|
REMOVE TENDON SHEATH LESION
|
Facility
|
IP
|
$4,879.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
9602616001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,610.95 |
| Max. Negotiated Rate |
$4,635.05 |
| Rate for Payer: Aetna of VT Commercial |
$4,635.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,610.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,610.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,147.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,098.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,903.20
|
| Rate for Payer: Cash Price |
$2,439.50
|
| Rate for Payer: Cigna Commercial |
$3,903.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,903.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,903.20
|
| Rate for Payer: Multiplan Commercial |
$4,537.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,147.15
|
| Rate for Payer: United Healthcare Commercial |
$4,635.05
|
|
|
REMOVE TENDON SHEATH LESION
|
Professional
|
Both
|
$1,996.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
9822616001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$306.73 |
| Max. Negotiated Rate |
$1,876.24 |
| Rate for Payer: Aetna of VT Commercial |
$1,876.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,788.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$315.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,788.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$429.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,030.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,030.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$352.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,030.05
|
| Rate for Payer: Cash Price |
$998.00
|
| Rate for Payer: Cash Price |
$998.00
|
| Rate for Payer: Cigna Commercial |
$579.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$946.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$946.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$581.68
|
| Rate for Payer: Multiplan Commercial |
$1,856.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$435.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$306.73
|
| Rate for Payer: United Healthcare Commercial |
$471.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$306.73
|
| Rate for Payer: United Healthcare VA CCN |
$306.73
|
|
|
REMOVE TENDON SHEATH LESION
|
Facility
|
IP
|
$1,996.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
9602616002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,477.24 |
| Max. Negotiated Rate |
$1,896.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,896.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,477.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,477.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,696.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,676.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,596.80
|
| Rate for Payer: Cash Price |
$998.00
|
| Rate for Payer: Cigna Commercial |
$1,596.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,596.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,596.80
|
| Rate for Payer: Multiplan Commercial |
$1,856.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,696.60
|
| Rate for Payer: United Healthcare Commercial |
$1,896.20
|
|
|
REMOVE TENDON SHEATH LESION
|
Facility
|
IP
|
$1,996.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
9822616001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,477.24 |
| Max. Negotiated Rate |
$1,896.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,896.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,477.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,477.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,696.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,676.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,596.80
|
| Rate for Payer: Cash Price |
$998.00
|
| Rate for Payer: Cigna Commercial |
$1,596.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,596.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,596.80
|
| Rate for Payer: Multiplan Commercial |
$1,856.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,696.60
|
| Rate for Payer: United Healthcare Commercial |
$1,896.20
|
|
|
REMOVE TENDON SHEATH LESION
|
Facility
|
OP
|
$1,996.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
9822616001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$884.03 |
| Max. Negotiated Rate |
$1,896.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,896.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,788.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$884.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,788.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,201.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,696.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,616.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$898.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,586.82
|
| Rate for Payer: Cash Price |
$998.00
|
| Rate for Payer: Cigna Commercial |
$1,596.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,596.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,596.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$898.20
|
| Rate for Payer: Multiplan Commercial |
$1,856.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,696.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$898.20
|
| Rate for Payer: United Healthcare Commercial |
$1,896.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$898.20
|
| Rate for Payer: United Healthcare VA CCN |
$898.20
|
|
|
REMOVE TENDON SHEATH LESION
|
Facility
|
OP
|
$4,879.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
9602616001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,160.91 |
| Max. Negotiated Rate |
$4,635.05 |
| Rate for Payer: Aetna of VT Commercial |
$4,635.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,371.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,160.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,371.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,937.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,147.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,951.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,195.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,878.80
|
| Rate for Payer: Cash Price |
$2,439.50
|
| Rate for Payer: Cigna Commercial |
$3,903.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,903.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,903.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,195.55
|
| Rate for Payer: Multiplan Commercial |
$4,537.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,147.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,195.55
|
| Rate for Payer: United Healthcare Commercial |
$4,635.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,195.55
|
| Rate for Payer: United Healthcare VA CCN |
$2,195.55
|
|
|
REMOVE WRIST TENDON LESION
|
Professional
|
Both
|
$1,122.00
|
|
|
Service Code
|
CPT 25111
|
| Hospital Charge Code |
9822511101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$317.00 |
| Max. Negotiated Rate |
$1,054.68 |
| Rate for Payer: Aetna of VT Commercial |
