|
PARTIAL AMPUTATION OF TOE
|
Facility
|
OP
|
$1,162.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
9602882502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$514.65 |
| Max. Negotiated Rate |
$1,103.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,103.90
|
| 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 |
$514.65
|
| 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 |
$699.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$987.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$941.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$522.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$923.79
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cigna Commercial |
$929.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$929.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$929.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$522.90
|
| Rate for Payer: Multiplan Commercial |
$1,080.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$987.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$522.90
|
| Rate for Payer: United Healthcare Commercial |
$1,103.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$522.90
|
| Rate for Payer: United Healthcare VA CCN |
$522.90
|
|
|
PARTIAL AMPUTATION OF TOE
|
Facility
|
OP
|
$5,543.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
9602882501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,454.99 |
| Max. Negotiated Rate |
$5,265.85 |
| Rate for Payer: Aetna of VT Commercial |
$5,265.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,965.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,454.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,965.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,336.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,711.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,489.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,494.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,406.69
|
| Rate for Payer: Cash Price |
$2,771.50
|
| Rate for Payer: Cigna Commercial |
$4,434.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,434.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,434.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,494.35
|
| Rate for Payer: Multiplan Commercial |
$5,154.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,711.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,494.35
|
| Rate for Payer: United Healthcare Commercial |
$5,265.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,494.35
|
| Rate for Payer: United Healthcare VA CCN |
$2,494.35
|
|
|
PARTIAL AMPUTATION OF TOE
|
Facility
|
OP
|
$1,162.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
9822882501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$514.65 |
| Max. Negotiated Rate |
$1,103.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,103.90
|
| 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 |
$514.65
|
| 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 |
$699.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$987.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$941.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$522.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$923.79
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cigna Commercial |
$929.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$929.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$929.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$522.90
|
| Rate for Payer: Multiplan Commercial |
$1,080.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$987.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$522.90
|
| Rate for Payer: United Healthcare Commercial |
$1,103.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$522.90
|
| Rate for Payer: United Healthcare VA CCN |
$522.90
|
|
|
PARTIAL AMPUTATION OF TOE
|
Facility
|
IP
|
$1,162.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
9602882502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$860.00 |
| Max. Negotiated Rate |
$1,103.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,103.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$860.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$860.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$987.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$976.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$929.60
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cigna Commercial |
$929.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$929.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$929.60
|
| Rate for Payer: Multiplan Commercial |
$1,080.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$987.70
|
| Rate for Payer: United Healthcare Commercial |
$1,103.90
|
|
|
PARTIAL AMPUTATION OF TOE
|
Professional
|
Both
|
$5,543.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
9602882501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$161.80 |
| Max. Negotiated Rate |
$5,210.42 |
| Rate for Payer: Aetna of VT Commercial |
$5,210.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,965.97
|
| 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 |
$4,965.97
|
| 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 |
$2,771.50
|
| Rate for Payer: Cash Price |
$2,771.50
|
| 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 |
$5,154.99
|
| 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
|
$5,543.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
9602882501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4,102.37 |
| Max. Negotiated Rate |
$5,265.85 |
| Rate for Payer: Aetna of VT Commercial |
$5,265.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,102.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,102.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,711.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,656.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,434.40
|
| Rate for Payer: Cash Price |
$2,771.50
|
| Rate for Payer: Cigna Commercial |
$4,434.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,434.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,434.40
|
| Rate for Payer: Multiplan Commercial |
$5,154.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,711.55
|
| Rate for Payer: United Healthcare Commercial |
$5,265.85
|
|
|
PARTIAL AMPUTATION OF TOE
|
Facility
|
IP
|
$1,162.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
9822882501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$860.00 |
| Max. Negotiated Rate |
$1,103.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,103.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$860.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$860.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$987.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$976.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$929.60
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cigna Commercial |
$929.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$929.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$929.60
|
| Rate for Payer: Multiplan Commercial |
$1,080.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$987.70
|
| Rate for Payer: United Healthcare Commercial |
$1,103.90
|
|
|
PARTIAL EXCISION BONE FIBULA
|
Facility
|
OP
