United Healthcare VA CCN |
$888.14
|
|
|
EXPLORE/TREAT FINGER JOINT
|
Professional
|
Both
|
$1,361.00
|
|
|
Service Code
|
CPT 26080
|
| Hospital Charge Code |
9822608001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$387.03 |
| Max. Negotiated Rate |
$1,279.34 |
| Rate for Payer: Aetna of VT Commercial |
$1,279.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,219.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$398.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,219.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$541.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$791.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$791.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$445.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$791.20
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cigna Commercial |
$731.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$638.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$638.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$387.03
|
| Rate for Payer: Multiplan Commercial |
$1,265.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$549.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$387.04
|
| Rate for Payer: United Healthcare Commercial |
$595.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.04
|
| Rate for Payer: United Healthcare VA CCN |
$387.04
|
|
|
EXPLORE/TREAT FINGER JOINT
|
Facility
|
OP
|
$1,361.00
|
|
|
Service Code
|
CPT 26080
|
| Hospital Charge Code |
9822608001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$602.79 |
| Max. Negotiated Rate |
$1,292.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,292.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,219.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$602.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,219.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$819.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,156.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,102.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$612.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,081.99
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cigna Commercial |
$1,088.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,088.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,088.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$612.45
|
| Rate for Payer: Multiplan Commercial |
$1,265.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,156.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$612.45
|
| Rate for Payer: United Healthcare Commercial |
$1,292.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$612.45
|
| Rate for Payer: United Healthcare VA CCN |
$612.45
|
|
|
EXPLORE/TREAT FINGER JOINT
|
Facility
|
IP
|
$1,361.00
|
|
|
Service Code
|
CPT 26080
|
| Hospital Charge Code |
9822608001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,007.28 |
| Max. Negotiated Rate |
$1,292.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,292.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,007.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,007.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,156.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,143.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,088.80
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cigna Commercial |
$1,088.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,088.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,088.80
|
| Rate for Payer: Multiplan Commercial |
$1,265.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,156.85
|
| Rate for Payer: United Healthcare Commercial |
$1,292.95
|
|
|
EXPLORE/TREAT WRIST JOINT
|
Professional
|
Both
|
$1,603.00
|
|
|
Service Code
|
CPT 25101
|
| Hospital Charge Code |
9822510101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$392.79 |
| Max. Negotiated Rate |
$1,506.82 |
| Rate for Payer: Aetna of VT Commercial |
$1,506.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,436.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$404.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,436.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$549.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$777.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$777.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$451.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$777.50
|
| Rate for Payer: Cash Price |
$801.50
|
| Rate for Payer: Cash Price |
$801.50
|
| Rate for Payer: Cigna Commercial |
$741.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$649.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$649.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$392.79
|
| Rate for Payer: Multiplan Commercial |
$1,490.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$557.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$392.79
|
| Rate for Payer: United Healthcare Commercial |
$604.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$392.79
|
| Rate for Payer: United Healthcare VA CCN |
$392.79
|
|
|
EXPLORE/TREAT WRIST JOINT
|
Facility
|
OP
|
$1,603.00
|
|
|
Service Code
|
CPT 25101
|
| Hospital Charge Code |
9822510101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$709.97 |
| Max. Negotiated Rate |
$1,522.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,522.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,436.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$709.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,436.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$965.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,362.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,298.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$721.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,274.38
|
| Rate for Payer: Cash Price |
$801.50
|
| Rate for Payer: Cigna Commercial |
$1,282.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,282.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,282.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$721.35
|
| Rate for Payer: Multiplan Commercial |
$1,490.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,362.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$721.35
|
| Rate for Payer: United Healthcare Commercial |
$1,522.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$721.35
|
| Rate for Payer: United Healthcare VA CCN |
$721.35
|
|
|
EXPLORE/TREAT WRIST JOINT
|
Facility
|
IP
|
$1,603.00
|
|
|
Service Code
|
CPT 25101
|
| Hospital Charge Code |
9822510101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,186.38 |
| Max. Negotiated Rate |
$1,522.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,522.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,186.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,186.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,362.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,346.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,282.40
|
| Rate for Payer: Cash Price |
$801.50
|
| Rate for Payer: Cigna Commercial |
$1,282.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,282.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,282.40
|
| Rate for Payer: Multiplan Commercial |
$1,490.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,362.55
|
| Rate for Payer: United Healthcare Commercial |
$1,522.85
|
|
|
EXPLORE WOUND ABDOMEN
|
Facility
|
IP
|
$1,396.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
9812010202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,033.18 |
| Max. Negotiated Rate |
$1,326.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,326.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,033.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,033.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,186.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,172.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,116.80
|
| Rate for Payer: Cash Price |
$698.00
|
| Rate for Payer: Cigna Commercial |
$1,116.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,116.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,116.80
|
| Rate for Payer: Multiplan Commercial |
$1,298.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,186.60
|
| Rate for Payer: United Healthcare Commercial |
$1,326.20
|
|
|
EXPLORE WOUND ABDOMEN
|
Facility
|
OP
|
$2,026.82
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
4502010201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$897.68 |
| Max. Negotiated Rate |
$1,925.48 |
| Rate for Payer: Aetna of VT Commercial |
$1,925.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,815.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$897.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,815.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,220.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,722.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,641.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$912.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,611.32
|
| Rate for Payer: Cash Price |
$1,013.41
|
| Rate for Payer: Cigna Commercial |
$1,621.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,621.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,621.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$912.07
|
| Rate for Payer: Multiplan Commercial |
$1,884.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,722.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$912.07
|
| Rate for Payer: United Healthcare Commercial |
$1,925.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$912.07
|
| Rate for Payer: United Healthcare VA CCN |
$912.07
|
|
|
EXPLORE WOUND ABDOMEN
|
Facility
|
IP
|
$1,396.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
9812010201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,033.18 |
| Max. Negotiated Rate |