$1,054.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,005.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$326.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,005.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$443.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$558.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$558.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$364.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$558.48
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cigna Commercial |
$597.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$522.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$522.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$317.00
|
| Rate for Payer: Multiplan Commercial |
$1,043.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$450.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$317.00
|
| Rate for Payer: United Healthcare Commercial |
$487.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$317.00
|
| Rate for Payer: United Healthcare VA CCN |
$317.00
|
|
|
REMOVE WRIST TENDON LESION
|
Facility
|
OP
|
$1,122.00
|
|
|
Service Code
|
CPT 25111
|
| Hospital Charge Code |
9822511101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$496.93 |
| Max. Negotiated Rate |
$1,065.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,065.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,005.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$496.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,005.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$675.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$953.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$908.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$504.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$891.99
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cigna Commercial |
$897.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$897.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$897.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$504.90
|
| Rate for Payer: Multiplan Commercial |
$1,043.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$953.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$504.90
|
| Rate for Payer: United Healthcare Commercial |
$1,065.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$504.90
|
| Rate for Payer: United Healthcare VA CCN |
$504.90
|
|
|
REMOVE WRIST TENDON LESION
|
Facility
|
IP
|
$1,122.00
|
|
|
Service Code
|
CPT 25111
|
| Hospital Charge Code |
9822511101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$830.39 |
| Max. Negotiated Rate |
$1,065.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,065.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$830.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$830.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$953.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$942.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$897.60
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cigna Commercial |
$897.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$897.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$897.60
|
| Rate for Payer: Multiplan Commercial |
$1,043.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$953.70
|
| Rate for Payer: United Healthcare Commercial |
$1,065.90
|
|
|
RENAL FUNCTION PANEL
|
Facility
|
IP
|
$154.89
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
3008006901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.63 |
| Max. Negotiated Rate |
$147.15 |
| Rate for Payer: Aetna of VT Commercial |
$147.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$114.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$114.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$131.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$130.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$123.91
|
| Rate for Payer: Cash Price |
$77.44
|
| Rate for Payer: Cigna Commercial |
$123.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$123.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$123.91
|
| Rate for Payer: Multiplan Commercial |
$144.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.66
|
| Rate for Payer: United Healthcare Commercial |
$147.15
|
|
|
RENAL FUNCTION PANEL
|
Facility
|
OP
|
$154.89
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
3008006901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$147.15 |
| Rate for Payer: Aetna of VT Commercial |
$147.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$42.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$42.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$131.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$125.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$123.14
|
| Rate for Payer: Cash Price |
$77.44
|
| Rate for Payer: Cash Price |
$77.44
|
| Rate for Payer: Cigna Commercial |
$123.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$123.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$123.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.70
|
| Rate for Payer: Multiplan Commercial |
$144.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.66
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.70
|
| Rate for Payer: United Healthcare Commercial |
$147.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.68
|
| Rate for Payer: United Healthcare VA CCN |
$69.70
|
|
|
REOPEN FALLOPIAN TUBE
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
CPT 58350
|
| Hospital Charge Code |
9825835001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$89.17 |
| Max. Negotiated Rate |
$291.40 |
| Rate for Payer: Aetna of VT Commercial |
$291.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$277.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$91.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$277.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$124.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$191.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$191.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$102.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$191.97
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$158.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$232.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$232.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.81
|
| Rate for Payer: Multiplan Commercial |
$288.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$89.17
|
| Rate for Payer: United Healthcare Commercial |
$137.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.17
|
| Rate for Payer: United Healthcare VA CCN |
$89.17
|
|
|
REOPEN FALLOPIAN TUBE
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 58350
|
| Hospital Charge Code |
9825835001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$229.43 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Aetna of VT Commercial |
$294.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$229.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$229.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$263.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$260.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$248.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$248.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$248.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$248.00
|
| Rate for Payer: Multiplan Commercial |
$288.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$263.50
