|
PAIRING/CUTTING BENIGN LES >4
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
9601105701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$80.16 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Aetna of VT Commercial |
$171.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$162.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$80.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$162.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$108.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$153.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$146.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.90
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cigna Commercial |
$144.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$81.45
|
| Rate for Payer: Multiplan Commercial |
$168.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$81.45
|
| Rate for Payer: United Healthcare Commercial |
$171.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.45
|
| Rate for Payer: United Healthcare VA CCN |
$81.45
|
|
|
PANTOPRAZOLE 40 MG VIAL
|
Facility
|
IP
|
$6.12
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
636J247001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: Aetna of VT Commercial |
$5.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.90
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cigna Commercial |
$4.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.90
|
| Rate for Payer: Multiplan Commercial |
$5.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.20
|
| Rate for Payer: United Healthcare Commercial |
$5.81
|
|
|
PANTOPRAZOLE 40 MG VIAL
|
Facility
|
OP
|
$6.12
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
636J247001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$12.51 |
| Rate for Payer: Aetna of VT Commercial |
$5.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$12.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$12.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.87
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cigna Commercial |
$4.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.75
|
| Rate for Payer: Multiplan Commercial |
$5.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.75
|
| Rate for Payer: United Healthcare Commercial |
$5.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.75
|
| Rate for Payer: United Healthcare VA CCN |
$2.75
|
|
|
PARAFFIN BATH THERAPY
|
Facility
|
IP
|
$139.59
|
|
|
Service Code
|
CPT 97018 GO
|
| Hospital Charge Code |
4309701801
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$103.31 |
| Max. Negotiated Rate |
$132.61 |
| Rate for Payer: Aetna of VT Commercial |
$132.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$117.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$111.67
|
| Rate for Payer: Cash Price |
$69.80
|
| Rate for Payer: Cigna Commercial |
$111.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$111.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$111.67
|
| Rate for Payer: Multiplan Commercial |
$129.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.65
|
| Rate for Payer: United Healthcare Commercial |
$132.61
|
|
|
PARAFFIN BATH THERAPY
|
Facility
|
OP
|
$139.59
|
|
|
Service Code
|
CPT 97018 GO
|
| Hospital Charge Code |
4309701801
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$61.82 |
| Max. Negotiated Rate |
$132.61 |
| Rate for Payer: Aetna of VT Commercial |
$132.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$61.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.97
|
| Rate for Payer: Cash Price |
$69.80
|
| Rate for Payer: Cigna Commercial |
$111.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$111.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$111.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$62.82
|
| Rate for Payer: Multiplan Commercial |
$129.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$62.82
|
| Rate for Payer: United Healthcare Commercial |
$132.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.82
|
| Rate for Payer: United Healthcare VA CCN |
$62.82
|
|
|
PARAGARD IUD
|
Facility
|
IP
|
$3,633.22
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
6360044351
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,688.95 |
| Max. Negotiated Rate |
$3,451.56 |
| Rate for Payer: Aetna of VT Commercial |
$3,451.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,688.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,688.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,088.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,051.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,906.58
|
| Rate for Payer: Cash Price |
$1,816.61
|
| Rate for Payer: Cigna Commercial |
$2,906.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,906.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,906.58
|
| Rate for Payer: Multiplan Commercial |
$3,378.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,088.24
|
| Rate for Payer: United Healthcare Commercial |
$3,451.56
|
|
|
PARAGARD IUD
|
Facility
|
OP
|
$3,633.22
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
6360044351
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,609.15 |
| Max. Negotiated Rate |
$3,451.56 |
| Rate for Payer: Aetna of VT Commercial |
$3,451.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,132.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,609.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,132.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,187.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,088.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,942.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,634.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,888.41
|
| Rate for Payer: Cash Price |
$1,816.61
|
| Rate for Payer: Cash Price |
$1,816.61
|
| Rate for Payer: Cigna Commercial |
$2,906.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,906.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,906.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,634.95
|
| Rate for Payer: Multiplan Commercial |
$3,378.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,088.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,634.95
|
| Rate for Payer: United Healthcare Commercial |
$3,451.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,634.95
|
| Rate for Payer: United Healthcare VA CCN |
$1,634.95
|
|
|
PARAGARD IUD
|
Professional
|
Both
|
$3,633.22
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
6360044351
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,006.00 |
| Max. Negotiated Rate |
$3,415.23 |
| Rate for Payer: Aetna of VT Commercial |
$3,415.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,132.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,132.25
|
| Rate for Payer: Cash Price |
$1,816.61
|
| Rate for Payer: Cash Price |
$1,816.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,106.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,106.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,297.70
|
| Rate for Payer: Multiplan Commercial |
$3,378.89
|
| Rate for Payer: United Healthcare Commercial |
$3,088.24
|
| Rate for Payer: United Healthcare VA CCN |
$1,006.00
|
|
|
PARING/CUTTING BENIGN LES 2-4
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
9821105601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$125.49 |
| Rate for Payer: Aetna of VT Commercial |
$83.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$79.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$79.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$102.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$102.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$102.09
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$23.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$125.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$125.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.88
|
| Rate for Payer: Multiplan Commercial |
$82.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.70
|
| Rate for Payer: United Healthcare Commercial |
$31.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.70
