|
REMOVAL OF FOREIGN BODY
|
Facility
|
IP
|
$1,097.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
9602052502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$811.89 |
| Max. Negotiated Rate |
$1,042.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,042.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$811.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$811.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$932.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$921.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$877.60
|
| Rate for Payer: Cash Price |
$548.50
|
| Rate for Payer: Cigna Commercial |
$877.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$877.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$877.60
|
| Rate for Payer: Multiplan Commercial |
$1,020.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$932.45
|
| Rate for Payer: United Healthcare Commercial |
$1,042.15
|
|
|
REMOVAL OF HEEL SPUR
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
CPT 28119
|
| Hospital Charge Code |
9822811901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$925.12 |
| Max. Negotiated Rate |
$1,187.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$925.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$925.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,062.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,050.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,000.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,000.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,000.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,000.00
|
| Rate for Payer: Multiplan Commercial |
$1,162.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,062.50
|
| Rate for Payer: United Healthcare Commercial |
$1,187.50
|
|
|
REMOVAL OF HEEL SPUR
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
CPT 28119
|
| Hospital Charge Code |
9822811901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$553.62 |
| Max. Negotiated Rate |
$1,187.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,119.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$553.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,119.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$752.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,062.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,012.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$562.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$993.75
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,000.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,000.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,000.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$562.50
|
| Rate for Payer: Multiplan Commercial |
$1,162.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,062.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$562.50
|
| Rate for Payer: United Healthcare Commercial |
$1,187.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$562.50
|
| Rate for Payer: United Healthcare VA CCN |
$562.50
|
|
|
REMOVAL OF HEEL SPUR
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
CPT 28119
|
| Hospital Charge Code |
9822811901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$349.84 |
| Max. Negotiated Rate |
$1,175.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,119.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$360.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,119.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$489.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$777.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$777.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$402.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$777.53
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$663.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$809.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$809.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$497.91
|
| Rate for Payer: Multiplan Commercial |
$1,162.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$496.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$349.84
|
| Rate for Payer: United Healthcare Commercial |
$538.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$349.84
|
| Rate for Payer: United Healthcare VA CCN |
$349.84
|
|
|
REMOVAL OF HEMORRHOID CLOT
|
Facility
|
OP
|
$4,133.25
|
|
|
Service Code
|
CPT 46320
|
| Hospital Charge Code |
9824632001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,830.62 |
| Max. Negotiated Rate |
$3,926.59 |
| Rate for Payer: Aetna of VT Commercial |
$3,926.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,702.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,830.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,702.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,488.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,513.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,347.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,859.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,285.93
|
| Rate for Payer: Cash Price |
$2,066.62
|
| Rate for Payer: Cigna Commercial |
$3,306.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,306.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,306.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,859.96
|
| Rate for Payer: Multiplan Commercial |
$3,843.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,513.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,859.96
|
| Rate for Payer: United Healthcare Commercial |
$3,926.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,859.96
|
| Rate for Payer: United Healthcare VA CCN |
$1,859.96
|
|
|
REMOVAL OF HEMORRHOID CLOT
|
Facility
|
IP
|
$4,133.25
|
|
|
Service Code
|
CPT 46320
|
| Hospital Charge Code |
9824632001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$3,059.02 |
| Max. Negotiated Rate |
$3,926.59 |
| Rate for Payer: Aetna of VT Commercial |
$3,926.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,059.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,059.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,513.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,471.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,306.60
|
| Rate for Payer: Cash Price |
$2,066.62
|
| Rate for Payer: Cigna Commercial |
$3,306.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,306.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,306.60
|
| Rate for Payer: Multiplan Commercial |
$3,843.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,513.26
|
| Rate for Payer: United Healthcare Commercial |
$3,926.59
|
|
|
REMOVAL OF HEMORRHOID CLOT
|
Professional
|
Both
|
$4,133.25
|
|
|
Service Code
|
CPT 46320
|
| Hospital Charge Code |
9824632001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$106.56 |
| Max. Negotiated Rate |
$3,885.26 |
| Rate for Payer: Aetna of VT Commercial |
$3,885.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,702.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$109.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,702.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$149.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$266.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$266.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$122.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$266.65
|
| Rate for Payer: Cash Price |
$2,066.62
|
| Rate for Payer: Cash Price |
$2,066.62
