|
PARTIAL REMOVAL OF COLON
|
Facility
|
IP
|
$3,461.00
|
|
|
Service Code
|
CPT 44140
|
| Hospital Charge Code |
9824414001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,561.49 |
| 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 |
$2,561.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,561.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,941.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,907.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,768.80
|
| 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: Multiplan Commercial |
$3,218.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,941.85
|
| Rate for Payer: United Healthcare Commercial |
$3,287.95
|
|
|
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
|
$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
|
$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
|
$2,119.00
|
|
|
Service Code
|
CPT 44146
|
| Hospital Charge Code |
9824414601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$938.51 |
| 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 |
$1,898.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$938.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,898.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,275.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,801.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,716.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$953.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,684.61
|
| 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: Martins Point Health Care Commercial |
$953.55
|
| Rate for Payer: Multiplan Commercial |
$1,970.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,801.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$953.55
|
| Rate for Payer: United Healthcare Commercial |
$2,013.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$953.55
|
| Rate for Payer: United Healthcare VA CCN |
$953.55
|
|
|
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
|
|
|
PARTIAL REMOVAL OF FOOT BONE
|
Facility
|
OP
|
$1,571.00
|
|
|
Service Code
|
CPT 28288
|
| Hospital Charge Code |
9602828802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$695.80 |
| Max. Negotiated Rate |
$1,492.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,492.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,407.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$695.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,407.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$945.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,335.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,272.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$706.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,248.94
|
| Rate for Payer: Cash Price |
$785.50
|
| Rate for Payer: Cigna Commercial |
$1,256.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,256.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,256.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$706.95
|
| Rate for Payer: Multiplan Commercial |
$1,461.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,335.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$706.95
|
| Rate for Payer: United Healthcare Commercial |
$1,492.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$706.95
|
| Rate for Payer: United Healthcare VA CCN |
$706.95
|
|
|
PARTIAL REMOVAL OF FOOT BONE
|
Facility
|
OP
|
$4,642.00
|
|
|
Service Code
|
CPT 28288
|
| Hospital Charge Code |
9602828801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,055.94 |
| Max. Negotiated Rate |
$4,409.90 |
| Rate for Payer: Aetna of VT Commercial |
$4,409.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,158.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,055.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,158.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,794.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,945.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,760.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,088.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,690.39
|
| Rate for Payer: Cash Price |
$2,321.00
|
| Rate for Payer: Cigna Commercial |
$3,713.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,713.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,713.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,088.90
|
| Rate for Payer: Multiplan Commercial |
$4,317.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,945.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,088.90
|
| Rate for Payer: United Healthcare Commercial |
$4,409.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,088.90
|
| Rate for Payer: United Healthcare VA CCN |
$2,088.90
|
|
|
PARTIAL REMOVAL OF FOOT BONE
|
Professional
|
Both
|
$4,642.00
|
|
|
Service Code
|
CPT 28288
|
| Hospital Charge Code |
9602828801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$418.41 |
| Max. Negotiated Rate |
$4,363.48 |
| Rate for Payer: Aetna of VT Commercial |
$4,363.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,158.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$430.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,158.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$585.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$772.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$772.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$481.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$772.60
|
| Rate for Payer: Cash Price |
$2,321.00
|
| Rate for Payer: Cash Price |
$2,321.00
|
| Rate for Payer: Cigna Commercial |
$794.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$927.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$927.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$570.97
|
| Rate for Payer: Multiplan Commercial |
$4,317.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$594.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$418.41
|
| Rate for Payer: United Healthcare Commercial |
$643.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$418.41
|
| Rate for Payer: United Healthcare VA CCN |
$418.41
|
|
|
PARTIAL REMOVAL OF FOOT BONE
|
Professional
|
Both
|
$3,071.00
|
|
|
Service Code
|
CPT 28288
|
| Hospital Charge Code |
