|
RELEASE PALM CONTRACTURE
|
Facility
|
IP
|
$2,303.00
|
|
|
Service Code
|
CPT 26123
|
| Hospital Charge Code |
9602612302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,704.45 |
| Max. Negotiated Rate |
$2,187.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,187.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,704.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,704.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,957.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,934.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,842.40
|
| Rate for Payer: Cash Price |
$1,151.50
|
| Rate for Payer: Cigna Commercial |
$1,842.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,842.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,842.40
|
| Rate for Payer: Multiplan Commercial |
$2,141.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,957.55
|
| Rate for Payer: United Healthcare Commercial |
$2,187.85
|
|
|
RELEASE PALM CONTRACTURE
|
Professional
|
Both
|
$11,438.00
|
|
|
Service Code
|
CPT 26123
|
| Hospital Charge Code |
9602612301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$800.44 |
| Max. Negotiated Rate |
$10,751.72 |
| Rate for Payer: Aetna of VT Commercial |
$10,751.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$10,247.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$824.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$10,247.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,120.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,275.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,275.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$920.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,275.50
|
| Rate for Payer: Cash Price |
$5,719.00
|
| Rate for Payer: Cash Price |
$5,719.00
|
| Rate for Payer: Cigna Commercial |
$1,512.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,327.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,327.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$800.44
|
| Rate for Payer: Multiplan Commercial |
$10,637.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,136.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$800.45
|
| Rate for Payer: United Healthcare Commercial |
$1,231.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$800.45
|
| Rate for Payer: United Healthcare VA CCN |
$800.45
|
|
|
RELEASE PALM CONTRACTURE
|
Professional
|
Both
|
$2,303.00
|
|
|
Service Code
|
CPT 26123
|
| Hospital Charge Code |
9822612301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$800.44 |
| Max. Negotiated Rate |
$2,164.82 |
| Rate for Payer: Aetna of VT Commercial |
$2,164.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,063.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$824.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,063.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,120.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,275.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,275.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$920.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,275.50
|
| Rate for Payer: Cash Price |
$1,151.50
|
| Rate for Payer: Cash Price |
$1,151.50
|
| Rate for Payer: Cigna Commercial |
$1,512.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,327.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,327.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$800.44
|
| Rate for Payer: Multiplan Commercial |
$2,141.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,136.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$800.45
|
| Rate for Payer: United Healthcare Commercial |
$1,231.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$800.45
|
| Rate for Payer: United Healthcare VA CCN |
$800.45
|
|
|
RELEASE PALM/FINGER TENDON
|
Facility
|
OP
|
$2,127.00
|
|
|
Service Code
|
CPT 26440
|
| Hospital Charge Code |
9822644001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$942.05 |
| Max. Negotiated Rate |
$2,020.65 |
| Rate for Payer: Aetna of VT Commercial |
$2,020.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,905.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$942.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,905.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,280.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,807.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,722.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$957.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,690.96
|
| Rate for Payer: Cash Price |
$1,063.50
|
| Rate for Payer: Cigna Commercial |
$1,701.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,701.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,701.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$957.15
|
| Rate for Payer: Multiplan Commercial |
$1,978.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,807.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$957.15
|
| Rate for Payer: United Healthcare Commercial |
$2,020.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$957.15
|
| Rate for Payer: United Healthcare VA CCN |
$957.15
|
|
|
RELEASE PALM/FINGER TENDON
|
Facility
|
IP
|
$2,127.00
|
|
|
Service Code
|
CPT 26440
|
| Hospital Charge Code |
9822644001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,574.19 |
| Max. Negotiated Rate |
$2,020.65 |
| Rate for Payer: Aetna of VT Commercial |
$2,020.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,574.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,574.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,807.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,786.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,701.60
|
| Rate for Payer: Cash Price |
$1,063.50
|
| Rate for Payer: Cigna Commercial |
$1,701.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,701.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,701.60
|
| Rate for Payer: Multiplan Commercial |
$1,978.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,807.95
|
| Rate for Payer: United Healthcare Commercial |
$2,020.65
|
|
|
RELEASE PALM/FINGER TENDON
|
Professional
|
Both
|
$2,127.00
|
|
|
Service Code
|
CPT 26440
|
| Hospital Charge Code |
9822644001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$617.10 |
| Max. Negotiated Rate |
$1,999.38 |
| Rate for Payer: Aetna of VT Commercial |
$1,999.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,905.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$635.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,905.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$863.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,130.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,130.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$709.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,130.32
|
| Rate for Payer: Cash Price |
$1,063.50
|
| Rate for Payer: Cash Price |
$1,063.50
|
| Rate for Payer: Cigna Commercial |