|
| Rate for Payer: Cigna Commercial |
$195.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$327.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$327.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$200.35
|
| Rate for Payer: Multiplan Commercial |
$3,843.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$106.56
|
| Rate for Payer: United Healthcare Commercial |
$163.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$106.56
|
| Rate for Payer: United Healthcare VA CCN |
$106.56
|
|
|
REMOVAL OF HYDROCELE
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
CPT 55500
|
| Hospital Charge Code |
9825550001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$369.00 |
| Max. Negotiated Rate |
$642.50 |
| Rate for Payer: Aetna of VT Commercial |
$416.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$396.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$380.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$396.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$516.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$594.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$594.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$424.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$594.61
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cigna Commercial |
$642.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$610.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$610.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$369.00
|
| Rate for Payer: Multiplan Commercial |
$411.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$523.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$369.00
|
| Rate for Payer: United Healthcare Commercial |
$567.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$369.00
|
| Rate for Payer: United Healthcare VA CCN |
$369.00
|
|
|
REMOVAL OF HYDROCELE
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
CPT 55500
|
| Hospital Charge Code |
9825550001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$327.86 |
| Max. Negotiated Rate |
$420.85 |
| Rate for Payer: Aetna of VT Commercial |
$420.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$327.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$327.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$376.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$372.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$354.40
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cigna Commercial |
$354.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$354.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$354.40
|
| Rate for Payer: Multiplan Commercial |
$411.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$376.55
|
| Rate for Payer: United Healthcare Commercial |
$420.85
|
|
|
REMOVAL OF HYDROCELE
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
CPT 55040
|
| Hospital Charge Code |
9825504001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$320.51 |
| Max. Negotiated Rate |
$830.96 |
| Rate for Payer: Aetna of VT Commercial |
$830.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$791.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$330.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$791.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$448.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$562.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$562.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$368.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$562.27
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cigna Commercial |
$558.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$528.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$528.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$320.51
|
| Rate for Payer: Multiplan Commercial |
$822.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$455.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$320.51
|
| Rate for Payer: United Healthcare Commercial |
$493.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$320.51
|
| Rate for Payer: United Healthcare VA CCN |
$320.51
|
|
|
REMOVAL OF HYDROCELE
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
CPT 55040
|
| Hospital Charge Code |
9825504001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$391.52 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: Aetna of VT Commercial |
$839.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$791.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$391.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$791.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$532.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$751.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$716.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$397.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$702.78
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cigna Commercial |
$707.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$707.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$707.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$397.80
|
| Rate for Payer: Multiplan Commercial |
$822.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$751.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$397.80
|
| Rate for Payer: United Healthcare Commercial |
$839.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$397.80
|
| Rate for Payer: United Healthcare VA CCN |
$397.80
|
|
|
REMOVAL OF HYDROCELE
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
CPT 55040
|
| Hospital Charge Code |
9825504001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$654.25 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: Aetna of VT Commercial |
$839.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$654.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$654.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$751.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$742.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$707.20
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cigna Commercial |
$707.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$707.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$707.20
|
| Rate for Payer: Multiplan Commercial |
$822.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$751.40
|
| Rate for Payer: United Healthcare Commercial |
$839.80
|
|
|
REMOVAL OF HYDROCELE
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
CPT 55500
|
| Hospital Charge Code |
9825550001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$420.85 |
| Rate for Payer: Aetna of VT Commercial |
$420.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$396.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$196.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$396.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$266.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$376.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$358.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$199.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$352.19
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cigna Commercial |
$354.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$354.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$354.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$199.35
|
| Rate for Payer: Multiplan Commercial |
$411.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$376.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$199.35