5102828801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$418.41 |
| Max. Negotiated Rate |
$2,886.74 |
| Rate for Payer: Aetna of VT Commercial |
$2,886.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,751.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$430.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,751.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$585.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$772.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$772.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$481.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$772.60
|
| Rate for Payer: Cash Price |
$1,535.50
|
| Rate for Payer: Cash Price |
$1,535.50
|
| Rate for Payer: Cigna Commercial |
$794.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$927.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$927.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$570.97
|
| Rate for Payer: Multiplan Commercial |
$2,856.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$594.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$418.41
|
| Rate for Payer: United Healthcare Commercial |
$643.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$418.41
|
| Rate for Payer: United Healthcare VA CCN |
$418.41
|
|
|
PARTIAL REMOVAL OF FOOT BONE
|
Facility
|
OP
|
$1,571.00
|
|
|
Service Code
|
CPT 28288
|
| Hospital Charge Code |
9822828801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$695.80 |
| Max. Negotiated Rate |
$1,492.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,492.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,407.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$695.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,407.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$945.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,335.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,272.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$706.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,248.94
|
| Rate for Payer: Cash Price |
$785.50
|
| Rate for Payer: Cigna Commercial |
$1,256.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,256.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,256.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$706.95
|
| Rate for Payer: Multiplan Commercial |
$1,461.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,335.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$706.95
|
| Rate for Payer: United Healthcare Commercial |
$1,492.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$706.95
|
| Rate for Payer: United Healthcare VA CCN |
$706.95
|
|
|
PARTIAL REMOVAL OF FOOT BONE
|
Facility
|
OP
|
$1,466.00
|
|
|
Service Code
|
CPT 28122
|
| Hospital Charge Code |
9822812201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$649.29 |
| Max. Negotiated Rate |
$1,392.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,392.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,313.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$649.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,313.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$882.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,246.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,187.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$659.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,165.47
|
| Rate for Payer: Cash Price |
$733.00
|
| Rate for Payer: Cigna Commercial |
$1,172.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,172.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,172.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$659.70
|
| Rate for Payer: Multiplan Commercial |
$1,363.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,246.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$659.70
|
| Rate for Payer: United Healthcare Commercial |
$1,392.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$659.70
|
| Rate for Payer: United Healthcare VA CCN |
$659.70
|
|
|
PARTIAL REMOVAL OF FOOT BONE
|
Facility
|
OP
|
$3,071.00
|
|
|
Service Code
|
CPT 28288
|
| Hospital Charge Code |
5102828801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,360.15 |
| Max. Negotiated Rate |
$2,917.45 |
| Rate for Payer: Aetna of VT Commercial |
$2,917.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,751.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,360.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,751.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,848.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,610.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,487.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,381.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,441.45
|
| Rate for Payer: Cash Price |
$1,535.50
|
| Rate for Payer: Cigna Commercial |
$2,456.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,456.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,456.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,381.95
|
| Rate for Payer: Multiplan Commercial |
$2,856.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,610.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,381.95
|
| Rate for Payer: United Healthcare Commercial |
$2,917.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,381.95
|
| Rate for Payer: United Healthcare VA CCN |
$1,381.95
|
|
|
PARTIAL REMOVAL OF FOOT BONE
|
Facility
|
IP
|
$1,466.00
|
|
|
Service Code
|
CPT 28122
|
| Hospital Charge Code |
9822812201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,084.99 |
| Max. Negotiated Rate |
$1,392.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,392.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,084.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,084.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,246.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,231.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,172.80
|
| Rate for Payer: Cash Price |
$733.00
|
| Rate for Payer: Cigna Commercial |
$1,172.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,172.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,172.80
|
| Rate for Payer: Multiplan Commercial |
$1,363.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,246.10
|
| Rate for Payer: United Healthcare Commercial |
$1,392.70
