|
REMOVAL OF FALLOPIAN TUBE
|
Facility
|
OP
|
$2,008.00
|
|
|
Service Code
|
CPT 58700
|
| Hospital Charge Code |
9825870001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$889.34 |
| Max. Negotiated Rate |
$1,907.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,907.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,798.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$889.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,798.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,208.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,706.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,626.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$903.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,596.36
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cigna Commercial |
$1,606.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,606.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,606.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$903.60
|
| Rate for Payer: Multiplan Commercial |
$1,867.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,706.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$903.60
|
| Rate for Payer: United Healthcare Commercial |
$1,907.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$903.60
|
| Rate for Payer: United Healthcare VA CCN |
$903.60
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Professional
|
Both
|
$3,103.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
9602819301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$350.03 |
| Max. Negotiated Rate |
$2,916.82 |
| Rate for Payer: Aetna of VT Commercial |
$2,916.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,779.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$360.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,779.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$490.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$711.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$711.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$402.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$711.48
|
| Rate for Payer: Cash Price |
$1,551.50
|
| Rate for Payer: Cash Price |
$1,551.50
|
| Rate for Payer: Cigna Commercial |
$664.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$799.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$799.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$492.97
|
| Rate for Payer: Multiplan Commercial |
$2,885.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$497.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$350.03
|
| Rate for Payer: United Healthcare Commercial |
$538.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$350.03
|
| Rate for Payer: United Healthcare VA CCN |
$350.03
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
IP
|
$1,927.38
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
4502819301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,426.45 |
| Max. Negotiated Rate |
$1,831.01 |
| Rate for Payer: Aetna of VT Commercial |
$1,831.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,426.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,426.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,638.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,619.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,541.90
|
| Rate for Payer: Cash Price |
$963.69
|
| Rate for Payer: Cigna Commercial |
$1,541.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,541.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,541.90
|
| Rate for Payer: Multiplan Commercial |
$1,792.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,638.27
|
| Rate for Payer: United Healthcare Commercial |
$1,831.01
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Professional
|
Both
|
$1,176.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
9602819302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$350.03 |
| Max. Negotiated Rate |
$1,105.44 |
| Rate for Payer: Aetna of VT Commercial |
$1,105.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,053.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$360.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,053.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$490.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$711.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$711.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$402.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$711.48
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cigna Commercial |
$664.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$799.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$799.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$492.97
|
| Rate for Payer: Multiplan Commercial |
$1,093.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$497.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$350.03
|
| Rate for Payer: United Healthcare Commercial |
$538.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$350.03
|
| Rate for Payer: United Healthcare VA CCN |
$350.03
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
IP
|
$1,176.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
9602819302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$870.36 |
| Max. Negotiated Rate |
$1,117.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,117.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$870.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$870.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$999.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$987.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$940.80
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cigna Commercial |
$940.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$940.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$940.80
|
| Rate for Payer: Multiplan Commercial |
$1,093.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$999.60
|
| Rate for Payer: United Healthcare Commercial |
$1,117.20
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Professional
|
Both
|
$1,176.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
9822819301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$350.03 |
| Max. Negotiated Rate |
$1,105.44 |
| Rate for Payer: Aetna of VT Commercial |
$1,105.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,053.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$360.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,053.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$490.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$711.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$711.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$402.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$711.48
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cigna Commercial |
$664.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$799.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$799.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$492.97
|
| Rate for Payer: Multiplan Commercial |
$1,093.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$497.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$350.03
|
| Rate for Payer: United Healthcare Commercial |
$538.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$350.03
|
| Rate for Payer: United Healthcare VA CCN |
$350.03
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
OP
|
$1,927.38
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
4502819301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$853.64 |
| Max. Negotiated Rate |
$1,831.01 |
| Rate for Payer: Aetna of VT Commercial |
$1,831.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,726.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$853.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,726.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,160.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,638.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,561.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$867.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,532.27
|
| Rate for Payer: Cash Price |
$963.69
|
| Rate for Payer: Cigna Commercial |
$1,541.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,541.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,541.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$867.32
|
| Rate for Payer: Multiplan Commercial |
$1,792.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,638.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$867.32
|
| Rate for Payer: United Healthcare Commercial |
$1,831.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$867.32
|
| Rate for Payer: United Healthcare VA CCN |
$867.32
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
OP
|
$1,928.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
5102819301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$853.91 |
| Max. Negotiated Rate |
$1,831.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,831.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,727.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$853.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,727.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,160.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,638.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,561.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$867.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,532.76