|
| Rate for Payer: United Healthcare VA CCN |
$20.70
|
|
|
PARING/CUTTING BENIGN LES 2-4
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
9821105601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$39.42 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Aetna of VT Commercial |
$84.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$79.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$79.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$75.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.75
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$71.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$71.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$71.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$40.05
|
| Rate for Payer: Multiplan Commercial |
$82.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.05
|
| Rate for Payer: United Healthcare Commercial |
$84.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.05
|
| Rate for Payer: United Healthcare VA CCN |
$40.05
|
|
|
PARING/CUTTING BENIGN LES 2-4
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
9601105602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$65.87 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Aetna of VT Commercial |
$84.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$75.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$74.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$71.20
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$71.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$71.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$71.20
|
| Rate for Payer: Multiplan Commercial |
$82.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.65
|
| Rate for Payer: United Healthcare Commercial |
$84.55
|
|
|
PARING/CUTTING BENIGN LES 2-4
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
5101105601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna of VT Commercial |
$58.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$55.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$55.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$52.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$50.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$27.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$49.29
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cigna Commercial |
$49.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$49.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$49.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$27.90
|
| Rate for Payer: Multiplan Commercial |
$57.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$27.90
|
| Rate for Payer: United Healthcare Commercial |
$58.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.90
|
| Rate for Payer: United Healthcare VA CCN |
$27.90
|
|
|
PARING/CUTTING BENIGN LES 2-4
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
9821105601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$65.87 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Aetna of VT Commercial |
$84.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$75.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$74.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$71.20
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$71.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$71.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$71.20
|
| Rate for Payer: Multiplan Commercial |
$82.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.65
|
| Rate for Payer: United Healthcare Commercial |
$84.55
|
|
|
PARING/CUTTING BENIGN LES 2-4
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
9601105601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$66.44 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Aetna of VT Commercial |
$142.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$134.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$66.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$134.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$90.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$121.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$119.25
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$120.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$120.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$120.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.50
|
| Rate for Payer: United Healthcare Commercial |
$142.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.50
|
| Rate for Payer: United Healthcare VA CCN |
$67.50
|
|
|
PARING/CUTTING BENIGN LES 2-4
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
9601105601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna of VT Commercial |
$141.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$134.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$134.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$102.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$102.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$102.09
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$23.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$125.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$125.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.88
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.70
|
| Rate for Payer: United Healthcare Commercial |
$31.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.70
|
| Rate for Payer: United Healthcare VA CCN |
$20.70
|
|
|
PARING/CUTTING BENIGN LES 2-4
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
5101105601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$125.49 |
| Rate for Payer: Aetna of VT Commercial |
$58.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$55.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$55.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$102.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$102.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$102.09
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cigna Commercial |
$23.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$125.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$125.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.88
|
| Rate for Payer: Multiplan Commercial |
$57.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.70
|
| Rate for Payer: United Healthcare Commercial |
$31.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.70
|
| Rate for Payer: United Healthcare VA CCN |
$20.70
|
|
|
PARING/CUTTING BENIGN LES 2-4
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
9601105602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$125.49 |
| Rate for Payer: Aetna of VT Commercial |
$83.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$79.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$79.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$102.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$102.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$102.09
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$23.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$125.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$125.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.88
|
| Rate for Payer: Multiplan Commercial |
$82.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.70
|
| Rate for Payer: United Healthcare Commercial |
$31.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.70
|
| Rate for Payer: United Healthcare VA CCN |
$20.70
|
|
|
PARING/CUTTING BENIGN LES 2-4
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
5101105601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.89 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna of VT Commercial |
$58.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$45.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$45.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$52.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$49.60
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cigna Commercial |
$49.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$49.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$49.60
