|
FUROSEMIDE 100MG/10ML VIAL
|
Facility
|
OP
|
$6.41
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
636J193803
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$6.09 |
| Rate for Payer: Aetna of VT Commercial |
$6.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5.10
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cigna Commercial |
$5.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.13
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.88
|
| Rate for Payer: United Healthcare Commercial |
$6.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.88
|
| Rate for Payer: United Healthcare VA CCN |
$2.88
|
|
|
FUROSEMIDE 20MG/2ML VIAL
|
Facility
|
IP
|
$4.25
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
636J193801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna of VT Commercial |
$4.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3.40
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$3.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.61
|
| Rate for Payer: United Healthcare Commercial |
$4.04
|
|
|
FUROSEMIDE 20MG/2ML VIAL
|
Facility
|
OP
|
$4.25
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
636J193801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna of VT Commercial |
$4.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3.38
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$3.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.91
|
| Rate for Payer: United Healthcare Commercial |
$4.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.91
|
| Rate for Payer: United Healthcare VA CCN |
$1.91
|
|
|
FUROSEMIDE 40 MG/4 ML VIAL
|
Facility
|
OP
|
$4.67
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
636J194002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna of VT Commercial |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3.71
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$4.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.10
|
| Rate for Payer: United Healthcare Commercial |
$4.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.10
|
| Rate for Payer: United Healthcare VA CCN |
$2.10
|
|
|
FUROSEMIDE 40 MG/4 ML VIAL
|
Facility
|
IP
|
$4.67
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
636J194002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna of VT Commercial |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3.74
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3.74
|
| Rate for Payer: Multiplan Commercial |
$4.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.97
|
| Rate for Payer: United Healthcare Commercial |
$4.44
|
|
|
FUROSEMIDE 40MG/4ML VIAL
|
Facility
|
OP
|
$4.52
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
636J193802
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna of VT Commercial |
$4.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3.59
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$4.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.03
|
| Rate for Payer: United Healthcare Commercial |
$4.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.03
|
| Rate for Payer: United Healthcare VA CCN |
$2.03
|
|
|
FUROSEMIDE 40MG/4ML VIAL
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
636J193802
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna of VT Commercial |
$4.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3.62
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3.62
|
| Rate for Payer: Multiplan Commercial |
$4.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.84
|
| Rate for Payer: United Healthcare Commercial |
$4.29
|
|
|
FUSION OF BIG TOE JOINT
|
Professional
|
Both
|
$1,973.00
|
|
|
Service Code
|
CPT 28750
|
| Hospital Charge Code |
9822875001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$546.68 |
| Max. Negotiated Rate |
$1,854.62 |
| Rate for Payer: Aetna of VT Commercial |
$1,854.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,767.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$563.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,767.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$765.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,167.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,167.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$628.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,167.09
|
| Rate for Payer: Cash Price |
$986.50
|
| Rate for Payer: Cash Price |
$986.50
|
| Rate for Payer: Cigna Commercial |
$1,039.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,199.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,199.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$733.94
|
| Rate for Payer: Multiplan Commercial |
$1,834.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$776.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$546.68
|
| Rate for Payer: United Healthcare Commercial |
$840.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$546.68
|
| Rate for Payer: United Healthcare VA CCN |
$546.68
|
|
|
FUSION OF BIG TOE JOINT
|
Facility
|
IP
|
$1,988.00
|
|
|
Service Code
|
CPT 28760
|
| Hospital Charge Code |
9822876001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,471.32 |
| Max. Negotiated Rate |
$1,888.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,888.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,471.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,471.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,689.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,669.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,590.40
|
| Rate for Payer: Cash Price |
$994.00
|
| Rate for Payer: Cigna Commercial |
$1,590.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,590.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,590.40
|
| Rate for Payer: Multiplan Commercial |
$1,848.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,689.80
|
| Rate for Payer: United Healthcare Commercial |
$1,888.60
|
|
|
FUSION OF BIG TOE JOINT
|
Professional
|
Both
|
$1,135.00
|
|
|
Service Code
|
CPT 28755
|
| Hospital Charge Code |
9822875501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$322.71 |
| Max. Negotiated Rate |
$1,066.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,066.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,016.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$332.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,016.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$451.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$778.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$778.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$371.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$778.36
