|
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 EXTREMITY
|
Facility
|
OP
|
$1,377.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
9812010302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$609.87 |
| Max. Negotiated Rate |
$1,308.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,308.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,233.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$609.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,233.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$828.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,170.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,115.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$619.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,094.71
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna Commercial |
$1,101.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,101.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,101.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$619.65
|
| Rate for Payer: Multiplan Commercial |
$1,280.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,170.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$619.65
|
| Rate for Payer: United Healthcare Commercial |
$1,308.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$619.65
|
| Rate for Payer: United Healthcare VA CCN |
$619.65
|
|
|
EXPLORE WOUND EXTREMITY
|
Professional
|
Both
|
$5,430.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
5102010301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$320.54 |
| Max. Negotiated Rate |
$5,104.20 |
| Rate for Payer: Aetna of VT Commercial |
$5,104.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,864.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$330.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,864.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$448.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$689.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$689.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$368.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$689.29
|
| Rate for Payer: Cash Price |
$2,715.00
|
| Rate for Payer: Cash Price |
$2,715.00
|
| Rate for Payer: Cigna Commercial |
$609.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$865.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$865.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$526.11
|
| Rate for Payer: Multiplan Commercial |
$5,049.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$455.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$320.54
|
| Rate for Payer: United Healthcare Commercial |
$493.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$320.54
|
| Rate for Payer: United Healthcare VA CCN |
$320.54
|
|
|
EXPLORE WOUND EXTREMITY
|
Facility
|
IP
|
$1,377.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
9812010302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,019.12 |
| Max. Negotiated Rate |
$1,308.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,308.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,019.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,019.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,170.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,156.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,101.60
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna Commercial |
$1,101.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,101.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,101.60
|
| Rate for Payer: Multiplan Commercial |
$1,280.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,170.45
|
| Rate for Payer: United Healthcare Commercial |
$1,308.15
|
|
|
EXPLORE WOUND EXTREMITY
|
Facility
|
OP
|
$1,377.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
9602010302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$609.87 |
| Max. Negotiated Rate |
$1,308.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,308.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,233.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$609.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,233.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$828.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,170.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,115.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$619.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,094.71
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna Commercial |
$1,101.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,101.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,101.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$619.65
|
| Rate for Payer: Multiplan Commercial |
$1,280.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,170.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$619.65
|
| Rate for Payer: United Healthcare Commercial |
$1,308.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$619.65
|
| Rate for Payer: United Healthcare VA CCN |
$619.65
|
|
|
EXPLORE WOUND EXTREMITY
|
Facility
|
OP
|
$1,377.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
9812010301
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$609.87 |
| Max. Negotiated Rate |
$1,308.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,308.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,233.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$609.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,233.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$828.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,170.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,115.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$619.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,094.71
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna Commercial |
$1,101.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,101.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,101.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$619.65
|
| Rate for Payer: Multiplan Commercial |
$1,280.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,170.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$619.65
|
| Rate for Payer: United Healthcare Commercial |
$1,308.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$619.65
|
| Rate for Payer: United Healthcare VA CCN |
$619.65
|
|
|
EXPLORE WOUND EXTREMITY
|
Professional
|
Both
|
$6,807.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
9602010301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$320.54 |
| Max. Negotiated Rate |
$6,398.58 |
| Rate for Payer: Aetna of VT Commercial |
$6,398.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,098.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$330.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,098.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$448.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$689.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$689.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$368.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$689.29
|
| Rate for Payer: Cash Price |
$3,403.50
|
| Rate for Payer: Cash Price |
$3,403.50
|
| Rate for Payer: Cigna Commercial |