|
| Rate for Payer: United Healthcare Commercial |
$294.50
|
|
|
REOPEN FALLOPIAN TUBE
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 58350
|
| Hospital Charge Code |
9825835001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$137.30 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Aetna of VT Commercial |
$294.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$277.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$137.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$277.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$186.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$263.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$139.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$246.45
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$248.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$248.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$248.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$139.50
|
| Rate for Payer: Multiplan Commercial |
$288.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$263.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$139.50
|
| Rate for Payer: United Healthcare Commercial |
$294.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$139.50
|
| Rate for Payer: United Healthcare VA CCN |
$139.50
|
|
|
REOPEN RECENT LAPAROTOMY
|
Facility
|
IP
|
$2,728.00
|
|
|
Service Code
|
CPT 49002
|
| Hospital Charge Code |
9824900201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,018.99 |
| Max. Negotiated Rate |
$2,591.60 |
| Rate for Payer: Aetna of VT Commercial |
$2,591.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,018.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,018.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,318.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,291.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,182.40
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Cigna Commercial |
$2,182.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,182.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,182.40
|
| Rate for Payer: Multiplan Commercial |
$2,537.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,318.80
|
| Rate for Payer: United Healthcare Commercial |
$2,591.60
|
|
|
REOPEN RECENT LAPAROTOMY
|
Facility
|
OP
|
$2,728.00
|
|
|
Service Code
|
CPT 49002
|
| Hospital Charge Code |
9824900201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,208.23 |
| Max. Negotiated Rate |
$2,591.60 |
| Rate for Payer: Aetna of VT Commercial |
$2,591.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,444.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,208.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,444.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,642.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,318.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,209.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,227.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,168.76
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Cigna Commercial |
$2,182.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,182.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,182.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,227.60
|
| Rate for Payer: Multiplan Commercial |
$2,537.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,318.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,227.60
|
| Rate for Payer: United Healthcare Commercial |
$2,591.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,227.60
|
| Rate for Payer: United Healthcare VA CCN |
$1,227.60
|
|
|
REOPEN RECENT LAPAROTOMY
|
Professional
|
Both
|
$2,728.00
|
|
|
Service Code
|
CPT 49002
|
| Hospital Charge Code |
9824900201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$948.67 |
| Max. Negotiated Rate |
$2,564.32 |
| Rate for Payer: Aetna of VT Commercial |
$2,564.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,444.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$977.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,444.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,328.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,293.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,293.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,090.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,293.28
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Cigna Commercial |
$1,734.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,615.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,615.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$948.68
|
| Rate for Payer: Multiplan Commercial |
$2,537.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,347.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$948.67
|
| Rate for Payer: United Healthcare Commercial |
$1,459.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$948.67
|
| Rate for Payer: United Healthcare VA CCN |
$948.67
|
|
|
REPAIR ACHILLES TENDON
|
Facility
|
OP
|
$2,281.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
9822765001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,010.25 |
| Max. Negotiated Rate |
$2,166.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,166.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,043.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,010.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,043.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,373.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,938.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,847.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,026.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,813.39
|
| Rate for Payer: Cash Price |
$1,140.50
|
| Rate for Payer: Cigna Commercial |
$1,824.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,824.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,824.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,026.45
|
| Rate for Payer: Multiplan Commercial |
$2,121.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,938.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,026.45
|
| Rate for Payer: United Healthcare Commercial |
$2,166.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,026.45
|
| Rate for Payer: United Healthcare VA CCN |
$1,026.45
|
|
|
REPAIR ACHILLES TENDON
|
Facility
|
IP
|
$2,281.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
9822765001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,688.17 |
| Max. Negotiated Rate |
$2,166.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,166.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,688.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,688.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,938.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,916.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,824.80
|
| Rate for Payer: Cash Price |
$1,140.50
|
| Rate for Payer: Cigna Commercial |
$1,824.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,824.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,824.80
|
| Rate for Payer: Multiplan Commercial |
$2,121.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,938.85
|
| Rate for Payer: United Healthcare Commercial |
$2,166.95
|
|
|
REPAIR ACHILLES TENDON
|
Professional
|
Both
|