$1,187.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,010.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,010.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$617.11
|
| Rate for Payer: Multiplan Commercial |
$1,978.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$876.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$617.10
|
| Rate for Payer: United Healthcare Commercial |
$949.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$617.10
|
| Rate for Payer: United Healthcare VA CCN |
$617.10
|
|
|
RELEASE TARSAL TUNNEL
|
Professional
|
Both
|
$1,441.00
|
|
|
Service Code
|
CPT 28035
|
| Hospital Charge Code |
9822803501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$346.93 |
| Max. Negotiated Rate |
$1,354.54 |
| Rate for Payer: Aetna of VT Commercial |
$1,354.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,290.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$357.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,290.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$485.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$803.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$803.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$398.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$803.04
|
| Rate for Payer: Cash Price |
$720.50
|
| Rate for Payer: Cash Price |
$720.50
|
| Rate for Payer: Cigna Commercial |
$650.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$822.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$822.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$504.96
|
| Rate for Payer: Multiplan Commercial |
$1,340.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$492.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$346.93
|
| Rate for Payer: United Healthcare Commercial |
$533.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$346.93
|
| Rate for Payer: United Healthcare VA CCN |
$346.93
|
|
|
RELEASE TARSAL TUNNEL
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
CPT 28035
|
| Hospital Charge Code |
9822803501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,066.48 |
| Max. Negotiated Rate |
$1,368.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,368.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,066.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,066.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,224.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,210.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,152.80
|
| Rate for Payer: Cash Price |
$720.50
|
| Rate for Payer: Cigna Commercial |
$1,152.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,152.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,152.80
|
| Rate for Payer: Multiplan Commercial |
$1,340.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,224.85
|
| Rate for Payer: United Healthcare Commercial |
$1,368.95
|
|
|
RELEASE TARSAL TUNNEL
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
CPT 28035
|
| Hospital Charge Code |
9822803501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$638.22 |
| Max. Negotiated Rate |
$1,368.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,368.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,290.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$638.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,290.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$867.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,224.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,167.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$648.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,145.60
|
| Rate for Payer: Cash Price |
$720.50
|
| Rate for Payer: Cigna Commercial |
$1,152.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,152.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,152.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$648.45
|
| Rate for Payer: Multiplan Commercial |
$1,340.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,224.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$648.45
|
| Rate for Payer: United Healthcare Commercial |
$1,368.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$648.45
|
| Rate for Payer: United Healthcare VA CCN |
$648.45
|
|
|
REMOTE 30 DAY ECG REV/REPORT
|
Professional
|
Both
|
$111.75
|
|
|
Service Code
|
CPT 93227
|
| Hospital Charge Code |
9859322801
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$105.05 |
| Rate for Payer: Aetna of VT Commercial |
$105.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$17.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$24.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$45.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$45.35
|
| Rate for Payer: Cash Price |
$55.88
|
| Rate for Payer: Cash Price |
$55.88
|
| Rate for Payer: Cigna Commercial |
$39.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$27.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$27.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.28
|
| Rate for Payer: Multiplan Commercial |
$103.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$17.28
|
| Rate for Payer: United Healthcare Commercial |
$26.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.28
|
| Rate for Payer: United Healthcare VA CCN |
$17.28
|
|
|
REMOTE 30 DAY ECG REV/REPORT
|
Facility
|
IP
|
$111.75
|
|
|
Service Code
|
CPT 93228
|
| Hospital Charge Code |
9859322801
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$82.71 |
| Max. Negotiated Rate |
$106.16 |
| Rate for Payer: Aetna of VT Commercial |
$106.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$82.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$82.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$93.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.40
|
| Rate for Payer: Cash Price |
$55.88
|
| Rate for Payer: Cigna Commercial |
$89.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$89.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$89.40
|
| Rate for Payer: Multiplan Commercial |
$103.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.99
|
| Rate for Payer: United Healthcare Commercial |
$106.16
|
|
|
REMOTE 30 DAY ECG REV/REPORT
|
Facility
|
OP
|
$111.75
|
|
|
Service Code
|
CPT 93228
|
| Hospital Charge Code |
9859322801
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$106.16 |
| Rate for Payer: Aetna of VT Commercial |
$106.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$67.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$50.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.84
|
| Rate for Payer: Cash Price |
$55.88
|
| Rate for Payer: Cigna Commercial |
$89.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$89.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$89.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$50.29
|
| Rate for Payer: Multiplan Commercial |
$103.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$50.29
|
| Rate for Payer: United Healthcare Commercial |