|
$2,173.00
|
|
|
Service Code
|
CPT 27641
|
| Hospital Charge Code |
9822764101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$962.42 |
| Max. Negotiated Rate |
$2,064.35 |
| Rate for Payer: Aetna of VT Commercial |
$2,064.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,946.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$962.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,946.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,308.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,847.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,760.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$977.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,727.54
|
| Rate for Payer: Cash Price |
$1,086.50
|
| Rate for Payer: Cigna Commercial |
$1,738.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,738.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,738.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$977.85
|
| Rate for Payer: Multiplan Commercial |
$2,020.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,847.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$977.85
|
| Rate for Payer: United Healthcare Commercial |
$2,064.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$977.85
|
| Rate for Payer: United Healthcare VA CCN |
$977.85
|
|
|
PARTIAL EXCISION BONE FIBULA
|
Facility
|
IP
|
$2,173.00
|
|
|
Service Code
|
CPT 27641
|
| Hospital Charge Code |
9822764101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,608.24 |
| Max. Negotiated Rate |
$2,064.35 |
| Rate for Payer: Aetna of VT Commercial |
$2,064.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,608.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,608.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,847.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,825.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,738.40
|
| Rate for Payer: Cash Price |
$1,086.50
|
| Rate for Payer: Cigna Commercial |
$1,738.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,738.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,738.40
|
| Rate for Payer: Multiplan Commercial |
$2,020.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,847.05
|
| Rate for Payer: United Healthcare Commercial |
$2,064.35
|
|
|
PARTIAL EXCISION BONE FIBULA
|
Professional
|
Both
|
$2,173.00
|
|
|
Service Code
|
CPT 27641
|
| Hospital Charge Code |
9822764101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$621.94 |
| Max. Negotiated Rate |
$2,042.62 |
| Rate for Payer: Aetna of VT Commercial |
$2,042.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,946.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$640.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,946.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$870.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,454.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,454.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$715.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,454.14
|
| Rate for Payer: Cash Price |
$1,086.50
|
| Rate for Payer: Cash Price |
$1,086.50
|
| Rate for Payer: Cigna Commercial |
$1,170.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,030.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,030.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$621.94
|
| Rate for Payer: Multiplan Commercial |
$2,020.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$883.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$621.95
|
| Rate for Payer: United Healthcare Commercial |
$956.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$621.95
|
| Rate for Payer: United Healthcare VA CCN |
$621.95
|
|
|
PARTIAL EXCISION BONE TIBIA
|
Professional
|
Both
|
$2,740.00
|
|
|
Service Code
|
CPT 27640
|
| Hospital Charge Code |
9822764001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$779.64 |
| Max. Negotiated Rate |
$2,575.60 |
| Rate for Payer: Aetna of VT Commercial |
$2,575.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,454.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$803.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,454.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,091.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,419.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,419.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$896.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,419.59
|
| Rate for Payer: Cash Price |
$1,370.00
|
| Rate for Payer: Cash Price |
$1,370.00
|
| Rate for Payer: Cigna Commercial |
$1,484.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,296.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,296.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$779.64
|
| Rate for Payer: Multiplan Commercial |
$2,548.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,107.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$779.64
|
| Rate for Payer: United Healthcare Commercial |
$1,199.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$779.64
|
| Rate for Payer: United Healthcare VA CCN |
$779.64
|
|
|
PARTIAL EXCISION BONE TIBIA
|
Facility
|
OP
|
$2,740.00
|
|
|
Service Code
|
CPT 27640
|
| Hospital Charge Code |
9822764001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,213.55 |
| Max. Negotiated Rate |
$2,603.00 |
| Rate for Payer: Aetna of VT Commercial |
$2,603.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,454.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,213.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,454.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,649.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,329.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,219.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,233.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,178.30
|
| Rate for Payer: Cash Price |
$1,370.00
|
| Rate for Payer: Cigna Commercial |
$2,192.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,192.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,192.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,233.00
|
| Rate for Payer: Multiplan Commercial |
$2,548.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,329.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,233.00
|
| Rate for Payer: United Healthcare Commercial |
$2,603.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,233.00
|
| Rate for Payer: United Healthcare VA CCN |
$1,233.00
|
|
|
PARTIAL EXCISION BONE TIBIA
|
Facility
|
IP
|
$2,740.00
|
|
|
Service Code
|
CPT 27640
|
| Hospital Charge Code |
9822764001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,027.87 |
| Max. Negotiated Rate |
$2,603.00 |
| Rate for Payer: Aetna of VT Commercial |
$2,603.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,027.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,027.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,329.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,301.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,192.00
|
| Rate for Payer: Cash Price |
$1,370.00
|
| Rate for Payer: Cigna Commercial |
$2,192.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,192.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,192.00
|
| Rate for Payer: Multiplan Commercial |
$2,548.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,329.00
