|
PARTIAL REMOVAL OF TOE
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
9812812401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$736.48 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| 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 |
$333.01
|
| 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 |
$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 |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| 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 |
$0.93
|
| 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
|
OP
|
$847.00
|
|
|
Service Code
|
CPT 28153
|
| Hospital Charge Code |
9822815301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$375.14 |
| 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 |
$758.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$375.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$758.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$509.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$719.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$686.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$381.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$673.37
|
| 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: Martins Point Health Care Commercial |
$381.15
|
| Rate for Payer: Multiplan Commercial |
$787.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$719.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$381.15
|
| Rate for Payer: United Healthcare Commercial |
$804.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.15
|
| Rate for Payer: United Healthcare VA CCN |
$381.15
|
|
|
PARTIAL REMOVAL OF TOE
|
Professional
|
Both
|
$847.00
|
|
|
Service Code
|
CPT 28153
|
| Hospital Charge Code |
9822815301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$254.20 |
| Max. Negotiated Rate |
$796.18 |
| Rate for Payer: Aetna of VT Commercial |
$796.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$758.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$261.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$758.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$355.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$662.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$662.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$292.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$662.31
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cigna Commercial |
$483.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$618.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$618.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$381.71
|
| Rate for Payer: Multiplan Commercial |
$787.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$360.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$254.20
|
| Rate for Payer: United Healthcare Commercial |
$391.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$254.20
|
| Rate for Payer: United Healthcare VA CCN |
$254.20
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
9812812401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| 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 |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| 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: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
9812812402
|
|
Hospital Revenue Code
|
981
|
| 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
|
IP
|
$1,071.00
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
9822812401
|
|
Hospital Revenue Code
|
982
|
| 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
|
|
|
PART REMOVAL OF ANKLE/HEEL
|
Facility
|
IP
|
$1,545.00
|
|
|
Service Code
|
CPT 28120
|
| Hospital Charge Code |
9822812001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,143.45 |
| Max. Negotiated Rate |
$1,467.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,467.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,143.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,143.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,313.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,297.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,236.00
|
| Rate for Payer: Cash Price |
$772.50
|
| Rate for Payer: Cigna Commercial |
$1,236.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,236.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,236.00
|
| Rate for Payer: Multiplan Commercial |
$1,436.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,313.25
|
| Rate for Payer: United Healthcare Commercial |
$1,467.75
|
|
|
PART REMOVAL OF ANKLE/HEEL
|
Facility
|
OP
|
$1,545.00
|
|
|
Service Code
|
CPT 28120
|
| Hospital Charge Code |
9822812001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$684.28 |
| Max. Negotiated Rate |
$1,467.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,467.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,384.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$684.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,384.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$930.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,313.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,251.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$695.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,228.28
|
| Rate for Payer: Cash Price |
$772.50
|
| Rate for Payer: Cigna Commercial |
$1,236.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,236.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,236.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$695.25
|
| Rate for Payer: Multiplan Commercial |
$1,436.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,313.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$695.25
|
| Rate for Payer: United Healthcare Commercial |
$1,467.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$695.25
|
| Rate for Payer: United Healthcare VA CCN |
$695.25
|
|
|
PART REMOVAL OF ANKLE/HEEL
|
Professional
|
Both
|
$1,545.00
|
|
|
Service Code
|
CPT 28120
|
| Hospital Charge Code |
9822812001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$472.69 |
| Max. Negotiated Rate |
$1,452.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,452.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,384.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$486.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,384.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$661.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$929.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$929.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$543.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$929.63
|
| Rate for Payer: Cash Price |
$772.50
|
| Rate for Payer: Cash Price |
$772.50
|
| Rate for Payer: Cigna Commercial |
$896.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,033.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,033.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$632.96
|
| Rate for Payer: Multiplan Commercial |
$1,436.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$671.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$472.69
|
| Rate for Payer: United Healthcare Commercial |
$727.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$472.69
|
| Rate for Payer: United Healthcare VA CCN |
$472.69
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
IP
|
$1,028.00
|
|
|
Service Code
|
CPT 28110
|
| Hospital Charge Code |
9822811001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$760.82 |
| Max. Negotiated Rate |
$976.60 |
| Rate for Payer: Aetna of VT Commercial |
$976.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$760.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$760.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$873.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$863.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$822.40
|
| Rate for Payer: Cash Price |
$514.00
|
| Rate for Payer: Cigna Commercial |
$822.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$822.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$822.40
|
| Rate for Payer: Multiplan Commercial |
$956.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$873.80
|
| Rate for Payer: United Healthcare Commercial |
$976.60
|
|
|
PART REMOVAL OF METATARSAL
|
Professional
|
Both
|
$1,028.00
|
|
|
Service Code
|
CPT 28110
|
| Hospital Charge Code |
9822811001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$284.10 |
| Max. Negotiated Rate |
$966.32 |
| Rate for Payer: Aetna of VT Commercial |
$966.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$920.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$292.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$920.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$397.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$721.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$721.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$326.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$721.96