$609.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$865.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$865.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$526.11
|
| Rate for Payer: Multiplan Commercial |
$6,330.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$455.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$320.54
|
| Rate for Payer: United Healthcare Commercial |
$493.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$320.54
|
| Rate for Payer: United Healthcare VA CCN |
$320.54
|
|
|
EXPLORE WOUND EXTREMITY
|
Facility
|
IP
|
$1,377.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
9602010302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,019.12 |
| Max. Negotiated Rate |
$1,308.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,308.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,019.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,019.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,170.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,156.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,101.60
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna Commercial |
$1,101.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,101.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,101.60
|
| Rate for Payer: Multiplan Commercial |
$1,280.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,170.45
|
| Rate for Payer: United Healthcare Commercial |
$1,308.15
|
|
|
EXPLORE WOUND EXTREMITY
|
Professional
|
Both
|
$1,377.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
9602010302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$320.54 |
| Max. Negotiated Rate |
$1,294.38 |
| Rate for Payer: Aetna of VT Commercial |
$1,294.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,233.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$330.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,233.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$448.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$689.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$689.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$368.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$689.29
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna Commercial |
$609.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$865.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$865.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$526.11
|
| Rate for Payer: Multiplan Commercial |
$1,280.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$455.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$320.54
|
| Rate for Payer: United Healthcare Commercial |
$493.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$320.54
|
| Rate for Payer: United Healthcare VA CCN |
$320.54
|
|
|
EXPLORE WOUND EXTREMITY
|
Facility
|
OP
|
$5,429.95
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
4502010301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,404.92 |
| Max. Negotiated Rate |
$5,158.45 |
| Rate for Payer: Aetna of VT Commercial |
$5,158.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,864.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,404.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,864.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,268.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,615.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,398.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,443.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,316.81
|
| Rate for Payer: Cash Price |
$2,714.98
|
| Rate for Payer: Cigna Commercial |
$4,343.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,343.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,343.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,443.48
|
| Rate for Payer: Multiplan Commercial |
$5,049.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,615.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,443.48
|
| Rate for Payer: United Healthcare Commercial |
$5,158.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,443.48
|
| Rate for Payer: United Healthcare VA CCN |
$2,443.48
|
|
|
EXPLORE WOUND EXTREMITY
|
Facility
|
IP
|
$5,429.95
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
4502010301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,018.71 |
| Max. Negotiated Rate |
$5,158.45 |
| Rate for Payer: Aetna of VT Commercial |
$5,158.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,018.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,018.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,615.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,561.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,343.96
|
| Rate for Payer: Cash Price |
$2,714.98
|
| Rate for Payer: Cigna Commercial |
$4,343.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,343.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,343.96
|
| Rate for Payer: Multiplan Commercial |
$5,049.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,615.46
|
| Rate for Payer: United Healthcare Commercial |
$5,158.45
|
|
|
EXPLORE WOUND EXTREMITY
|
Facility
|
IP
|
$1,377.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
9812010301
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,019.12 |
| Max. Negotiated Rate |
$1,308.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,308.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,019.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,019.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,170.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,156.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,101.60
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna Commercial |
$1,101.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,101.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,101.60
|
| Rate for Payer: Multiplan Commercial |
$1,280.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,170.45
|
| Rate for Payer: United Healthcare Commercial |
$1,308.15
|
|
|
EXPLORE WOUND EXTREMITY
|
Facility
|
IP
|
$1,377.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
9822010301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,019.12 |
| Max. Negotiated Rate |
$1,308.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,308.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,019.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,019.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,170.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,156.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,101.60
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna Commercial |
$1,101.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,101.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,101.60
|
| Rate for Payer: Multiplan Commercial |
$1,280.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,170.45
|
| Rate for Payer: United Healthcare Commercial |
$1,308.15
|
|
|
EXPLORE WOUND EXTREMITY
|
Professional
|
Both
|
$1,377.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
9812010302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$320.54 |
| Max. Negotiated Rate |
$1,294.38 |
| Rate for Payer: Aetna of VT Commercial |
