|
PARTIAL REMOVAL OF HYMEN
|
Professional
|
Both
|
$4,950.00
|
|
|
Service Code
|
CPT 56700
|
| Hospital Charge Code |
5105670001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$190.33 |
| Max. Negotiated Rate |
$4,653.00 |
| Rate for Payer: Aetna of VT Commercial |
$4,653.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,434.70
|
| 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 |
$4,434.70
|
| 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 |
$2,475.00
|
| Rate for Payer: Cash Price |
$2,475.00
|
| 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 |
$4,603.50
|
| 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
|
Professional
|
Both
|
$551.00
|
|
|
Service Code
|
CPT 56700
|
| Hospital Charge Code |
9825670001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$190.33 |
| Max. Negotiated Rate |
$517.94 |
| Rate for Payer: Aetna of VT Commercial |
$517.94
|
| 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 |
$196.04
|
| 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 |
$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 |
$275.50
|
| Rate for Payer: Cash Price |
$275.50
|
| 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 |
$512.43
|
| 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
|
$551.00
|
|
|
Service Code
|
CPT 56700
|
| Hospital Charge Code |
9605670002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$407.80 |
| 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 |
$407.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$407.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$468.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$462.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$440.80
|
| 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: Multiplan Commercial |
$512.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$468.35
|
| Rate for Payer: United Healthcare Commercial |
$523.45
|
|
|
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
|
|
|
PARTIAL REMOVAL OF HYMEN
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 56700
|
| Hospital Charge Code |
9825670001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$407.80 |
| 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 |
$407.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$407.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$468.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$462.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$440.80
|
| 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: Multiplan Commercial |
$512.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$468.35
|
| Rate for Payer: United Healthcare Commercial |
$523.45
|
|
|
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
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 56700
|
| Hospital Charge Code |
9825670001
|
|
Hospital Revenue Code
|
982
|
| 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
|
OP
|
$5,500.00
|
|
|
Service Code
|
CPT 56700
|
| Hospital Charge Code |
9605670001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,435.95 |
| 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 |
$4,927.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,435.95
|
| 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 |
$3,311.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,675.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,455.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,475.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,372.50
|
| 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: Martins Point Health Care Commercial |
$2,475.00
|
| Rate for Payer: Multiplan Commercial |
$5,115.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,675.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,475.00
|
| Rate for Payer: United Healthcare Commercial |
$5,225.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,475.00
|
| Rate for Payer: United Healthcare VA CCN |
$2,475.00
|
|
|
PARTIAL REMOVAL OF THYROID
|
Professional
|
Both
|
$2,450.00
|
|
|
Service Code
|
CPT 60220
|
| Hospital Charge Code |
9826022001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$657.18 |
| Max. Negotiated Rate |
$2,303.00 |
| Rate for Payer: Aetna of VT Commercial |
$2,303.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,194.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$676.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,194.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$920.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,091.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,091.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$755.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,091.12
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$1,204.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,100.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,100.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$657.18
|
| Rate for Payer: Multiplan Commercial |
$2,278.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$933.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$657.18
|
| Rate for Payer: United Healthcare Commercial |
$1,010.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.18
|
| Rate for Payer: United Healthcare VA CCN |
$657.18
|
|
|
PARTIAL REMOVAL OF THYROID
|
Facility
|
OP
|
$2,450.00
|
|
|
Service Code
|
CPT 60220
|
| Hospital Charge Code |
9826022001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,085.11 |
| Max. Negotiated Rate |
$2,327.50 |
| Rate for Payer: Aetna of VT Commercial |
$2,327.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,194.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,085.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,194.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,474.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,082.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,984.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,102.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,947.75
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$1,960.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,960.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,960.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,102.50
|
| Rate for Payer: Multiplan Commercial |
$2,278.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,082.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,102.50
|
| Rate for Payer: United Healthcare Commercial |
$2,327.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,102.50
|
| Rate for Payer: United Healthcare VA CCN |
$1,102.50
|
|
|
PARTIAL REMOVAL OF THYROID
|
Facility
|
IP
|
$2,450.00
|
|
|
Service Code
|
CPT 60220
|
| Hospital Charge Code |
9826022001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,813.24 |
| Max. Negotiated Rate |
$2,327.50 |
| Rate for Payer: Aetna of VT Commercial |
$2,327.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,813.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,813.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,082.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,058.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,960.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$1,960.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,960.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,960.00
|
| Rate for Payer: Multiplan Commercial |
$2,278.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,082.50
|
| Rate for Payer: United Healthcare Commercial |
$2,327.50
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
OP
|
$852.00
|
|
|
Service Code
|
CPT 28160
|
| Hospital Charge Code |
