|
FNA BX W/O IMG GDN 1ST LES
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
9601002102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$165.04 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Aetna of VT Commercial |
$211.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$165.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$165.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$189.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$187.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$178.40
|
| Rate for Payer: Cash Price |
$111.50
|
| Rate for Payer: Cigna Commercial |
$178.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$178.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$178.40
|
| Rate for Payer: Multiplan Commercial |
$207.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$189.55
|
| Rate for Payer: United Healthcare Commercial |
$211.85
|
|
|
FNA BX W/O IMG GDN 1ST LES
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
5101002101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.93 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna of VT Commercial |
$160.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$153.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$52.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$153.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$71.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$140.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$140.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$58.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.06
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$92.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.93
|
| Rate for Payer: Multiplan Commercial |
$159.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$72.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$50.93
|
| Rate for Payer: United Healthcare Commercial |
$78.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.93
|
| Rate for Payer: United Healthcare VA CCN |
$50.93
|
|
|
FNA BX W/O IMG GDN 1ST LES
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
5101002101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.74 |
| Max. Negotiated Rate |
$162.45 |
| Rate for Payer: Aetna of VT Commercial |
$162.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$153.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$75.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$153.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$102.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$138.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.94
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$136.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.95
|
| Rate for Payer: Multiplan Commercial |
$159.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.95
|
| Rate for Payer: United Healthcare Commercial |
$162.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.95
|
| Rate for Payer: United Healthcare VA CCN |
$76.95
|
|
|
FNA BX W/O IMG GDN 1ST LES
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
9821002101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$163.87 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Aetna of VT Commercial |
$351.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$331.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$163.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$331.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$222.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$314.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$299.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$166.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$294.15
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$296.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$296.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$296.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$166.50
|
| Rate for Payer: Multiplan Commercial |
$344.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$314.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$166.50
|
| Rate for Payer: United Healthcare Commercial |
$351.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$166.50
|
| Rate for Payer: United Healthcare VA CCN |
$166.50
|
|
|
FNA BX W/O IMG GDN 1ST LES
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
9601002101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$290.86 |
| Max. Negotiated Rate |
$373.35 |
| Rate for Payer: Aetna of VT Commercial |
$373.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$290.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$290.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$334.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$330.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$314.40
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$314.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$314.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$314.40
|
| Rate for Payer: Multiplan Commercial |
$365.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$334.05
|
| Rate for Payer: United Healthcare Commercial |
$373.35
|
|
|
FNA BX W/US GDN 1ST LES
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
9601000501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$551.41 |
| Max. Negotiated Rate |
$1,182.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,182.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,115.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$551.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,115.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$749.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,058.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,008.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$560.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$989.77
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$996.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$996.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$560.25
|
| Rate for Payer: Multiplan Commercial |
$1,157.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,058.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$560.25
|
| Rate for Payer: United Healthcare Commercial |
$1,182.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$560.25
|
| Rate for Payer: United Healthcare VA CCN |
$560.25
|
|
|
FNA BX W/US GDN 1ST LES
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
9601000501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$67.57 |
| Max. Negotiated Rate |
$1,170.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,170.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,115.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,115.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$94.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$181.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$181.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$181.42
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$123.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$205.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$205.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$126.03
|
| Rate for Payer: Multiplan Commercial |
$1,157.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.57
|
| Rate for Payer: United Healthcare Commercial |
$103.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.57
|
| Rate for Payer: United Healthcare VA CCN |
$67.57
|
|
|
FNA BX W/US GDN 1ST LES
|
Professional
|
Both
|
$988.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
5101000501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.57 |
| Max. Negotiated Rate |
$928.72 |
| Rate for Payer: Aetna of VT Commercial |
$928.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$885.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$885.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$94.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$181.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$181.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$181.42