|
| Rate for Payer: Cash Price |
$514.00
|
| Rate for Payer: Cash Price |
$514.00
|
| Rate for Payer: Cigna Commercial |
$535.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$713.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$713.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$439.24
|
| Rate for Payer: Multiplan Commercial |
$956.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$403.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$284.10
|
| Rate for Payer: United Healthcare Commercial |
$437.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$284.10
|
| Rate for Payer: United Healthcare VA CCN |
$284.10
|
|
|
PART REMOVAL OF METATARSAL
|
Professional
|
Both
|
$1,027.00
|
|
|
Service Code
|
CPT 28112
|
| Hospital Charge Code |
9822811201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$301.40 |
| Max. Negotiated Rate |
$965.38 |
| Rate for Payer: Aetna of VT Commercial |
$965.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$920.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$310.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$920.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$421.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$786.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$786.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$346.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$786.00
|
| Rate for Payer: Cash Price |
$513.50
|
| Rate for Payer: Cash Price |
$513.50
|
| Rate for Payer: Cigna Commercial |
$569.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$741.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$741.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$456.54
|
| Rate for Payer: Multiplan Commercial |
$955.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$427.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$301.40
|
| Rate for Payer: United Healthcare Commercial |
$463.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$301.40
|
| Rate for Payer: United Healthcare VA CCN |
$301.40
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
OP
|
$1,027.00
|
|
|
Service Code
|
CPT 28112
|
| Hospital Charge Code |
9822811201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$454.86 |
| Max. Negotiated Rate |
$975.65 |
| Rate for Payer: Aetna of VT Commercial |
$975.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$920.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$454.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$920.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$618.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$872.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$831.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$462.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$816.47
|
| Rate for Payer: Cash Price |
$513.50
|
| Rate for Payer: Cigna Commercial |
$821.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$821.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$821.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$462.15
|
| Rate for Payer: Multiplan Commercial |
$955.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$872.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$462.15
|
| Rate for Payer: United Healthcare Commercial |
$975.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$462.15
|
| Rate for Payer: United Healthcare VA CCN |
$462.15
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
OP
|
$1,028.00
|
|
|
Service Code
|
CPT 28110
|
| Hospital Charge Code |
9822811001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$455.30 |
| Max. Negotiated Rate |
$976.60 |
| Rate for Payer: Aetna of VT Commercial |
$976.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$920.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$455.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$920.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$618.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$873.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$832.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$462.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$817.26
|
| Rate for Payer: Cash Price |
$514.00
|
| Rate for Payer: Cigna Commercial |
$822.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$822.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$822.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$462.60
|
| Rate for Payer: Multiplan Commercial |
$956.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$873.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$462.60
|
| Rate for Payer: United Healthcare Commercial |
$976.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$462.60
|
| Rate for Payer: United Healthcare VA CCN |
$462.60
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
IP
|
$1,088.00
|
|
|
Service Code
|
CPT 28113
|
| Hospital Charge Code |
9822811301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$805.23 |
| Max. Negotiated Rate |
$1,033.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,033.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$805.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$805.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$924.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$913.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$870.40
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cigna Commercial |
$870.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$870.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$870.40
|
| Rate for Payer: Multiplan Commercial |
$1,011.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$924.80
|
| Rate for Payer: United Healthcare Commercial |
$1,033.60
|
|
|
PART REMOVAL OF METATARSAL
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
CPT 28113
|
| Hospital Charge Code |
9822811301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$412.62 |
| Max. Negotiated Rate |
$1,022.72 |
| Rate for Payer: Aetna of VT Commercial |
$1,022.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$974.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$425.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$974.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$577.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$760.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$760.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$474.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$760.74
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cigna Commercial |
$778.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$903.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$903.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$556.52
|
| Rate for Payer: Multiplan Commercial |
$1,011.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$585.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$412.62
|
| Rate for Payer: United Healthcare Commercial |
$634.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$412.62
|
| Rate for Payer: United Healthcare VA CCN |
$412.62
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
IP
|
$1,027.00
|
|
|
Service Code
|
CPT 28112
|
| Hospital Charge Code |
9822811201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$760.08 |
| Max. Negotiated Rate |
$975.65 |
| Rate for Payer: Aetna of VT Commercial |
$975.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$760.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$760.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$872.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$862.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$821.60
|
| Rate for Payer: Cash Price |
$513.50
|
| Rate for Payer: Cigna Commercial |
$821.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$821.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$821.60
|
| Rate for Payer: Multiplan Commercial |
$955.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$872.95
|
| Rate for Payer: United Healthcare Commercial |
$975.65
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
OP
|
$1,088.00
|
|
|
Service Code
|
CPT 28113
|
| Hospital Charge Code |
9822811301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$481.88 |
| Max. Negotiated Rate |
$1,033.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,033.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$974.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$481.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$974.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$654.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$924.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$881.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$489.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$864.96