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cigna Commercial |
$1,542.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,542.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,542.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$867.60
|
| Rate for Payer: Multiplan Commercial |
$1,793.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,638.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$867.60
|
| Rate for Payer: United Healthcare Commercial |
$1,831.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$867.60
|
| Rate for Payer: United Healthcare VA CCN |
$867.60
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
9812819301
|
|
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 OF FOOT FOREIGN BODY
|
Facility
|
OP
|
$1,176.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
9602819302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$520.85 |
| Max. Negotiated Rate |
$1,117.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,117.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,053.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$520.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,053.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$707.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$999.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$952.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$934.92
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cigna Commercial |
$940.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$940.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$940.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$529.20
|
| Rate for Payer: Multiplan Commercial |
$1,093.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$999.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$529.20
|
| Rate for Payer: United Healthcare Commercial |
$1,117.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$529.20
|
| Rate for Payer: United Healthcare VA CCN |
$529.20
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
IP
|
$1,928.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
5102819301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,426.91 |
| Max. Negotiated Rate |
$1,831.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,831.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,426.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,426.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,638.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,619.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,542.40
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cigna Commercial |
$1,542.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,542.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,542.40
|
| Rate for Payer: Multiplan Commercial |
$1,793.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,638.80
|
| Rate for Payer: United Healthcare Commercial |
$1,831.60
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
OP
|
$1,176.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
9812819302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$520.85 |
| Max. Negotiated Rate |
$1,117.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,117.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,053.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$520.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,053.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$707.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$999.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$952.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$934.92
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cigna Commercial |
$940.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$940.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$940.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$529.20
|
| Rate for Payer: Multiplan Commercial |
$1,093.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$999.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$529.20
|
| Rate for Payer: United Healthcare Commercial |
$1,117.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$529.20
|
| Rate for Payer: United Healthcare VA CCN |
$529.20
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
IP
|
$1,176.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
9822819301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$870.36 |
| Max. Negotiated Rate |
$1,117.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,117.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$870.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$870.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$999.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$987.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$940.80
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cigna Commercial |
$940.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$940.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$940.80
|
| Rate for Payer: Multiplan Commercial |
$1,093.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$999.60
|
| Rate for Payer: United Healthcare Commercial |
$1,117.20
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Professional
|
Both
|
$1,928.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
5102819301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$350.03 |
| Max. Negotiated Rate |
$1,812.32 |
| Rate for Payer: Aetna of VT Commercial |
$1,812.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,727.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$360.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,727.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$490.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$711.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$711.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$402.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$711.48
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cigna Commercial |
$664.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$799.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$799.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$492.97
|
| Rate for Payer: Multiplan Commercial |
$1,793.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$497.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$350.03
|
| Rate for Payer: United Healthcare Commercial |
$538.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$350.03
|
| Rate for Payer: United Healthcare VA CCN |
$350.03
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
IP
|
$1,176.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
9812819302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$870.36 |
| Max. Negotiated Rate |
$1,117.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,117.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$870.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$870.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$999.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$987.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$940.80
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cigna Commercial |
$940.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$940.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$940.80
|
| Rate for Payer: Multiplan Commercial |
$1,093.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$999.60
|
| Rate for Payer: United Healthcare Commercial |
$1,117.20
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
OP
|
$3,103.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
9602819301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,374.32 |
| Max. Negotiated Rate |
$2,947.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,947.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,779.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,374.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,779.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,868.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,637.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,513.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,396.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,466.89
|
| Rate for Payer: Cash Price |
$1,551.50
|
| Rate for Payer: Cigna Commercial |
$2,482.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,482.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,482.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,396.35
|
| Rate for Payer: Multiplan Commercial |
$2,885.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,637.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,396.35
|
| Rate for Payer: United Healthcare Commercial |
$2,947.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,396.35
|
| Rate for Payer: United Healthcare VA CCN |
$1,396.35
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Professional
|
Both
|
$1,176.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
9812819302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$350.03 |
| Max. Negotiated Rate |
$1,105.44 |
| Rate for Payer: Aetna of VT Commercial |