$106.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.29
|
| Rate for Payer: United Healthcare VA CCN |
$50.29
|
|
|
REMOVAL FOREIGN BODY FOOT DEEP
|
Facility
|
IP
|
$3,558.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
5102819201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,633.28 |
| Max. Negotiated Rate |
$3,380.10 |
| Rate for Payer: Aetna of VT Commercial |
$3,380.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,633.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,633.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,024.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,988.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,846.40
|
| Rate for Payer: Cash Price |
$1,779.00
|
| Rate for Payer: Cigna Commercial |
$2,846.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,846.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,846.40
|
| Rate for Payer: Multiplan Commercial |
$3,308.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,024.30
|
| Rate for Payer: United Healthcare Commercial |
$3,380.10
|
|
|
REMOVAL FOREIGN BODY FOOT DEEP
|
Professional
|
Both
|
$968.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
9822819201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$298.85 |
| Max. Negotiated Rate |
$909.92 |
| Rate for Payer: Aetna of VT Commercial |
$909.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$867.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$307.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$867.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$612.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$612.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$343.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$612.07
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cigna Commercial |
$564.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$705.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$705.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$434.39
|
| Rate for Payer: Multiplan Commercial |
$900.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$424.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$298.85
|
| Rate for Payer: United Healthcare Commercial |
$459.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$298.85
|
| Rate for Payer: United Healthcare VA CCN |
$298.85
|
|
|
REMOVAL FOREIGN BODY FOOT DEEP
|
Professional
|
Both
|
$968.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
9812819202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$298.85 |
| Max. Negotiated Rate |
$909.92 |
| Rate for Payer: Aetna of VT Commercial |
$909.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$867.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$307.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$867.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$612.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$612.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$343.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$612.07
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cigna Commercial |
$564.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$705.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$705.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$434.39
|
| Rate for Payer: Multiplan Commercial |
$900.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$424.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$298.85
|
| Rate for Payer: United Healthcare Commercial |
$459.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$298.85
|
| Rate for Payer: United Healthcare VA CCN |
$298.85
|
|
|
REMOVAL FOREIGN BODY FOOT DEEP
|
Facility
|
OP
|
$968.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
9822819201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$428.73 |
| Max. Negotiated Rate |
$919.60 |
| Rate for Payer: Aetna of VT Commercial |
$919.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$867.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$428.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$867.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$582.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$822.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$784.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$435.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$769.56
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cigna Commercial |
$774.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$774.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$774.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$435.60
|
| Rate for Payer: Multiplan Commercial |
$900.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$822.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$435.60
|
| Rate for Payer: United Healthcare Commercial |
$919.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$435.60
|
| Rate for Payer: United Healthcare VA CCN |
$435.60
|
|
|
REMOVAL FOREIGN BODY FOOT DEEP
|
Professional
|
Both
|
$4,526.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
9602819201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$298.85 |
| Max. Negotiated Rate |
$4,254.44 |
| Rate for Payer: Aetna of VT Commercial |
$4,254.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,054.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$307.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,054.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$612.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$612.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$343.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$612.07
|
| Rate for Payer: Cash Price |
$2,263.00
|
| Rate for Payer: Cash Price |
$2,263.00
|
| Rate for Payer: Cigna Commercial |
$564.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$705.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$705.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$434.39
|
| Rate for Payer: Multiplan Commercial |
$4,209.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$424.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$298.85
|
| Rate for Payer: United Healthcare Commercial |
$459.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$298.85
|
| Rate for Payer: United Healthcare VA CCN |
$298.85
|
|
|
REMOVAL FOREIGN BODY FOOT DEEP
|
Facility
|
IP
|
$968.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
9602819202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$716.42 |
| Max. Negotiated Rate |
$919.60 |
| Rate for Payer: Aetna of VT Commercial |
$919.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$716.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$716.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$822.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$813.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$774.40
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cigna Commercial |