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cigna Commercial |
$870.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$870.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$870.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$489.60
|
| Rate for Payer: Multiplan Commercial |
$1,011.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$924.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$489.60
|
| Rate for Payer: United Healthcare Commercial |
$1,033.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$489.60
|
| Rate for Payer: United Healthcare VA CCN |
$489.60
|
|
|
PATH CLIN CONSLTJ HIGH 41-60
|
Facility
|
IP
|
$618.33
|
|
|
Service Code
|
CPT 80505
|
| Hospital Charge Code |
3008050501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$457.63 |
| Max. Negotiated Rate |
$587.41 |
| Rate for Payer: Aetna of VT Commercial |
$587.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$457.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$457.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$525.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$519.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$494.66
|
| Rate for Payer: Cash Price |
$309.16
|
| Rate for Payer: Cigna Commercial |
$494.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$494.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$494.66
|
| Rate for Payer: Multiplan Commercial |
$575.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$525.58
|
| Rate for Payer: United Healthcare Commercial |
$587.41
|
|
|
PATH CLIN CONSLTJ HIGH 41-60
|
Facility
|
OP
|
$618.33
|
|
|
Service Code
|
CPT 80505
|
| Hospital Charge Code |
3008050501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.97 |
| Max. Negotiated Rate |
$587.41 |
| Rate for Payer: Aetna of VT Commercial |
$587.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$459.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$273.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$459.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$372.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$525.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$500.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$278.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$491.57
|
| Rate for Payer: Cash Price |
$309.16
|
| Rate for Payer: Cash Price |
$309.16
|
| Rate for Payer: Cigna Commercial |
$494.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$494.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$494.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$278.25
|
| Rate for Payer: Multiplan Commercial |
$575.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$525.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$278.25
|
| Rate for Payer: United Healthcare Commercial |
$587.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.97
|
| Rate for Payer: United Healthcare VA CCN |
$278.25
|
|
|
PATH CLIN CONSLTJ HIGH 41-60
|
Professional
|
Both
|
$618.33
|
|
|
Service Code
|
CPT 80505
|
| Hospital Charge Code |
3008050501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.97 |
| Max. Negotiated Rate |
$581.23 |
| Rate for Payer: Aetna of VT Commercial |
$581.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$459.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$86.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$459.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$117.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$114.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$96.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.26
|
| Rate for Payer: Cash Price |
$309.16
|
| Rate for Payer: Cash Price |
$309.16
|
| Rate for Payer: Cigna Commercial |
$102.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$91.03
|
| Rate for Payer: Multiplan Commercial |
$575.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$83.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.97
|
| Rate for Payer: United Healthcare Commercial |
$129.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.97
|
| Rate for Payer: United Healthcare VA CCN |
$83.97
|
|
|
PATH CLIN CONSLTJ MOD 21-40
|
Facility
|
IP
|
$222.72
|
|
|
Service Code
|
CPT 80504
|
| Hospital Charge Code |
3008050401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$164.84 |
| Max. Negotiated Rate |
$211.58 |
| Rate for Payer: Aetna of VT Commercial |
$211.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$164.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$164.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$189.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$187.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$178.18
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cigna Commercial |
$178.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$178.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$178.18
|
| Rate for Payer: Multiplan Commercial |
$207.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$189.31
|
| Rate for Payer: United Healthcare Commercial |
$211.58
|
|
|
PATH CLIN CONSLTJ MOD 21-40
|
Facility
|
OP
|
$222.72
|
|
|
Service Code
|
CPT 80504
|
| Hospital Charge Code |
3008050401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.24 |
| Max. Negotiated Rate |
$254.95 |
| Rate for Payer: Aetna of VT Commercial |
$211.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$254.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$98.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$254.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$134.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$189.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$180.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$100.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$177.06
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cigna Commercial |
$178.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$178.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$178.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$100.22
|
| Rate for Payer: Multiplan Commercial |
$207.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$189.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.22
|
| Rate for Payer: United Healthcare Commercial |
$211.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.24
|
| Rate for Payer: United Healthcare VA CCN |
$100.22
|
|
|
PATH CLIN CONSLTJ MOD 21-40
|
Professional
|
Both
|
$222.72
|
|
|
Service Code
|
CPT 80504
|
| Hospital Charge Code |
3008050401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.24 |
| Max. Negotiated Rate |
$254.95 |
| Rate for Payer: Aetna of VT Commercial |
$209.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$254.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$254.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$61.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$50.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$63.17
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cigna Commercial |
$54.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$50.02
|
| Rate for Payer: Multiplan Commercial |
$207.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$44.24
|
| Rate for Payer: United Healthcare Commercial |
$68.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.24
|
| Rate for Payer: United Healthcare VA CCN |
$44.24
|
|
|
PATH CLIN CONSLTJ PROLNG SVC
|
Professional
|
Both
|
$86.86
|
|
|
Service Code
|
CPT 80506
|
| Hospital Charge Code |
3008050601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.04 |
| Max. Negotiated Rate |
$203.31 |
| Rate for Payer: Aetna of VT Commercial |
$81.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$203.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$41.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$203.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$56.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$51.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$51.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$51.28
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cigna Commercial |
$49.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$46.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$46.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$40.04
|
| Rate for Payer: Multiplan Commercial |
$80.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.04
|
| Rate for Payer: United Healthcare Commercial |
$61.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.04
|
| Rate for Payer: United Healthcare VA CCN |
$40.04
|
|