|
| Rate for Payer: Multiplan Commercial |
$57.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.70
|
| Rate for Payer: United Healthcare Commercial |
$58.90
|
|
|
PARING/CUTTING BENIGN LES 2-4
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
9601105602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.42 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Aetna of VT Commercial |
$84.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$79.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$79.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$75.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.75
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$71.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$71.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$71.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$40.05
|
| Rate for Payer: Multiplan Commercial |
$82.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.05
|
| Rate for Payer: United Healthcare Commercial |
$84.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.05
|
| Rate for Payer: United Healthcare VA CCN |
$40.05
|
|
|
PARING/CUTTING BENIGN LES 2-4
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
9601105601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$111.02 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Aetna of VT Commercial |
$142.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$111.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$111.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$120.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$120.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$120.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.50
|
| Rate for Payer: United Healthcare Commercial |
$142.50
|
|
|
PARTIAL AMPUTATION OF TOE
|
Professional
|
Both
|
$4,382.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
5102882501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$161.80 |
| Max. Negotiated Rate |
$4,119.08 |
| Rate for Payer: Aetna of VT Commercial |
$4,119.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,925.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$166.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,925.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$226.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$669.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$669.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$186.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$669.64
|
| Rate for Payer: Cash Price |
$2,191.00
|
| Rate for Payer: Cash Price |
$2,191.00
|
| Rate for Payer: Cigna Commercial |
$307.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$444.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$444.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$272.62
|
| Rate for Payer: Multiplan Commercial |
$4,075.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$229.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.80
|
| Rate for Payer: United Healthcare Commercial |
$248.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.80
|
| Rate for Payer: United Healthcare VA CCN |
$161.80
|
|
|
PARTIAL AMPUTATION OF TOE
|
Facility
|
IP
|
$4,382.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
5102882501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,243.12 |
| Max. Negotiated Rate |
$4,162.90 |
| Rate for Payer: Aetna of VT Commercial |
$4,162.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,243.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,243.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,724.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,680.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,505.60
|
| Rate for Payer: Cash Price |
$2,191.00
|
| Rate for Payer: Cigna Commercial |
$3,505.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,505.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,505.60
|
| Rate for Payer: Multiplan Commercial |
$4,075.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,724.70
|
| Rate for Payer: United Healthcare Commercial |
$4,162.90
|
|
|
PARTIAL AMPUTATION OF TOE
|
Professional
|
Both
|
$1,162.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
9602882502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$161.80 |
| Max. Negotiated Rate |
$1,092.28 |
| Rate for Payer: Aetna of VT Commercial |
$1,092.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,041.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$166.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,041.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$226.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$669.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$669.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$186.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$669.64
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cigna Commercial |
$307.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$444.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$444.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$272.62
|
| Rate for Payer: Multiplan Commercial |
$1,080.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$229.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.80
|
| Rate for Payer: United Healthcare Commercial |
$248.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.80
|
| Rate for Payer: United Healthcare VA CCN |
$161.80
|
|
|
PARTIAL AMPUTATION OF TOE
|
Facility
|
OP
|
$4,382.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
5102882501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,940.79 |
| Max. Negotiated Rate |
$4,162.90 |
| Rate for Payer: Aetna of VT Commercial |
$4,162.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,925.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,940.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,925.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,637.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,724.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,549.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,971.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,483.69
|
| Rate for Payer: Cash Price |
$2,191.00
|
| Rate for Payer: Cigna Commercial |
$3,505.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,505.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,505.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,971.90
|
| Rate for Payer: Multiplan Commercial |
$4,075.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,724.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,971.90
|
| Rate for Payer: United Healthcare Commercial |
$4,162.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,971.90
|
| Rate for Payer: United Healthcare VA CCN |
$1,971.90
|
|
|
PARTIAL AMPUTATION OF TOE
|
Professional
|
Both
|
$1,162.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
9822882501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$161.80 |
| Max. Negotiated Rate |
$1,092.28 |
| Rate for Payer: Aetna of VT Commercial |
$1,092.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,041.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$166.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,041.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$226.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$669.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$669.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$186.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$669.64
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cigna Commercial |
$307.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$444.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$444.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$272.62
|
| Rate for Payer: Multiplan Commercial |
$1,080.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$229.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.80
|
| Rate for Payer: United Healthcare Commercial |
$248.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.80
|
| Rate for Payer: United Healthcare VA CCN |
$161.80
|
|