9822816001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$377.35 |
| Max. Negotiated Rate |
$809.40 |
| Rate for Payer: Aetna of VT Commercial |
$809.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$763.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$377.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$763.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$512.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$724.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$690.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$383.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$677.34
|
| Rate for Payer: Cash Price |
$426.00
|
| Rate for Payer: Cigna Commercial |
$681.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$681.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$681.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$383.40
|
| Rate for Payer: Multiplan Commercial |
$792.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$724.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$383.40
|
| Rate for Payer: United Healthcare Commercial |
$809.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$383.40
|
| Rate for Payer: United Healthcare VA CCN |
$383.40
|
|
|
PARTIAL REMOVAL OF TOE
|
Professional
|
Both
|
$852.00
|
|
|
Service Code
|
CPT 28160
|
| Hospital Charge Code |
9822816001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$257.78 |
| Max. Negotiated Rate |
$800.88 |
| Rate for Payer: Aetna of VT Commercial |
$800.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$763.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$265.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$763.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$360.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$684.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$684.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$296.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$684.12
|
| Rate for Payer: Cash Price |
$426.00
|
| Rate for Payer: Cash Price |
$426.00
|
| Rate for Payer: Cigna Commercial |
$488.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$626.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$626.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$386.58
|
| Rate for Payer: Multiplan Commercial |
$792.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$257.78
|
| Rate for Payer: United Healthcare Commercial |
$396.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.78
|
| Rate for Payer: United Healthcare VA CCN |
$257.78
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
IP
|
$852.00
|
|
|
Service Code
|
CPT 28160
|
| Hospital Charge Code |
9822816001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$630.57 |
| Max. Negotiated Rate |
$809.40 |
| Rate for Payer: Aetna of VT Commercial |
$809.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$630.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$630.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$724.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$715.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$681.60
|
| Rate for Payer: Cash Price |
$426.00
|
| Rate for Payer: Cigna Commercial |
$681.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$681.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$681.60
|
| Rate for Payer: Multiplan Commercial |
$792.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$724.20
|
| Rate for Payer: United Healthcare Commercial |
$809.40
|
|
|
PARTIAL REMOVAL OF TOE
|
Professional
|
Both
|
$1,071.00
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
9812812402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$323.31 |
| Max. Negotiated Rate |
$1,006.74 |
| Rate for Payer: Aetna of VT Commercial |
$1,006.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$959.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$333.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$959.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$452.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$669.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$669.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$371.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$669.55
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cigna Commercial |
$611.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$736.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$736.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$453.71
|
| Rate for Payer: Multiplan Commercial |
$996.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$459.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$323.31
|
| Rate for Payer: United Healthcare Commercial |
$497.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$323.31
|
| Rate for Payer: United Healthcare VA CCN |
$323.31
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
IP
|
$2,882.85
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
4502812401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,133.60 |
| Max. Negotiated Rate |
$2,738.71 |
| Rate for Payer: Aetna of VT Commercial |
$2,738.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,133.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,133.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,450.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,421.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,306.28
|
| Rate for Payer: Cash Price |
$1,441.42
|
| Rate for Payer: Cigna Commercial |
$2,306.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,306.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,306.28
|
| Rate for Payer: Multiplan Commercial |
$2,681.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,450.42
|
| Rate for Payer: United Healthcare Commercial |
$2,738.71
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
CPT 28126
|
| Hospital Charge Code |
9822812601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$368.94 |
| Max. Negotiated Rate |
$791.35 |
| Rate for Payer: Aetna of VT Commercial |
$791.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$746.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$368.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$746.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$501.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$708.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$674.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$374.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$662.24
|
| Rate for Payer: Cash Price |
$416.50
|
| Rate for Payer: Cigna Commercial |
$666.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$666.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$666.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$374.85
|
| Rate for Payer: Multiplan Commercial |
$774.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$708.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$374.85
|
| Rate for Payer: United Healthcare Commercial |
$791.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$374.85
|
| Rate for Payer: United Healthcare VA CCN |
$374.85
|
|
|
PARTIAL REMOVAL OF TOE
|
Professional
|
Both
|
$833.00
|
|
|
Service Code
|
CPT 28126
|
| Hospital Charge Code |
9822812601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$239.91 |
| Max. Negotiated Rate |
$783.02 |
| Rate for Payer: Aetna of VT Commercial |
$783.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$746.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$247.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$746.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$335.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$654.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$654.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$275.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$654.78