|
| Rate for Payer: United Healthcare Commercial |
$2,603.00
|
|
|
PARTIAL HYSTERECTOMY
|
Professional
|
Both
|
$3,194.00
|
|
|
Service Code
|
CPT 58180
|
| Hospital Charge Code |
9825818001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$891.41 |
| Max. Negotiated Rate |
$3,002.36 |
| Rate for Payer: Aetna of VT Commercial |
$3,002.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,861.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$918.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,861.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,247.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,566.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,566.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,025.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,566.83
|
| Rate for Payer: Cash Price |
$1,597.00
|
| Rate for Payer: Cash Price |
$1,597.00
|
| Rate for Payer: Cigna Commercial |
$1,571.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,489.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,489.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$891.41
|
| Rate for Payer: Multiplan Commercial |
$2,970.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,265.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$891.41
|
| Rate for Payer: United Healthcare Commercial |
$1,371.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$891.41
|
| Rate for Payer: United Healthcare VA CCN |
$891.41
|
|
|
PARTIAL HYSTERECTOMY
|
Facility
|
OP
|
$3,194.00
|
|
|
Service Code
|
CPT 58180
|
| Hospital Charge Code |
9825818001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,414.62 |
| Max. Negotiated Rate |
$3,034.30 |
| Rate for Payer: Aetna of VT Commercial |
$3,034.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,861.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,414.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,861.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,922.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,714.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,587.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,437.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,539.23
|
| Rate for Payer: Cash Price |
$1,597.00
|
| Rate for Payer: Cigna Commercial |
$2,555.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,555.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,555.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,437.30
|
| Rate for Payer: Multiplan Commercial |
$2,970.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,714.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,437.30
|
| Rate for Payer: United Healthcare Commercial |
$3,034.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,437.30
|
| Rate for Payer: United Healthcare VA CCN |
$1,437.30
|
|
|
PARTIAL HYSTERECTOMY
|
Facility
|
IP
|
$3,194.00
|
|
|
Service Code
|
CPT 58180
|
| Hospital Charge Code |
9825818001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,363.88 |
| Max. Negotiated Rate |
$3,034.30 |
| Rate for Payer: Aetna of VT Commercial |
$3,034.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,363.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,363.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,714.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,682.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,555.20
|
| Rate for Payer: Cash Price |
$1,597.00
|
| Rate for Payer: Cigna Commercial |
$2,555.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,555.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,555.20
|
| Rate for Payer: Multiplan Commercial |
$2,970.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,714.90
|
| Rate for Payer: United Healthcare Commercial |
$3,034.30
|
|
|
PARTIAL REMOVAL FOOT FASCIA
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT 28060
|
| Hospital Charge Code |
9822806001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$235.62 |
| Max. Negotiated Rate |
$505.40 |
| Rate for Payer: Aetna of VT Commercial |
$505.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$476.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$476.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$320.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$430.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$239.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$422.94
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: Cigna Commercial |
$425.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$425.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$425.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$239.40
|
| Rate for Payer: Multiplan Commercial |
$494.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$452.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$239.40
|
| Rate for Payer: United Healthcare Commercial |
$505.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$239.40
|
| Rate for Payer: United Healthcare VA CCN |
$239.40
|
|
|
PARTIAL REMOVAL FOOT FASCIA
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT 28060
|
| Hospital Charge Code |
9822806001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$393.73 |
| Max. Negotiated Rate |
$505.40 |
| Rate for Payer: Aetna of VT Commercial |
$505.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$393.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$393.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$425.60
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: Cigna Commercial |
$425.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$425.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$425.60
|
| Rate for Payer: Multiplan Commercial |
$494.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$452.20
|
| Rate for Payer: United Healthcare Commercial |
$505.40
|
|
|
PARTIAL REMOVAL FOOT FASCIA
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
CPT 28060
|
| Hospital Charge Code |
9822806001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$345.16 |
| Max. Negotiated Rate |
$795.62 |
| Rate for Payer: Aetna of VT Commercial |
$500.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$476.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$355.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$476.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$483.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$779.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$779.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$396.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$779.44
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: Cigna Commercial |
$655.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$795.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$795.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$489.05
|
| Rate for Payer: Multiplan Commercial |
$494.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$490.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$345.16
|
| Rate for Payer: United Healthcare Commercial |
$530.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$345.16
|
| Rate for Payer: United Healthcare VA CCN |
$345.16
|
|
|
PARTIAL REMOVAL OF COLON
|
Facility
|
IP
|
$4,068.00
|
|
|
Service Code
|
CPT 44143
|
| Hospital Charge Code |