$1,294.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,233.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$330.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,233.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$448.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$689.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$689.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$368.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$689.29
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna Commercial |
$609.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$865.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$865.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$526.11
|
| Rate for Payer: Multiplan Commercial |
$1,280.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$455.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$320.54
|
| Rate for Payer: United Healthcare Commercial |
$493.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$320.54
|
| Rate for Payer: United Healthcare VA CCN |
$320.54
|
|
|
EXPLORE WOUND EXTREMITY
|
Professional
|
Both
|
$1,377.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
9822010301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$320.54 |
| Max. Negotiated Rate |
$1,294.38 |
| Rate for Payer: Aetna of VT Commercial |
$1,294.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,233.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$330.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,233.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$448.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$689.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$689.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$368.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$689.29
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna Commercial |
$609.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$865.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$865.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$526.11
|
| Rate for Payer: Multiplan Commercial |
$1,280.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$455.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$320.54
|
| Rate for Payer: United Healthcare Commercial |
$493.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$320.54
|
| Rate for Payer: United Healthcare VA CCN |
$320.54
|
|
|
EXPLORE WOUND EXTREMITY
|
Facility
|
IP
|
$5,430.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
5102010301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,018.74 |
| Max. Negotiated Rate |
$5,158.50 |
| Rate for Payer: Aetna of VT Commercial |
$5,158.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,018.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,018.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,615.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,561.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,344.00
|
| Rate for Payer: Cash Price |
$2,715.00
|
| Rate for Payer: Cigna Commercial |
$4,344.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,344.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,344.00
|
| Rate for Payer: Multiplan Commercial |
$5,049.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,615.50
|
| Rate for Payer: United Healthcare Commercial |
$5,158.50
|
|
|
EXPLORE WOUND EXTREMITY
|
Facility
|
IP
|
$6,807.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
9602010301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$5,037.86 |
| Max. Negotiated Rate |
$6,466.65 |
| Rate for Payer: Aetna of VT Commercial |
$6,466.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,037.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,037.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,785.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,717.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,445.60
|
| Rate for Payer: Cash Price |
$3,403.50
|
| Rate for Payer: Cigna Commercial |
$5,445.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,445.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,445.60
|
| Rate for Payer: Multiplan Commercial |
$6,330.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,785.95
|
| Rate for Payer: United Healthcare Commercial |
$6,466.65
|
|
|
EXPLORE WOUND EXTREMITY
|
Professional
|
Both
|
$1,377.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
9812010301
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$320.54 |
| Max. Negotiated Rate |
$1,294.38 |
| Rate for Payer: Aetna of VT Commercial |
$1,294.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,233.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$330.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,233.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$448.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$689.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$689.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$368.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$689.29
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna Commercial |
$609.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$865.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$865.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$526.11
|
| Rate for Payer: Multiplan Commercial |
$1,280.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$455.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$320.54
|
| Rate for Payer: United Healthcare Commercial |
$493.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$320.54
|
| Rate for Payer: United Healthcare VA CCN |
$320.54
|
|
|
EXPLORE WOUND EXTREMITY
|
Facility
|
OP
|
$1,377.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
9822010301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$609.87 |
| Max. Negotiated Rate |
$1,308.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,308.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,233.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$609.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,233.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$828.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,170.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,115.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$619.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,094.71
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna Commercial |
$1,101.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,101.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,101.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$619.65
|
| Rate for Payer: Multiplan Commercial |
$1,280.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,170.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$619.65
|
| Rate for Payer: United Healthcare Commercial |
$1,308.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$619.65
|
| Rate for Payer: United Healthcare VA CCN |
$619.65
|
|
|
EXPLORE WOUND EXTREMITY
|
Facility
|
OP
|
$6,807.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
9602010301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,014.82 |
| Max. Negotiated Rate |
$6,466.65 |
| Rate for Payer: Aetna of VT Commercial |