$774.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$774.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$774.40
|
| Rate for Payer: Multiplan Commercial |
$900.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$822.80
|
| Rate for Payer: United Healthcare Commercial |
$919.60
|
|
|
REMOVAL FOREIGN BODY FOOT DEEP
|
Facility
|
OP
|
$3,558.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
5102819201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,575.84 |
| Max. Negotiated Rate |
$3,380.10 |
| Rate for Payer: Aetna of VT Commercial |
$3,380.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,187.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,575.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,187.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,141.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,024.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,881.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,601.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,828.61
|
| Rate for Payer: Cash Price |
$1,779.00
|
| Rate for Payer: Cigna Commercial |
$2,846.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,846.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,846.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,601.10
|
| Rate for Payer: Multiplan Commercial |
$3,308.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,024.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,601.10
|
| Rate for Payer: United Healthcare Commercial |
$3,380.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,601.10
|
| Rate for Payer: United Healthcare VA CCN |
$1,601.10
|
|
|
REMOVAL FOREIGN BODY FOOT DEEP
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
9812819201
|
|
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
|
|
|
REMOVAL FOREIGN BODY FOOT DEEP
|
Professional
|
Both
|
$968.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
9602819202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$298.85 |
| Max. Negotiated Rate |
$909.92 |
| Rate for Payer: Aetna of VT Commercial |
$909.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$867.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$307.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$867.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$612.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$612.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$343.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$612.07
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cigna Commercial |
$564.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$705.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$705.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$434.39
|
| Rate for Payer: Multiplan Commercial |
$900.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$424.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$298.85
|
| Rate for Payer: United Healthcare Commercial |
$459.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$298.85
|
| Rate for Payer: United Healthcare VA CCN |
$298.85
|
|
|
REMOVAL FOREIGN BODY FOOT DEEP
|
Facility
|
OP
|
$968.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
9812819202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$428.73 |
| Max. Negotiated Rate |
$919.60 |
| Rate for Payer: Aetna of VT Commercial |
$919.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$867.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$428.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$867.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$582.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$822.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$784.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$435.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$769.56
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cigna Commercial |
$774.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$774.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$774.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$435.60
|
| Rate for Payer: Multiplan Commercial |
$900.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$822.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$435.60
|
| Rate for Payer: United Healthcare Commercial |
$919.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$435.60
|
| Rate for Payer: United Healthcare VA CCN |
$435.60
|
|
|
REMOVAL FOREIGN BODY FOOT DEEP
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
9812819201
|
|
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
|
|
|
REMOVAL FOREIGN BODY FOOT DEEP
|
Facility
|
OP
|
$3,557.48
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
4502819201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,575.61 |
| Max. Negotiated Rate |
$3,379.61 |
| Rate for Payer: Aetna of VT Commercial |
$3,379.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,187.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,575.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,187.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,141.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,023.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,881.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,600.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,828.20
|
| Rate for Payer: Cash Price |
$1,778.74
|
| Rate for Payer: Cigna Commercial |
$2,845.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,845.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,845.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,600.87
|
| Rate for Payer: Multiplan Commercial |
$3,308.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,023.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,600.87
|
| Rate for Payer: United Healthcare Commercial |
$3,379.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,600.87
|
| Rate for Payer: United Healthcare VA CCN |
$1,600.87
|
|
|
REMOVAL FOREIGN BODY FOOT DEEP
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
9812819201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$705.62 |
| 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 |
$307.82
|
| 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 |
$418.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$612.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$612.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$343.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$612.07
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$564.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$705.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$705.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$434.39
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$424.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$298.85
|
| Rate for Payer: United Healthcare Commercial |
$459.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$298.85
|
| Rate for Payer: United Healthcare VA CCN |
$298.85
|
|