|
|
|
PARTIAL REMOVAL OF FOOT BONE
|
Facility
|
IP
|
$3,071.00
|
|
|
Service Code
|
CPT 28288
|
| Hospital Charge Code |
5102828801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,272.85 |
| Max. Negotiated Rate |
$2,917.45 |
| Rate for Payer: Aetna of VT Commercial |
$2,917.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,272.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,272.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,610.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,579.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,456.80
|
| Rate for Payer: Cash Price |
$1,535.50
|
| Rate for Payer: Cigna Commercial |
$2,456.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,456.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,456.80
|
| Rate for Payer: Multiplan Commercial |
$2,856.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,610.35
|
| Rate for Payer: United Healthcare Commercial |
$2,917.45
|
|
|
PARTIAL REMOVAL OF FOOT BONE
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
CPT 28288
|
| Hospital Charge Code |
9602828802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$418.41 |
| Max. Negotiated Rate |
$1,476.74 |
| Rate for Payer: Aetna of VT Commercial |
$1,476.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,407.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$430.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,407.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$585.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$772.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$772.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$481.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$772.60
|
| Rate for Payer: Cash Price |
$785.50
|
| Rate for Payer: Cash Price |
$785.50
|
| Rate for Payer: Cigna Commercial |
$794.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$927.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$927.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$570.97
|
| Rate for Payer: Multiplan Commercial |
$1,461.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$594.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$418.41
|
| Rate for Payer: United Healthcare Commercial |
$643.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$418.41
|
| Rate for Payer: United Healthcare VA CCN |
$418.41
|
|
|
PARTIAL REMOVAL OF FOOT BONE
|
Professional
|
Both
|
$1,466.00
|
|
|
Service Code
|
CPT 28122
|
| Hospital Charge Code |
9822812201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$421.35 |
| Max. Negotiated Rate |
$1,378.04 |
| Rate for Payer: Aetna of VT Commercial |
$1,378.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,313.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$433.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,313.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$589.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$879.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$879.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$484.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$879.40
|
| Rate for Payer: Cash Price |
$733.00
|
| Rate for Payer: Cash Price |
$733.00
|
| Rate for Payer: Cigna Commercial |
$797.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$914.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$914.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$561.72
|
| Rate for Payer: Multiplan Commercial |
$1,363.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$598.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$421.35
|
| Rate for Payer: United Healthcare Commercial |
$648.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$421.35
|
| Rate for Payer: United Healthcare VA CCN |
$421.35
|
|
|
PARTIAL REMOVAL OF FOOT BONE
|
Facility
|
IP
|
$1,571.00
|
|
|
Service Code
|
CPT 28288
|
| Hospital Charge Code |
9822828801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,162.70 |
| Max. Negotiated Rate |
$1,492.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,492.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,162.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,162.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,335.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,319.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,256.80
|
| Rate for Payer: Cash Price |
$785.50
|
| Rate for Payer: Cigna Commercial |
$1,256.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,256.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,256.80
|
| Rate for Payer: Multiplan Commercial |
$1,461.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,335.35
|
| Rate for Payer: United Healthcare Commercial |
$1,492.45
|
|
|
PARTIAL REMOVAL OF FOOT BONE
|
Facility
|
IP
|
$4,642.00
|
|
|
Service Code
|
CPT 28288
|
| Hospital Charge Code |
9602828801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,435.54 |
| Max. Negotiated Rate |
$4,409.90 |
| Rate for Payer: Aetna of VT Commercial |
$4,409.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,435.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,435.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,945.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,899.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,713.60
|
| Rate for Payer: Cash Price |
$2,321.00
|
| Rate for Payer: Cigna Commercial |
$3,713.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,713.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,713.60
|
| Rate for Payer: Multiplan Commercial |
$4,317.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,945.70
|
| Rate for Payer: United Healthcare Commercial |
$4,409.90
|
|
|
PARTIAL REMOVAL OF FOOT BONE
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
CPT 28288
|
| Hospital Charge Code |
9822828801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$418.41 |
| Max. Negotiated Rate |
$1,476.74 |
| Rate for Payer: Aetna of VT Commercial |
$1,476.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,407.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$430.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,407.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$585.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$772.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$772.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$481.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$772.60
