|
TREATMENT OF HEEL FRACTURE
|
Professional
|
Both
|
$551.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
9602840002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$226.58 |
| Max. Negotiated Rate |
$517.94 |
| Rate for Payer: Aetna of VT Commercial |
$517.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$493.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$233.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$493.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$317.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$460.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$460.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$260.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$460.63
|
| Rate for Payer: Cash Price |
$275.50
|
| Rate for Payer: Cash Price |
$275.50
|
| Rate for Payer: Cigna Commercial |
$429.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$399.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$399.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$244.24
|
| Rate for Payer: Multiplan Commercial |
$512.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$321.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$226.58
|
| Rate for Payer: United Healthcare Commercial |
$348.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$226.58
|
| Rate for Payer: United Healthcare VA CCN |
$226.58
|
|
|
TREATMENT OF HEEL FRACTURE
|
Professional
|
Both
|
$1,101.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
9602840001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$226.58 |
| Max. Negotiated Rate |
$1,034.94 |
| Rate for Payer: Aetna of VT Commercial |
$1,034.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$986.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$233.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$986.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$317.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$460.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$460.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$260.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$460.63
|
| Rate for Payer: Cash Price |
$550.50
|
| Rate for Payer: Cash Price |
$550.50
|
| Rate for Payer: Cigna Commercial |
$429.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$399.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$399.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$244.24
|
| Rate for Payer: Multiplan Commercial |
$1,023.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$321.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$226.58
|
| Rate for Payer: United Healthcare Commercial |
$348.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$226.58
|
| Rate for Payer: United Healthcare VA CCN |
$226.58
|
|
|
TREATMENT OF HEEL FRACTURE
|
Facility
|
OP
|
$1,101.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
9602840001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$487.63 |
| Max. Negotiated Rate |
$1,045.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,045.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$986.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$487.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$986.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$662.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$935.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$891.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$495.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$875.29
|
| Rate for Payer: Cash Price |
$550.50
|
| Rate for Payer: Cigna Commercial |
$880.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$880.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$880.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$495.45
|
| Rate for Payer: Multiplan Commercial |
$1,023.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$935.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$495.45
|
| Rate for Payer: United Healthcare Commercial |
$1,045.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$495.45
|
| Rate for Payer: United Healthcare VA CCN |
$495.45
|
|
|
TREATMENT OF HEEL FRACTURE
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
9602840002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$244.04 |
| Max. Negotiated Rate |
$523.45 |
| Rate for Payer: Aetna of VT Commercial |
$523.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$493.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$244.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$493.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$331.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$468.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$446.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$247.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$438.05
|
| Rate for Payer: Cash Price |
$275.50
|
| Rate for Payer: Cigna Commercial |
$440.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$440.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$440.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$247.95
|
| Rate for Payer: Multiplan Commercial |
$512.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$468.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$247.95
|
| Rate for Payer: United Healthcare Commercial |
$523.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$247.95
|
| Rate for Payer: United Healthcare VA CCN |
$247.95
|
|
|
TREATMENT OF HEEL FRACTURE
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
9602840002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$407.80 |
| Max. Negotiated Rate |
$523.45 |
| Rate for Payer: Aetna of VT Commercial |
$523.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$407.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$407.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$468.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$462.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$440.80
|
| Rate for Payer: Cash Price |
$275.50
|
| Rate for Payer: Cigna Commercial |
$440.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$440.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$440.80
|
| Rate for Payer: Multiplan Commercial |
$512.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$468.35
|
| Rate for Payer: United Healthcare Commercial |
$523.45
|
|
|
TREATMENT OF HEEL FRACTURE
|
Professional
|
Both
|
$551.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
5102840001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.58 |
| Max. Negotiated Rate |
$517.94 |
| Rate for Payer: Aetna of VT Commercial |
$517.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$493.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$233.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$493.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$317.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$460.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$460.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$260.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$460.63
|
| Rate for Payer: Cash Price |
$275.50
|
| Rate for Payer: Cash Price |
$275.50
|
| Rate for Payer: Cigna Commercial |
$429.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$399.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$399.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$244.24
|
| Rate for Payer: Multiplan Commercial |
$512.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$321.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$226.58
|
| Rate for Payer: United Healthcare Commercial |
$348.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$226.58
|
| Rate for Payer: United Healthcare VA CCN |
$226.58
|
|
|
TREATMENT OF HEEL FRACTURE
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
5102840001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$407.80 |
| Max. Negotiated Rate |
$523.45 |
| Rate for Payer: Aetna of VT Commercial |
$523.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$407.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$407.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$468.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$462.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$440.80
|
| Rate for Payer: Cash Price |
$275.50
|
| Rate for Payer: Cigna Commercial |
$440.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$440.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$440.80
|
| Rate for Payer: Multiplan Commercial |
$512.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$468.35
|
| Rate for Payer: United Healthcare Commercial |
$523.45
|
|
|
TREATMENT OF HEEL FRACTURE
|
Facility
|
IP
|
$1,101.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
9602840001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$814.85 |
| Max. Negotiated Rate |
$1,045.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,045.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$814.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$814.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$935.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$924.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$880.80
|
| Rate for Payer: Cash Price |
$550.50
|
| Rate for Payer: Cigna Commercial |
$880.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$880.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$880.80
|
| Rate for Payer: Multiplan Commercial |
$1,023.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$935.85
|
| Rate for Payer: United Healthcare Commercial |
$1,045.95
|
|
|
TREATMENT OF HEEL FRACTURE
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
5102840001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$244.04 |
| Max. Negotiated Rate |
$523.45 |
| Rate for Payer: Aetna of VT Commercial |
$523.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$493.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$244.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$493.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$331.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$468.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$446.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$247.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$438.05
|
| Rate for Payer: Cash Price |