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Cigna Commercial |
$123.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$205.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$205.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$126.03
|
| Rate for Payer: Multiplan Commercial |
$918.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.57
|
| Rate for Payer: United Healthcare Commercial |
$103.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.57
|
| Rate for Payer: United Healthcare VA CCN |
$67.57
|
|
|
FNA BX W/US GDN 1ST LES
|
Facility
|
IP
|
$988.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
5101000501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$731.22 |
| Max. Negotiated Rate |
$938.60 |
| Rate for Payer: Aetna of VT Commercial |
$938.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$731.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$731.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$839.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$829.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$790.40
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Cigna Commercial |
$790.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$790.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$790.40
|
| Rate for Payer: Multiplan Commercial |
$918.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$839.80
|
| Rate for Payer: United Healthcare Commercial |
$938.60
|
|
|
FNA BX W/US GDN 1ST LES
|
Facility
|
OP
|
$988.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
5101000501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$437.59 |
| Max. Negotiated Rate |
$938.60 |
| Rate for Payer: Aetna of VT Commercial |
$938.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$885.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$437.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$885.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$594.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$839.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$800.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$444.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$785.46
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Cigna Commercial |
$790.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$790.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$790.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$444.60
|
| Rate for Payer: Multiplan Commercial |
$918.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$839.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$444.60
|
| Rate for Payer: United Healthcare Commercial |
$938.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$444.60
|
| Rate for Payer: United Healthcare VA CCN |
$444.60
|
|
|
FNA BX W/US GDN 1ST LES
|
Professional
|
Both
|
$258.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
9601000502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$67.57 |
| Max. Negotiated Rate |
$242.52 |
| Rate for Payer: Aetna of VT Commercial |
$242.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$231.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$231.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$94.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$181.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$181.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$181.42
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$123.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$205.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$205.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$126.03
|
| Rate for Payer: Multiplan Commercial |
$239.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.57
|
| Rate for Payer: United Healthcare Commercial |
$103.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.57
|
| Rate for Payer: United Healthcare VA CCN |
$67.57
|
|
|
FNA BX W/US GDN 1ST LES
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
9601000502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$114.27 |
| Max. Negotiated Rate |
$245.10 |
| Rate for Payer: Aetna of VT Commercial |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$231.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$114.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$231.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$155.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$219.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$208.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$205.11
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$206.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$206.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$206.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$116.10
|
| Rate for Payer: Multiplan Commercial |
$239.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$219.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$116.10
|
| Rate for Payer: United Healthcare Commercial |
$245.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.10
|
| Rate for Payer: United Healthcare VA CCN |
$116.10
|
|
|
FNA BX W/US GDN 1ST LES
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
9601000502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$190.95 |
| Max. Negotiated Rate |
$245.10 |
| Rate for Payer: Aetna of VT Commercial |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$219.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$216.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$206.40
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$206.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$206.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$206.40
|
| Rate for Payer: Multiplan Commercial |
$239.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$219.30
|
| Rate for Payer: United Healthcare Commercial |
$245.10
|
|
|
FNA BX W/US GDN 1ST LES
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
9601000501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$921.42 |
| Max. Negotiated Rate |
$1,182.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,182.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$921.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$921.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,058.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,045.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$996.00
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$996.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$996.00
|
| Rate for Payer: Multiplan Commercial |
$1,157.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,058.25
|
| Rate for Payer: United Healthcare Commercial |
$1,182.75
|
|
|
FNA BX W/US GDN EA ADDL
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
9821000601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$71.31 |
| Max. Negotiated Rate |
$152.95 |
| Rate for Payer: Aetna of VT Commercial |
$152.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$144.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$71.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$144.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$96.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$136.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$130.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$128.00
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$128.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$128.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$128.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$72.45
|
| Rate for Payer: Multiplan Commercial |
$149.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$136.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$72.45
|
| Rate for Payer: United Healthcare Commercial |
$152.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.45
|
| Rate for Payer: United Healthcare VA CCN |
$72.45
|
|
|
FNA BX W/US GDN EA ADDL
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
9821000601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$46.23 |