|
| Rate for Payer: United Healthcare Commercial |
$420.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$199.35
|
| Rate for Payer: United Healthcare VA CCN |
$199.35
|
|
|
REMOVAL OF IMPLANT DEEP
|
Professional
|
Both
|
$2,055.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
9822068001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$396.66 |
| Max. Negotiated Rate |
$1,931.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,931.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,841.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$408.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,841.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$555.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$731.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$731.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$456.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$731.87
|
| Rate for Payer: Cash Price |
$1,027.50
|
| Rate for Payer: Cash Price |
$1,027.50
|
| Rate for Payer: Cigna Commercial |
$751.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$926.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$926.77
|
| Rate for Payer: Martins Point Health Care Commercial |
$564.32
|
| Rate for Payer: Multiplan Commercial |
$1,911.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$563.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$396.66
|
| Rate for Payer: United Healthcare Commercial |
$610.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$396.66
|
| Rate for Payer: United Healthcare VA CCN |
$396.66
|
|
|
REMOVAL OF IMPLANT DEEP
|
Facility
|
OP
|
$2,055.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
9822068001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$910.16 |
| Max. Negotiated Rate |
$1,952.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,952.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,841.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$910.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,841.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,237.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,746.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,664.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$924.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,633.72
|
| Rate for Payer: Cash Price |
$1,027.50
|
| Rate for Payer: Cigna Commercial |
$1,644.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,644.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,644.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$924.75
|
| Rate for Payer: Multiplan Commercial |
$1,911.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,746.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$924.75
|
| Rate for Payer: United Healthcare Commercial |
$1,952.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$924.75
|
| Rate for Payer: United Healthcare VA CCN |
$924.75
|
|
|
REMOVAL OF IMPLANT DEEP
|
Facility
|
IP
|
$2,055.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
9822068001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,520.91 |
| Max. Negotiated Rate |
$1,952.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,952.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,520.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,520.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,746.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,726.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,644.00
|
| Rate for Payer: Cash Price |
$1,027.50
|
| Rate for Payer: Cigna Commercial |
$1,644.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,644.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,644.00
|
| Rate for Payer: Multiplan Commercial |
$1,911.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,746.75
|
| Rate for Payer: United Healthcare Commercial |
$1,952.25
|
|
|
REMOVAL OF IMPLANT FROM HAND
|
Professional
|
Both
|
$1,216.00
|
|
|
Service Code
|
CPT 26320
|
| Hospital Charge Code |
9822632001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$338.24 |
| Max. Negotiated Rate |
$1,143.04 |
| Rate for Payer: Aetna of VT Commercial |
$1,143.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,089.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$348.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,089.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$473.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$619.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$619.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$388.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$619.59
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cigna Commercial |
$638.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$559.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$559.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$338.25
|
| Rate for Payer: Multiplan Commercial |
$1,130.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$480.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$338.24
|
| Rate for Payer: United Healthcare Commercial |
$520.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$338.24
|
| Rate for Payer: United Healthcare VA CCN |
$338.24
|
|
|
REMOVAL OF IMPLANT FROM HAND
|
Facility
|
OP
|
$1,216.00
|
|
|
Service Code
|
CPT 26320
|
| Hospital Charge Code |
9822632001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$538.57 |
| Max. Negotiated Rate |
$1,155.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,155.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,089.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$538.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,089.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$732.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,033.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$984.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$547.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$966.72
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cigna Commercial |
$972.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$972.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$972.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$547.20
|
| Rate for Payer: Multiplan Commercial |
$1,130.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,033.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$547.20
|
| Rate for Payer: United Healthcare Commercial |
$1,155.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$547.20
|
| Rate for Payer: United Healthcare VA CCN |
$547.20
|
|
|
REMOVAL OF IMPLANT FROM HAND
|
Facility
|
IP
|
$1,216.00
|
|
|
Service Code
|
CPT 26320
|
| Hospital Charge Code |
9822632001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$899.96 |
| Max. Negotiated Rate |
$1,155.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,155.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$899.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$899.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,033.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,021.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$972.80
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cigna Commercial |
$972.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$972.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$972.80
|
| Rate for Payer: Multiplan Commercial |
$1,130.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,033.60
|