9824414301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$3,010.73 |
| Max. Negotiated Rate |
$3,864.60 |
| Rate for Payer: Aetna of VT Commercial |
$3,864.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,010.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,010.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,457.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,417.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,254.40
|
| Rate for Payer: Cash Price |
$2,034.00
|
| Rate for Payer: Cigna Commercial |
$3,254.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,254.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,254.40
|
| Rate for Payer: Multiplan Commercial |
$3,783.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,457.80
|
| Rate for Payer: United Healthcare Commercial |
$3,864.60
|
|
|
PARTIAL REMOVAL OF COLON
|
Facility
|
OP
|
$4,068.00
|
|
|
Service Code
|
CPT 44143
|
| Hospital Charge Code |
9824414301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,801.72 |
| Max. Negotiated Rate |
$3,864.60 |
| Rate for Payer: Aetna of VT Commercial |
$3,864.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,644.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,801.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,644.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,448.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,457.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,295.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,830.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,234.06
|
| Rate for Payer: Cash Price |
$2,034.00
|
| Rate for Payer: Cigna Commercial |
$3,254.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,254.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,254.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,830.60
|
| Rate for Payer: Multiplan Commercial |
$3,783.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,457.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,830.60
|
| Rate for Payer: United Healthcare Commercial |
$3,864.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,830.60
|
| Rate for Payer: United Healthcare VA CCN |
$1,830.60
|
|
|
PARTIAL REMOVAL OF COLON
|
Facility
|
OP
|
$3,461.00
|
|
|
Service Code
|
CPT 44140
|
| Hospital Charge Code |
9824414001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,532.88 |
| Max. Negotiated Rate |
$3,287.95 |
| Rate for Payer: Aetna of VT Commercial |
$3,287.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,100.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,532.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,100.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,083.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,941.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,803.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,557.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,751.49
|
| Rate for Payer: Cash Price |
$1,730.50
|
| Rate for Payer: Cigna Commercial |
$2,768.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,768.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,768.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,557.45
|
| Rate for Payer: Multiplan Commercial |
$3,218.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,941.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,557.45
|
| Rate for Payer: United Healthcare Commercial |
$3,287.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,557.45
|
| Rate for Payer: United Healthcare VA CCN |
$1,557.45
|
|
|
PARTIAL REMOVAL OF COLON
|
Professional
|
Both
|
$4,068.00
|
|
|
Service Code
|
CPT 44143
|
| Hospital Charge Code |
9824414301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,496.67 |
| Max. Negotiated Rate |
$3,823.92 |
| Rate for Payer: Aetna of VT Commercial |
$3,823.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,644.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,541.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,644.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,095.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,360.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,360.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,721.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,360.44
|
| Rate for Payer: Cash Price |
$2,034.00
|
| Rate for Payer: Cash Price |
$2,034.00
|
| Rate for Payer: Cigna Commercial |
$2,744.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,545.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,545.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,496.67
|
| Rate for Payer: Multiplan Commercial |
$3,783.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,125.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,496.67
|
| Rate for Payer: United Healthcare Commercial |
$2,302.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,496.67
|
| Rate for Payer: United Healthcare VA CCN |
$1,496.67
|
|
|
PARTIAL REMOVAL OF COLON
|
Facility
|
IP
|
$2,119.00
|
|
|
Service Code
|
CPT 44146
|
| Hospital Charge Code |
9824414601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,568.27 |
| Max. Negotiated Rate |
$2,013.05 |
| Rate for Payer: Aetna of VT Commercial |
$2,013.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,568.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,568.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,801.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,779.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,695.20
|
| Rate for Payer: Cash Price |
$1,059.50
|
| Rate for Payer: Cigna Commercial |
$1,695.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,695.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,695.20
|
| Rate for Payer: Multiplan Commercial |
$1,970.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,801.15
|
| Rate for Payer: United Healthcare Commercial |
$2,013.05
|
|
|
PARTIAL REMOVAL OF COLON
|
Professional
|
Both
|
$7,052.00
|
|
|
Service Code
|
CPT 44145
|
| Hospital Charge Code |
9824414501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,501.02 |
| Max. Negotiated Rate |
$6,628.88 |
| Rate for Payer: Aetna of VT Commercial |
$6,628.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,317.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,546.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,317.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,101.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,594.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,594.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,726.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,594.12
|
| Rate for Payer: Cash Price |
$3,526.00
|
| Rate for Payer: Cash Price |
$3,526.00
|
| Rate for Payer: Cigna Commercial |
$2,749.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,540.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,540.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,501.02
|
| Rate for Payer: Multiplan Commercial |
$6,558.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,131.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,501.02
|
| Rate for Payer: United Healthcare Commercial |
$2,309.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,501.02
|
| Rate for Payer: United Healthcare VA CCN |
$1,501.02
|
|