|
| Rate for Payer: Cash Price |
$785.50
|
| Rate for Payer: Cash Price |
$785.50
|
| Rate for Payer: Cigna Commercial |
$794.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$927.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$927.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$570.97
|
| Rate for Payer: Multiplan Commercial |
$1,461.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$594.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$418.41
|
| Rate for Payer: United Healthcare Commercial |
$643.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$418.41
|
| Rate for Payer: United Healthcare VA CCN |
$418.41
|
|
|
PARTIAL REMOVAL OF FOOT BONE
|
Facility
|
IP
|
$1,571.00
|
|
|
Service Code
|
CPT 28288
|
| Hospital Charge Code |
9602828802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,162.70 |
| Max. Negotiated Rate |
$1,492.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,492.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,162.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,162.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,335.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,319.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,256.80
|
| Rate for Payer: Cash Price |
$785.50
|
| Rate for Payer: Cigna Commercial |
$1,256.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,256.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,256.80
|
| Rate for Payer: Multiplan Commercial |
$1,461.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,335.35
|
| Rate for Payer: United Healthcare Commercial |
$1,492.45
|
|
|
PARTIAL REMOVAL OF HYMEN
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 56700
|
| Hospital Charge Code |
9605670002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$244.04 |
| Max. Negotiated Rate |
$523.45 |
| Rate for Payer: Aetna of VT Commercial |
$523.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$493.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$244.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$493.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$331.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$468.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$446.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$247.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$438.05
|
| Rate for Payer: Cash Price |
$275.50
|
| Rate for Payer: Cigna Commercial |
$440.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$440.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$440.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$247.95
|
| Rate for Payer: Multiplan Commercial |
$512.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$468.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$247.95
|
| Rate for Payer: United Healthcare Commercial |
$523.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$247.95
|
| Rate for Payer: United Healthcare VA CCN |
$247.95
|
|
|
PARTIAL REMOVAL OF HYMEN
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
CPT 56700
|
| Hospital Charge Code |
9605670001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4,070.55 |
| Max. Negotiated Rate |
$5,225.00 |
| Rate for Payer: Aetna of VT Commercial |
$5,225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,070.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,070.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,675.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,620.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,400.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,400.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,400.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,400.00
|
| Rate for Payer: Multiplan Commercial |
$5,115.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,675.00
|
| Rate for Payer: United Healthcare Commercial |
$5,225.00
|
|
|
PARTIAL REMOVAL OF HYMEN
|
Professional
|
Both
|
$5,500.00
|
|
|
Service Code
|
CPT 56700
|
| Hospital Charge Code |
9605670001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$190.33 |
| Max. Negotiated Rate |
$5,170.00 |
| Rate for Payer: Aetna of VT Commercial |
$5,170.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,927.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$196.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,927.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$266.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$311.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$311.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$218.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$311.02
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$337.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$315.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$315.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$190.33
|
| Rate for Payer: Multiplan Commercial |
$5,115.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$270.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$190.33
|
| Rate for Payer: United Healthcare Commercial |
$292.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$190.33
|
| Rate for Payer: United Healthcare VA CCN |
$190.33
|
|
|
PARTIAL REMOVAL OF HYMEN
|
Facility
|
IP
|
$4,950.00
|
|
|
Service Code
|
CPT 56700
|
| Hospital Charge Code |
5105670001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,663.49 |
| Max. Negotiated Rate |
$4,702.50 |
| Rate for Payer: Aetna of VT Commercial |
$4,702.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,663.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,663.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,207.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,158.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,960.00
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Cigna Commercial |
$3,960.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,960.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,960.00
|
| Rate for Payer: Multiplan Commercial |
$4,603.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,207.50
|
| Rate for Payer: United Healthcare Commercial |
$4,702.50
|
|