|
| Rate for Payer: Cash Price |
$567.50
|
| Rate for Payer: Cash Price |
$567.50
|
| Rate for Payer: Cigna Commercial |
$608.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$781.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$781.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$480.09
|
| Rate for Payer: Multiplan Commercial |
$1,055.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$458.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$322.71
|
| Rate for Payer: United Healthcare Commercial |
$496.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$322.71
|
| Rate for Payer: United Healthcare VA CCN |
$322.71
|
|
|
FUSION OF BIG TOE JOINT
|
Facility
|
OP
|
$1,973.00
|
|
|
Service Code
|
CPT 28750
|
| Hospital Charge Code |
9822875001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$873.84 |
| Max. Negotiated Rate |
$1,874.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,874.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,767.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$873.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,767.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,187.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,677.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,598.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$887.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,568.54
|
| Rate for Payer: Cash Price |
$986.50
|
| Rate for Payer: Cigna Commercial |
$1,578.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,578.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,578.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$887.85
|
| Rate for Payer: Multiplan Commercial |
$1,834.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,677.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$887.85
|
| Rate for Payer: United Healthcare Commercial |
$1,874.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$887.85
|
| Rate for Payer: United Healthcare VA CCN |
$887.85
|
|
|
FUSION OF BIG TOE JOINT
|
Facility
|
IP
|
$1,973.00
|
|
|
Service Code
|
CPT 28750
|
| Hospital Charge Code |
9822875001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,460.22 |
| Max. Negotiated Rate |
$1,874.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,874.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,460.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,460.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,677.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,657.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,578.40
|
| Rate for Payer: Cash Price |
$986.50
|
| Rate for Payer: Cigna Commercial |
$1,578.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,578.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,578.40
|
| Rate for Payer: Multiplan Commercial |
$1,834.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,677.05
|
| Rate for Payer: United Healthcare Commercial |
$1,874.35
|
|
|
FUSION OF BIG TOE JOINT
|
Facility
|
OP
|
$1,135.00
|
|
|
Service Code
|
CPT 28755
|
| Hospital Charge Code |
9822875501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$502.69 |
| Max. Negotiated Rate |
$1,078.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,078.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,016.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$502.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,016.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$683.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$964.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$919.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$510.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$902.33
|
| Rate for Payer: Cash Price |
$567.50
|
| Rate for Payer: Cigna Commercial |
$908.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$908.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$908.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$510.75
|
| Rate for Payer: Multiplan Commercial |
$1,055.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$964.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$510.75
|
| Rate for Payer: United Healthcare Commercial |
$1,078.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$510.75
|
| Rate for Payer: United Healthcare VA CCN |
$510.75
|
|
|
FUSION OF BIG TOE JOINT
|
Facility
|
IP
|
$1,135.00
|
|
|
Service Code
|
CPT 28755
|
| Hospital Charge Code |
9822875501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$840.01 |
| Max. Negotiated Rate |
$1,078.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,078.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$840.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$840.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$964.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$953.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$908.00
|
| Rate for Payer: Cash Price |
$567.50
|
| Rate for Payer: Cigna Commercial |
$908.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$908.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$908.00
|
| Rate for Payer: Multiplan Commercial |
$1,055.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$964.75
|
| Rate for Payer: United Healthcare Commercial |
$1,078.25
|
|
|
FUSION OF BIG TOE JOINT
|
Facility
|
OP
|
$1,988.00
|
|
|
Service Code
|
CPT 28760
|
| Hospital Charge Code |
9822876001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$880.49 |
| Max. Negotiated Rate |
$1,888.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,888.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,781.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$880.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,781.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,196.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,689.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,610.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$894.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,580.46
|
| Rate for Payer: Cash Price |
$994.00
|
| Rate for Payer: Cigna Commercial |
$1,590.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,590.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,590.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$894.60