$1,105.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,053.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$360.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,053.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$490.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$711.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$711.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$402.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$711.48
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cigna Commercial |
$664.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$799.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$799.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$492.97
|
| Rate for Payer: Multiplan Commercial |
$1,093.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$497.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$350.03
|
| Rate for Payer: United Healthcare Commercial |
$538.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$350.03
|
| Rate for Payer: United Healthcare VA CCN |
$350.03
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
OP
|
$1,176.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
9822819301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$520.85 |
| Max. Negotiated Rate |
$1,117.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,117.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,053.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$520.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,053.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$707.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$999.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$952.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$934.92
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cigna Commercial |
$940.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$940.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$940.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$529.20
|
| Rate for Payer: Multiplan Commercial |
$1,093.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$999.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$529.20
|
| Rate for Payer: United Healthcare Commercial |
$1,117.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$529.20
|
| Rate for Payer: United Healthcare VA CCN |
$529.20
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
IP
|
$3,103.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
9602819301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,296.53 |
| Max. Negotiated Rate |
$2,947.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,947.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,296.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,296.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,637.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,606.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,482.40
|
| Rate for Payer: Cash Price |
$1,551.50
|
| Rate for Payer: Cigna Commercial |
$2,482.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,482.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,482.40
|
| Rate for Payer: Multiplan Commercial |
$2,885.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,637.55
|
| Rate for Payer: United Healthcare Commercial |
$2,947.85
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
9812819301
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$799.75 |
| 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 |
$360.53
|
| 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 |
$490.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$711.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$711.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$402.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$711.48
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$664.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$799.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$799.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$492.97
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$497.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$350.03
|
| Rate for Payer: United Healthcare Commercial |
$538.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$350.03
|
| Rate for Payer: United Healthcare VA CCN |
$350.03
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
9812819301
|
|
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 OF FOOT LESION
|
Professional
|
Both
|
$1,129.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
9602809002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$297.04 |
| Max. Negotiated Rate |
$1,061.26 |
| Rate for Payer: Aetna of VT Commercial |
$1,061.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,011.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$305.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,011.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$415.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$600.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$600.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$341.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$600.40
|
| Rate for Payer: Cash Price |
$564.50
|
| Rate for Payer: Cash Price |
$564.50
|
| Rate for Payer: Cigna Commercial |
$562.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$716.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$716.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$440.94
|
| Rate for Payer: Multiplan Commercial |
$1,049.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$421.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$297.04
|
| Rate for Payer: United Healthcare Commercial |
$456.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$297.04
|
| Rate for Payer: United Healthcare VA CCN |
$297.04
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
OP
|
$1,953.00
|
|
|
Service Code
|
CPT 28104
|
| Hospital Charge Code |
9822810401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$864.98 |
| Max. Negotiated Rate |
$1,855.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,855.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,749.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$864.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,749.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,175.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,660.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,581.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$878.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,552.63
|
| Rate for Payer: Cash Price |
$976.50
|
| Rate for Payer: Cigna Commercial |
$1,562.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,562.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,562.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$878.85
|
| Rate for Payer: Multiplan Commercial |
$1,816.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,660.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$878.85
|
| Rate for Payer: United Healthcare Commercial |
$1,855.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$878.85
|
| Rate for Payer: United Healthcare VA CCN |
$878.85
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
IP
|
$1,129.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
9822809001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$835.57 |
| Max. Negotiated Rate |
$1,072.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,072.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$835.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$835.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$959.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$948.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$903.20
|
| Rate for Payer: Cash Price |
$564.50
|
| Rate for Payer: Cigna Commercial |
$903.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$903.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$903.20
|
| Rate for Payer: Multiplan Commercial |
$1,049.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$959.65
|
| Rate for Payer: United Healthcare Commercial |
$1,072.55
|
|
|
REMOVAL OF FOOT LESION
|
Professional
|
Both
|
$7,454.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
5102809001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$297.04 |
| Max. Negotiated Rate |
$7,006.76 |
| Rate for Payer: Aetna of VT Commercial |
$7,006.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,678.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$305.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,678.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$415.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$600.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$600.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$341.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$600.40
|
| Rate for Payer: Cash Price |
$3,727.00
|
| Rate for Payer: Cash Price |
$3,727.00
|
| Rate for Payer: Cigna Commercial |
$562.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$716.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$716.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$440.94
|
| Rate for Payer: Multiplan Commercial |
$6,932.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$421.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$297.04
|
| Rate for Payer: United Healthcare Commercial |
$456.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$297.04
|
| Rate for Payer: United Healthcare VA CCN |
$297.04
|
|