| Rate for Payer: United Healthcare Commercial |
$1,155.20
|
|
|
REMOVAL OF NAIL BED
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
9601175002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$358.95 |
| Max. Negotiated Rate |
$460.75 |
| Rate for Payer: Aetna of VT Commercial |
$460.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$358.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$358.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$412.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$407.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$388.00
|
| Rate for Payer: Cash Price |
$242.50
|
| Rate for Payer: Cigna Commercial |
$388.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$388.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$388.00
|
| Rate for Payer: Multiplan Commercial |
$451.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$412.25
|
| Rate for Payer: United Healthcare Commercial |
$460.75
|
|
|
REMOVAL OF NAIL BED
|
Facility
|
OP
|
$297.28
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
4501175001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$282.42 |
| Rate for Payer: Aetna of VT Commercial |
$282.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$266.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$131.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$266.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$178.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$252.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$240.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$133.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$236.34
|
| Rate for Payer: Cash Price |
$148.64
|
| Rate for Payer: Cigna Commercial |
$237.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$237.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$237.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$133.78
|
| Rate for Payer: Multiplan Commercial |
$276.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$252.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$133.78
|
| Rate for Payer: United Healthcare Commercial |
$282.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$133.78
|
| Rate for Payer: United Healthcare VA CCN |
$133.78
|
|
|
REMOVAL OF NAIL BED
|
Professional
|
Both
|
$298.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
5101175001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.97 |
| Max. Negotiated Rate |
$280.12 |
| Rate for Payer: Aetna of VT Commercial |
$280.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$266.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$99.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$266.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$135.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$263.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$263.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$111.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$263.55
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna Commercial |
$177.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$246.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$246.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$152.53
|
| Rate for Payer: Multiplan Commercial |
$277.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$137.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$96.97
|
| Rate for Payer: United Healthcare Commercial |
$149.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.97
|
| Rate for Payer: United Healthcare VA CCN |
$96.97
|
|
|
REMOVAL OF NAIL BED
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
9601175002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$96.97 |
| Max. Negotiated Rate |
$455.90 |
| Rate for Payer: Aetna of VT Commercial |
$455.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$434.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$99.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$434.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$135.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$263.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$263.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$111.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$263.55
|
| Rate for Payer: Cash Price |
$242.50
|
| Rate for Payer: Cash Price |
$242.50
|
| Rate for Payer: Cigna Commercial |
$177.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$246.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$246.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$152.53
|
| Rate for Payer: Multiplan Commercial |
$451.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$137.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$96.97
|
| Rate for Payer: United Healthcare Commercial |
$149.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.97
|
| Rate for Payer: United Healthcare VA CCN |
$96.97
|
|
|
REMOVAL OF NAIL BED
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
5101175001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.98 |
| Max. Negotiated Rate |
$283.10 |
| Rate for Payer: Aetna of VT Commercial |
$283.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$266.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$131.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$266.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$179.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$253.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$241.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$134.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$236.91
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna Commercial |
$238.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$238.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$238.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$134.10
|
| Rate for Payer: Multiplan Commercial |
$277.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$253.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$134.10
|
| Rate for Payer: United Healthcare Commercial |
$283.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$134.10
|
| Rate for Payer: United Healthcare VA CCN |
$134.10
|
|
|
REMOVAL OF NAIL BED
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
9811175002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$214.81 |
| Max. Negotiated Rate |
$460.75 |
| Rate for Payer: Aetna of VT Commercial |
$460.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$434.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$214.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$434.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$291.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$412.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$392.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$218.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$385.57
|
| Rate for Payer: Cash Price |
$242.50
|
| Rate for Payer: Cigna Commercial |
$388.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$388.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$388.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$218.25
|
| Rate for Payer: Multiplan Commercial |
$451.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$412.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$218.25
|
| Rate for Payer: United Healthcare Commercial |
$460.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$218.25
|
| Rate for Payer: United Healthcare VA CCN |
$218.25
|
|