|
| Rate for Payer: Multiplan Commercial |
$1,848.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,689.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$894.60
|
| Rate for Payer: United Healthcare Commercial |
$1,888.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$894.60
|
| Rate for Payer: United Healthcare VA CCN |
$894.60
|
|
|
FUSION OF BIG TOE JOINT
|
Professional
|
Both
|
$1,988.00
|
|
|
Service Code
|
CPT 28760
|
| Hospital Charge Code |
9822876001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$544.16 |
| Max. Negotiated Rate |
$1,868.72 |
| Rate for Payer: Aetna of VT Commercial |
$1,868.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,781.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$560.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,781.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$761.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,154.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,154.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$625.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,154.86
|
| Rate for Payer: Cash Price |
$994.00
|
| Rate for Payer: Cash Price |
$994.00
|
| Rate for Payer: Cigna Commercial |
$1,035.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,185.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,185.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$727.24
|
| Rate for Payer: Multiplan Commercial |
$1,848.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$772.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$544.16
|
| Rate for Payer: United Healthcare Commercial |
$837.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$544.16
|
| Rate for Payer: United Healthcare VA CCN |
$544.16
|
|
|
FUSION OF FOOT BONES
|
Facility
|
IP
|
$2,337.00
|
|
|
Service Code
|
CPT 28730
|
| Hospital Charge Code |
9822873001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,729.61 |
| Max. Negotiated Rate |
$2,220.15 |
| Rate for Payer: Aetna of VT Commercial |
$2,220.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,729.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,729.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,986.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,963.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,869.60
|
| Rate for Payer: Cash Price |
$1,168.50
|
| Rate for Payer: Cigna Commercial |
$1,869.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,869.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,869.60
|
| Rate for Payer: Multiplan Commercial |
$2,173.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,986.45
|
| Rate for Payer: United Healthcare Commercial |
$2,220.15
|
|
|
FUSION OF FOOT BONES
|
Facility
|
IP
|
$3,908.00
|
|
|
Service Code
|
CPT 28730
|
| Hospital Charge Code |
9602873001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,892.31 |
| Max. Negotiated Rate |
$3,712.60 |
| Rate for Payer: Aetna of VT Commercial |
$3,712.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,892.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,892.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,321.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,282.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,126.40
|
| Rate for Payer: Cash Price |
$1,954.00
|
| Rate for Payer: Cigna Commercial |
$3,126.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,126.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,126.40
|
| Rate for Payer: Multiplan Commercial |
$3,634.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,321.80
|
| Rate for Payer: United Healthcare Commercial |
$3,712.60
|
|
|
FUSION OF FOOT BONES
|
Professional
|
Both
|
$3,908.00
|
|
|
Service Code
|
CPT 28730
|
| Hospital Charge Code |
9602873001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$687.36 |
| Max. Negotiated Rate |
$3,673.52 |
| Rate for Payer: Aetna of VT Commercial |
$3,673.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,501.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$707.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,501.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$962.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,429.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,429.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$790.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,429.13
|
| Rate for Payer: Cash Price |
$1,954.00
|
| Rate for Payer: Cash Price |
$1,954.00
|
| Rate for Payer: Cigna Commercial |
$1,303.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,135.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,135.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$687.36
|
| Rate for Payer: Multiplan Commercial |
$3,634.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$976.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$687.36
|
| Rate for Payer: United Healthcare Commercial |
$1,057.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$687.36
|
| Rate for Payer: United Healthcare VA CCN |
$687.36
|
|
|
FUSION OF FOOT BONES
|
Facility
|
OP
|
$3,908.00
|
|
|
Service Code
|
CPT 28730
|
| Hospital Charge Code |
9602873001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,730.85 |
| Max. Negotiated Rate |
$3,712.60 |
| Rate for Payer: Aetna of VT Commercial |
$3,712.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,501.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,730.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,501.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,352.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,321.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,165.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,758.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,106.86
|
| Rate for Payer: Cash Price |
$1,954.00
|
| Rate for Payer: Cigna Commercial |
$3,126.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,126.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,126.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,758.60
|
| Rate for Payer: Multiplan Commercial |
$3,634.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,321.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,758.60
|
| Rate for Payer: United Healthcare Commercial |
$3,712.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,758.60
|
| Rate for Payer: United Healthcare VA CCN |
$1,758.60
|
|
|