$1,326.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,326.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,033.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,033.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,186.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,172.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,116.80
|
| Rate for Payer: Cash Price |
$698.00
|
| Rate for Payer: Cigna Commercial |
$1,116.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,116.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,116.80
|
| Rate for Payer: Multiplan Commercial |
$1,298.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,186.60
|
| Rate for Payer: United Healthcare Commercial |
$1,326.20
|
|
|
EXPLORE WOUND ABDOMEN
|
Facility
|
OP
|
$1,396.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
9812010201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$618.29 |
| Max. Negotiated Rate |
$1,326.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,326.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,250.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$618.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,250.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$840.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,186.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,130.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$628.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,109.82
|
| Rate for Payer: Cash Price |
$698.00
|
| Rate for Payer: Cigna Commercial |
$1,116.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,116.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,116.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$628.20
|
| Rate for Payer: Multiplan Commercial |
$1,298.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,186.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$628.20
|
| Rate for Payer: United Healthcare Commercial |
$1,326.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$628.20
|
| Rate for Payer: United Healthcare VA CCN |
$628.20
|
|
|
EXPLORE WOUND ABDOMEN
|
Professional
|
Both
|
$1,396.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
9812010202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$235.07 |
| Max. Negotiated Rate |
$1,312.24 |
| Rate for Payer: Aetna of VT Commercial |
$1,312.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,250.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$242.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,250.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$329.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$824.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$824.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$270.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$824.23
|
| Rate for Payer: Cash Price |
$698.00
|
| Rate for Payer: Cash Price |
$698.00
|
| Rate for Payer: Cigna Commercial |
$446.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$917.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$917.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$559.16
|
| Rate for Payer: Multiplan Commercial |
$1,298.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$333.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$235.07
|
| Rate for Payer: United Healthcare Commercial |
$361.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$235.07
|
| Rate for Payer: United Healthcare VA CCN |
$235.07
|
|
|
EXPLORE WOUND ABDOMEN
|
Facility
|
OP
|
$1,396.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
9822010201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$618.29 |
| Max. Negotiated Rate |
$1,326.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,326.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,250.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$618.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,250.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$840.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,186.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,130.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$628.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,109.82
|
| Rate for Payer: Cash Price |
$698.00
|
| Rate for Payer: Cigna Commercial |
$1,116.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,116.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,116.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$628.20
|
| Rate for Payer: Multiplan Commercial |
$1,298.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,186.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$628.20
|
| Rate for Payer: United Healthcare Commercial |
$1,326.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$628.20
|
| Rate for Payer: United Healthcare VA CCN |
$628.20
|
|
|
EXPLORE WOUND ABDOMEN
|
Facility
|
OP
|
$1,396.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
9812010202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$618.29 |
| Max. Negotiated Rate |
$1,326.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,326.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,250.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$618.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,250.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$840.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,186.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,130.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$628.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,109.82
|
| Rate for Payer: Cash Price |
$698.00
|
| Rate for Payer: Cigna Commercial |
$1,116.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,116.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,116.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$628.20
|
| Rate for Payer: Multiplan Commercial |
$1,298.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,186.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$628.20
|
| Rate for Payer: United Healthcare Commercial |
$1,326.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$628.20
|
| Rate for Payer: United Healthcare VA CCN |
$628.20
|
|
|
EXPLORE WOUND ABDOMEN
|
Professional
|
Both
|
$1,396.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
9822010201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$235.07 |
| Max. Negotiated Rate |
$1,312.24 |
| Rate for Payer: Aetna of VT Commercial |
$1,312.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,250.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$242.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,250.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$329.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$824.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$824.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$270.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$824.23
|
| Rate for Payer: Cash Price |
$698.00
|
| Rate for Payer: Cash Price |
$698.00
|
| Rate for Payer: Cigna Commercial |
$446.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$917.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$917.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$559.16
|
| Rate for Payer: Multiplan Commercial |
$1,298.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$333.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$235.07
|
| Rate for Payer: United Healthcare Commercial |
$361.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$235.07
|
| Rate for Payer: United Healthcare VA CCN |
$235.07
|
|
|
EXPLORE WOUND ABDOMEN
|
Facility
|
IP
|
$1,396.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
9822010201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,033.18 |
| Max. Negotiated Rate |
$1,326.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,326.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,033.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,033.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,186.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,172.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,116.80
|
| Rate for Payer: Cash Price |
$698.00
|
| Rate for Payer: Cigna Commercial |
$1,116.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,116.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,116.80
|
| Rate for Payer: Multiplan Commercial |
$1,298.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,186.60
|
| Rate for Payer: United Healthcare Commercial |
$1,326.20
|
|
|
EXPLORE WOUND ABDOMEN
|
Professional
|
Both
|
$1,396.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
9812010201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$235.07 |
| Max. Negotiated Rate |
$1,312.24 |
| Rate for Payer: Aetna of VT Commercial |
$1,312.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,250.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$242.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,250.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$329.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$824.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$824.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$270.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$824.23
|
| Rate for Payer: Cash Price |
$698.00
|
| Rate for Payer: Cash Price |
$698.00
|
| Rate for Payer: Cigna Commercial |
$446.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$917.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$917.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$559.16
|
| Rate for Payer: Multiplan Commercial |
$1,298.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$333.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$235.07
|
| Rate for Payer: United Healthcare Commercial |
$361.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$235.07
|
| Rate for Payer: United Healthcare VA CCN |
$235.07
|
|