|
| Rate for Payer: Cash Price |
$416.50
|
| Rate for Payer: Cash Price |
$416.50
|
| Rate for Payer: Cigna Commercial |
$456.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$598.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$598.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$368.39
|
| Rate for Payer: Multiplan Commercial |
$774.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$340.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$239.91
|
| Rate for Payer: United Healthcare Commercial |
$369.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$239.91
|
| Rate for Payer: United Healthcare VA CCN |
$239.91
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
CPT 28153
|
| Hospital Charge Code |
9822815301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$626.86 |
| Max. Negotiated Rate |
$804.65 |
| Rate for Payer: Aetna of VT Commercial |
$804.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$626.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$626.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$719.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$711.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$677.60
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cigna Commercial |
$677.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$677.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$677.60
|
| Rate for Payer: Multiplan Commercial |
$787.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$719.95
|
| Rate for Payer: United Healthcare Commercial |
$804.65
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
9812812402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$792.65 |
| Max. Negotiated Rate |
$1,017.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,017.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$792.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$792.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$910.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$899.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$856.80
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cigna Commercial |
$856.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$856.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$856.80
|
| Rate for Payer: Multiplan Commercial |
$996.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$910.35
|
| Rate for Payer: United Healthcare Commercial |
$1,017.45
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
9822812401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$474.35 |
| Max. Negotiated Rate |
$1,017.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,017.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$959.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$474.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$959.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$644.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$910.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$867.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$481.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$851.45
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cigna Commercial |
$856.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$856.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$856.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$481.95
|
| Rate for Payer: Multiplan Commercial |
$996.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$910.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$481.95
|
| Rate for Payer: United Healthcare Commercial |
$1,017.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$481.95
|
| Rate for Payer: United Healthcare VA CCN |
$481.95
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
9812812401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
PARTIAL REMOVAL OF TOE
|
Professional
|
Both
|
$1,071.00
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
9822812401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$323.31 |
| Max. Negotiated Rate |
$1,006.74 |
| Rate for Payer: Aetna of VT Commercial |
$1,006.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$959.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$333.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$959.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$452.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$669.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$669.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$371.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$669.55
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cigna Commercial |
$611.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$736.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$736.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$453.71
|
| Rate for Payer: Multiplan Commercial |
$996.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$459.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$323.31
|
| Rate for Payer: United Healthcare Commercial |
$497.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$323.31
|
| Rate for Payer: United Healthcare VA CCN |
$323.31
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
CPT 28126
|
| Hospital Charge Code |
9822812601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$616.50 |
| Max. Negotiated Rate |
$791.35 |
| Rate for Payer: Aetna of VT Commercial |
$791.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$616.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$616.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$708.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$699.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$666.40
|
| Rate for Payer: Cash Price |
$416.50
|
| Rate for Payer: Cigna Commercial |
$666.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$666.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$666.40
|
| Rate for Payer: Multiplan Commercial |
$774.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$708.05
|
| Rate for Payer: United Healthcare Commercial |
$791.35
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
OP
|
$2,882.85
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
4502812401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,276.81 |
| Max. Negotiated Rate |
$2,738.71 |
| Rate for Payer: Aetna of VT Commercial |
$2,738.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,582.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,276.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,582.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,735.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,450.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,335.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,297.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,291.87
|
| Rate for Payer: Cash Price |
$1,441.42
|
| Rate for Payer: Cigna Commercial |
$2,306.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,306.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,306.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,297.28
|
| Rate for Payer: Multiplan Commercial |
$2,681.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,450.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,297.28
|
| Rate for Payer: United Healthcare Commercial |
$2,738.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,297.28
|
| Rate for Payer: United Healthcare VA CCN |
$1,297.28
|
|