FUSION OF FOOT BONES
|
Facility
|
OP
|
$2,337.00
|
|
|
Service Code
|
CPT 28730
|
| Hospital Charge Code |
9602873002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,035.06 |
| Max. Negotiated Rate |
$2,220.15 |
| Rate for Payer: Aetna of VT Commercial |
$2,220.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,093.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,035.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,093.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,406.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,986.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,892.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,051.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,857.91
|
| Rate for Payer: Cash Price |
$1,168.50
|
| Rate for Payer: Cigna Commercial |
$1,869.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,869.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,869.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,051.65
|
| Rate for Payer: Multiplan Commercial |
$2,173.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,986.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,051.65
|
| Rate for Payer: United Healthcare Commercial |
$2,220.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,051.65
|
| Rate for Payer: United Healthcare VA CCN |
$1,051.65
|
|
|
FUSION OF FOOT BONES
|
Professional
|
Both
|
$2,337.00
|
|
|
Service Code
|
CPT 28730
|
| Hospital Charge Code |
9822873001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$687.36 |
| Max. Negotiated Rate |
$2,196.78 |
| Rate for Payer: Aetna of VT Commercial |
$2,196.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,093.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$707.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,093.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$962.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,429.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,429.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$790.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,429.13
|
| Rate for Payer: Cash Price |
$1,168.50
|
| Rate for Payer: Cash Price |
$1,168.50
|
| Rate for Payer: Cigna Commercial |
$1,303.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,135.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,135.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$687.36
|
| Rate for Payer: Multiplan Commercial |
$2,173.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$976.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$687.36
|
| Rate for Payer: United Healthcare Commercial |
$1,057.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$687.36
|
| Rate for Payer: United Healthcare VA CCN |
$687.36
|
|
|
FUSION OF FOOT BONES
|
Professional
|
Both
|
$2,337.00
|
|
|
Service Code
|
CPT 28730
|
| Hospital Charge Code |
9602873002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$687.36 |
| Max. Negotiated Rate |
$2,196.78 |
| Rate for Payer: Aetna of VT Commercial |
$2,196.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,093.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$707.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,093.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$962.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,429.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,429.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$790.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,429.13
|
| Rate for Payer: Cash Price |
$1,168.50
|
| Rate for Payer: Cash Price |
$1,168.50
|
| Rate for Payer: Cigna Commercial |
$1,303.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,135.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,135.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$687.36
|
| Rate for Payer: Multiplan Commercial |
$2,173.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$976.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$687.36
|
| Rate for Payer: United Healthcare Commercial |
$1,057.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$687.36
|
| Rate for Payer: United Healthcare VA CCN |
$687.36
|
|
|
FUSION OF FOOT BONES
|
Facility
|
IP
|
$2,323.00
|
|
|
Service Code
|
CPT 28740
|
| Hospital Charge Code |
9822874001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,719.25 |
| Max. Negotiated Rate |
$2,206.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,206.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,719.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,719.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,974.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,951.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,858.40
|
| Rate for Payer: Cash Price |
$1,161.50
|
| Rate for Payer: Cigna Commercial |
$1,858.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,858.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,858.40
|
| Rate for Payer: Multiplan Commercial |
$2,160.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,974.55
|
| Rate for Payer: United Healthcare Commercial |
$2,206.85
|
|
|
FUSION OF FOOT BONES
|
Facility
|
OP
|
$2,323.00
|
|
|
Service Code
|
CPT 28740
|
| Hospital Charge Code |
9822874001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,028.86 |
| Max. Negotiated Rate |
$2,206.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,206.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,081.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,028.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,081.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,398.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,974.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,881.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,045.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,846.79
|
| Rate for Payer: Cash Price |
$1,161.50
|
| Rate for Payer: Cigna Commercial |
$1,858.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,858.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,858.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,045.35
|
| Rate for Payer: Multiplan Commercial |
$2,160.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,974.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,045.35
|
| Rate for Payer: United Healthcare Commercial |
$2,206.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,045.35
|
| Rate for Payer: United Healthcare VA CCN |
$1,045.35
|
|