$2,281.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
9822765001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$627.81 |
| Max. Negotiated Rate |
$2,144.14 |
| Rate for Payer: Aetna of VT Commercial |
$2,144.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,043.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$646.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,043.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$878.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,160.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,160.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$721.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,160.87
|
| Rate for Payer: Cash Price |
$1,140.50
|
| Rate for Payer: Cash Price |
$1,140.50
|
| Rate for Payer: Cigna Commercial |
$1,185.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,036.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,036.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$627.81
|
| Rate for Payer: Multiplan Commercial |
$2,121.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$891.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$627.81
|
| Rate for Payer: United Healthcare Commercial |
$965.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$627.81
|
| Rate for Payer: United Healthcare VA CCN |
$627.81
|
|
|
REPAIR BLADDER DEFECT
|
Facility
|
IP
|
$2,132.00
|
|
|
Service Code
|
CPT 57288
|
| Hospital Charge Code |
9825728801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,577.89 |
| Max. Negotiated Rate |
$2,025.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,025.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,577.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,577.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,812.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,790.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,705.60
|
| Rate for Payer: Cash Price |
$1,066.00
|
| Rate for Payer: Cigna Commercial |
$1,705.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,705.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,705.60
|
| Rate for Payer: Multiplan Commercial |
$1,982.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,812.20
|
| Rate for Payer: United Healthcare Commercial |
$2,025.40
|
|
|
REPAIR BLADDER DEFECT
|
Professional
|
Both
|
$2,132.00
|
|
|
Service Code
|
CPT 57288
|
| Hospital Charge Code |
9825728801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$694.79 |
| Max. Negotiated Rate |
$2,004.08 |
| Rate for Payer: Aetna of VT Commercial |
$2,004.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,910.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$715.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,910.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$972.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,295.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,295.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$799.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,295.44
|
| Rate for Payer: Cash Price |
$1,066.00
|
| Rate for Payer: Cash Price |
$1,066.00
|
| Rate for Payer: Cigna Commercial |
$1,225.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,154.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,154.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$694.79
|
| Rate for Payer: Multiplan Commercial |
$1,982.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$986.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$694.79
|
| Rate for Payer: United Healthcare Commercial |
$1,068.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$694.79
|
| Rate for Payer: United Healthcare VA CCN |
$694.79
|
|
|
REPAIR BLADDER DEFECT
|
Facility
|
OP
|
$2,132.00
|
|
|
Service Code
|
CPT 57288
|
| Hospital Charge Code |
9825728801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$944.26 |
| Max. Negotiated Rate |
$2,025.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,025.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,910.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$944.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,910.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,283.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,812.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,726.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$959.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,694.94
|
| Rate for Payer: Cash Price |
$1,066.00
|
| Rate for Payer: Cigna Commercial |
$1,705.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,705.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,705.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$959.40
|
| Rate for Payer: Multiplan Commercial |
$1,982.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,812.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$959.40
|
| Rate for Payer: United Healthcare Commercial |
$2,025.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$959.40
|
| Rate for Payer: United Healthcare VA CCN |
$959.40
|
|
|
REPAIR BLOOD VESSEL, DIRECT: N
|
Facility
|
IP
|
$4,337.00
|
|
|
Service Code
|
CPT 35201
|
| Hospital Charge Code |
9823520101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$3,209.81 |
| Max. Negotiated Rate |
$4,120.15 |
| Rate for Payer: Aetna of VT Commercial |
$4,120.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,209.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,209.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,686.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,643.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,469.60
|
| Rate for Payer: Cash Price |
$2,168.50
|
| Rate for Payer: Cigna Commercial |
$3,469.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,469.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,469.60
|
| Rate for Payer: Multiplan Commercial |
$4,033.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,686.45
|
| Rate for Payer: United Healthcare Commercial |
$4,120.15
|
|
|
REPAIR BLOOD VESSEL, DIRECT: N
|
Facility
|
OP
|
$4,337.00
|
|
|
Service Code
|
CPT 35201
|
| Hospital Charge Code |
9823520101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,920.86 |
| Max. Negotiated Rate |
$4,120.15 |
| Rate for Payer: Aetna of VT Commercial |
$4,120.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,885.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,920.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,885.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,610.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,686.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,512.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,951.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,447.91
|
| Rate for Payer: Cash Price |
$2,168.50
|
| Rate for Payer: Cigna Commercial |
$3,469.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,469.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,469.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,951.65
|
| Rate for Payer: Multiplan Commercial |
$4,033.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,686.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,951.65
|
| Rate for Payer: United Healthcare Commercial |
$4,120.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,951.65
|
| Rate for Payer: United Healthcare VA CCN |
$1,951.65
|
|