$6,466.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,098.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,014.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,098.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,097.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,785.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,513.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,063.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,411.56
|
| Rate for Payer: Cash Price |
$3,403.50
|
| Rate for Payer: Cigna Commercial |
$5,445.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,445.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,445.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,063.15
|
| Rate for Payer: Multiplan Commercial |
$6,330.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,785.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,063.15
|
| Rate for Payer: United Healthcare Commercial |
$6,466.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,063.15
|
| Rate for Payer: United Healthcare VA CCN |
$3,063.15
|
|
|
EXPLORE WOUND EXTREMITY
|
Facility
|
OP
|
$5,430.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
5102010301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,404.95 |
| Max. Negotiated Rate |
$5,158.50 |
| Rate for Payer: Aetna of VT Commercial |
$5,158.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,864.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,404.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,864.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,268.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,615.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,398.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,443.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,316.85
|
| Rate for Payer: Cash Price |
$2,715.00
|
| Rate for Payer: Cigna Commercial |
$4,344.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,344.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,344.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,443.50
|
| Rate for Payer: Multiplan Commercial |
$5,049.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,615.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,443.50
|
| Rate for Payer: United Healthcare Commercial |
$5,158.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,443.50
|
| Rate for Payer: United Healthcare VA CCN |
$2,443.50
|
|
|
EXPLORE WOUND NECK
|
Facility
|
OP
|
$1,676.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
9812010002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$742.30 |
| Max. Negotiated Rate |
$1,592.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,592.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,501.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$742.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,501.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,008.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,424.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,357.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$754.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,332.42
|
| Rate for Payer: Cash Price |
$838.00
|
| Rate for Payer: Cigna Commercial |
$1,340.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,340.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,340.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$754.20
|
| Rate for Payer: Multiplan Commercial |
$1,558.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,424.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$754.20
|
| Rate for Payer: United Healthcare Commercial |
$1,592.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$754.20
|
| Rate for Payer: United Healthcare VA CCN |
$754.20
|
|
|
EXPLORE WOUND NECK
|
Facility
|
IP
|
$1,676.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
9812010001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,240.41 |
| Max. Negotiated Rate |
$1,592.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,592.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,240.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,240.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,424.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,407.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,340.80
|
| Rate for Payer: Cash Price |
$838.00
|
| Rate for Payer: Cigna Commercial |
$1,340.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,340.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,340.80
|
| Rate for Payer: Multiplan Commercial |
$1,558.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,424.60
|
| Rate for Payer: United Healthcare Commercial |
$1,592.20
|
|
|
EXPLORE WOUND NECK
|
Professional
|
Both
|
$1,676.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
9812010002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$549.72 |
| Max. Negotiated Rate |
$1,575.44 |
| Rate for Payer: Aetna of VT Commercial |
$1,575.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,501.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$566.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,501.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$769.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,056.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,056.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$632.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,056.46
|
| Rate for Payer: Cash Price |
$838.00
|
| Rate for Payer: Cash Price |
$838.00
|
| Rate for Payer: Cigna Commercial |
$1,043.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$929.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$929.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$549.72
|
| Rate for Payer: Multiplan Commercial |
$1,558.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$780.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$549.73
|
| Rate for Payer: United Healthcare Commercial |
$845.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$549.73
|
| Rate for Payer: United Healthcare VA CCN |
$549.73
|
|
|
EXPLORE WOUND NECK
|
Facility
|
OP
|
$1,676.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
9812010001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$742.30 |
| Max. Negotiated Rate |
$1,592.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,592.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,501.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$742.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,501.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,008.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,424.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,357.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$754.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,332.42
|
| Rate for Payer: Cash Price |
$838.00
|
| Rate for Payer: Cigna Commercial |
$1,340.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,340.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,340.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$754.20
|
| Rate for Payer: Multiplan Commercial |
$1,558.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,424.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$754.20
|
| Rate for Payer: United Healthcare Commercial |
$1,592.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$754.20
|
| Rate for Payer: United Healthcare VA CCN |
$754.20
|
|