| Max. Negotiated Rate |
$151.34 |
| Rate for Payer: Aetna of VT Commercial |
$151.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$144.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$47.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$144.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$64.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$53.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$85.59
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$85.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.50
|
| Rate for Payer: Multiplan Commercial |
$149.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.23
|
| Rate for Payer: United Healthcare Commercial |
$71.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.23
|
| Rate for Payer: United Healthcare VA CCN |
$46.23
|
|
|
FNA BX W/US GDN EA ADDL
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
9821000601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$119.16 |
| Max. Negotiated Rate |
$152.95 |
| Rate for Payer: Aetna of VT Commercial |
$152.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$119.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$119.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$136.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$135.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$128.80
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$128.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$128.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$149.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$136.85
|
| Rate for Payer: United Healthcare Commercial |
$152.95
|
|
|
FOOT ARCH SUPP LONGITUD/META
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS L3060
|
| Hospital Charge Code |
274L306001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.21 |
| Max. Negotiated Rate |
$133.40 |
| Rate for Payer: Aetna of VT Commercial |
$75.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$89.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$121.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.73
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$70.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$70.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.72
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$123.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$86.72
|
| Rate for Payer: United Healthcare Commercial |
$133.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.72
|
| Rate for Payer: United Healthcare VA CCN |
$86.72
|
|
|
FOOT ARCH SUPP LONGITUD/META
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS L3060
|
| Hospital Charge Code |
274L306001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.21 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna of VT Commercial |
$76.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$67.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$64.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.00
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.00
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
|
|
FOOT ARCH SUPP LONGITUD/META
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS L3060
|
| Hospital Charge Code |
274L306001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.43 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna of VT Commercial |
$76.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$48.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$63.60
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$64.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.00
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.00
|
| Rate for Payer: United Healthcare VA CCN |
$36.00
|
|
|
FOOT ARCH SUPP PREMOLD METAT
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS L3050
|
| Hospital Charge Code |
274L305001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.79 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Aetna of VT Commercial |
$61.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$39.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$55.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$51.67
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$52.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$52.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$52.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.25
|
| Rate for Payer: Multiplan Commercial |
$60.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$29.25
|
| Rate for Payer: United Healthcare Commercial |
$61.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.25
|
| Rate for Payer: United Healthcare VA CCN |
$29.25
|
|
|
FOOT ARCH SUPP PREMOLD METAT
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS L3050
|
| Hospital Charge Code |
274L305001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$85.13 |
| Rate for Payer: Aetna of VT Commercial |
$61.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$57.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$77.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.64
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$44.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$44.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$55.34
|
| Rate for Payer: Multiplan Commercial |
$60.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$55.34
|
| Rate for Payer: United Healthcare Commercial |
$85.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.34
|
| Rate for Payer: United Healthcare VA CCN |
$55.34
|
|
|
FOOT ARCH SUPP PREMOLD METAT
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS L3050
|
| Hospital Charge Code |
274L305001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.11 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Aetna of VT Commercial |
$61.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$55.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$54.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.00
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$52.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$52.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$52.00
|
| Rate for Payer: Multiplan Commercial |
$60.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.25
|
| Rate for Payer: United Healthcare Commercial |
$61.75
|
|
|
FOOT LONGITUDINAL ARCH 1ST PR
|
Facility
|
IP
|
$361.90
|
|
|
Service Code
|
HCPCS L3010 50
|
| Hospital Charge Code |
274L301001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$267.84 |
| Max. Negotiated Rate |
$343.81 |
| Rate for Payer: Aetna of VT Commercial |
$343.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$267.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$267.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$307.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$304.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$289.52
|
| Rate for Payer: Cash Price |
$180.95
|
| Rate for Payer: Cigna Commercial |
$289.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$289.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$289.52
|
| Rate for Payer: Multiplan Commercial |
$336.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$307.62
|
| Rate for Payer: United Healthcare Commercial |
$343.81
|
|
|
FOOT LONGITUDINAL ARCH 1ST PR
|
Professional
|
Both
|
$361.90
|
|
|
Service Code
|
HCPCS L3010 50
|
| Hospital Charge Code |
274L301001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$144.76 |
| Max. Negotiated Rate |
$340.19 |
| Rate for Payer: Aetna of VT Commercial |
$340.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$324.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$324.23
|
| Rate for Payer: Cash Price |
$180.95
|
| Rate for Payer: Cash Price |
$180.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$165.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$165.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$204.94
|
| Rate for Payer: Multiplan Commercial |
$336.57
|
| Rate for Payer: United Healthcare Commercial |
$307.62
|
| Rate for Payer: United Healthcare VA CCN |
$144.76
|
|