$275.50
|
| Rate for Payer: Cigna Commercial |
$440.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$440.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$440.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$247.95
|
| Rate for Payer: Multiplan Commercial |
$512.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$468.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$247.95
|
| Rate for Payer: United Healthcare Commercial |
$523.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$247.95
|
| Rate for Payer: United Healthcare VA CCN |
$247.95
|
|
|
TREATMENT OF MISCARRIAGE
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
CPT 59821
|
| Hospital Charge Code |
9695982101
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$805.97 |
| Max. Negotiated Rate |
$1,034.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,034.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$805.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$805.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$925.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$914.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$871.20
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Cigna Commercial |
$871.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$871.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$871.20
|
| Rate for Payer: Multiplan Commercial |
$1,012.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$925.65
|
| Rate for Payer: United Healthcare Commercial |
$1,034.55
|
|
|
TREATMENT OF MISCARRIAGE
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
CPT 59821
|
| Hospital Charge Code |
9695982101
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$482.32 |
| Max. Negotiated Rate |
$1,034.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,034.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$975.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$482.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$975.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$655.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$925.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$882.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$490.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$865.75
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Cigna Commercial |
$871.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$871.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$871.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$490.05
|
| Rate for Payer: Multiplan Commercial |
$1,012.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$925.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$490.05
|
| Rate for Payer: United Healthcare Commercial |
$1,034.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$490.05
|
| Rate for Payer: United Healthcare VA CCN |
$490.05
|
|
|
TREATMENT OF MISCARRIAGE
|
Professional
|
Both
|
$1,089.00
|
|
|
Service Code
|
CPT 59821
|
| Hospital Charge Code |
9695982101
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$345.43 |
| Max. Negotiated Rate |
$1,023.66 |
| Rate for Payer: Aetna of VT Commercial |
$1,023.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$975.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$355.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$975.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$483.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$580.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$580.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$397.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$580.49
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Cigna Commercial |
$380.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$671.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$671.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$396.50
|
| Rate for Payer: Multiplan Commercial |
$1,012.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$490.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$345.43
|
| Rate for Payer: United Healthcare Commercial |
$531.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$345.43
|
| Rate for Payer: United Healthcare VA CCN |
$345.43
|
|
|
TREATMENT OF MISCARRIAGE
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
9825981201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$280.10 |
| Max. Negotiated Rate |
$772.68 |
| Rate for Payer: Aetna of VT Commercial |
$772.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$736.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$288.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$736.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$392.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$449.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$449.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$322.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$449.62
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$307.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$561.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$561.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$331.16
|
| Rate for Payer: Multiplan Commercial |
$764.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$397.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$280.10
|
| Rate for Payer: United Healthcare Commercial |
$430.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.10
|
| Rate for Payer: United Healthcare VA CCN |
$280.10
|
|
|
TREATMENT OF MISCARRIAGE
|
Facility
|
OP
|
$822.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
9825981201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$364.06 |
| Max. Negotiated Rate |
$780.90 |
| Rate for Payer: Aetna of VT Commercial |
$780.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$736.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$364.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$736.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$494.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$698.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$665.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$369.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$653.49
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$657.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$657.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$657.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$369.90
|
| Rate for Payer: Multiplan Commercial |
$764.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$698.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$369.90
|
| Rate for Payer: United Healthcare Commercial |
$780.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$369.90
|
| Rate for Payer: United Healthcare VA CCN |
$369.90
|
|
|
TREATMENT OF MISCARRIAGE
|
Facility
|
IP
|
$822.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
9825981201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$608.36 |
| Max. Negotiated Rate |
$780.90 |
| Rate for Payer: Aetna of VT Commercial |
$780.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$608.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$608.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$698.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$690.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$657.60
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$657.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$657.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$657.60
|
| Rate for Payer: Multiplan Commercial |
$764.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$698.70
|
| Rate for Payer: United Healthcare Commercial |
$780.90
|
|
|
TREATMENT OF PENIS LESION
|
Professional
|
Both
|
$1,102.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
9815422002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$1,035.88 |
| Rate for Payer: Aetna of VT Commercial |
$1,035.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$987.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$127.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$987.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$173.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$419.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$419.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$419.60
|
| Rate for Payer: Cash Price |
$551.00
|
| Rate for Payer: Cash Price |
$551.00
|
| Rate for Payer: Cigna Commercial |
$216.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$344.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$344.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$209.44
|
| Rate for Payer: Multiplan Commercial |
$1,024.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$176.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$124.00
|
| Rate for Payer: United Healthcare Commercial |
$190.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.00
|
| Rate for Payer: United Healthcare VA CCN |
$124.00
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
OP
|
$1,102.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
9825422001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$488.08 |
| Max. Negotiated Rate |
$1,046.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,046.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$987.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$488.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$987.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$663.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$936.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$892.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$495.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$876.09
|
| Rate for Payer: Cash Price |
$551.00
|
| Rate for Payer: Cigna Commercial |
$881.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$881.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$881.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$495.90
|
| Rate for Payer: Multiplan Commercial |
$1,024.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$936.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$495.90
|
| Rate for Payer: United Healthcare Commercial |
$1,046.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$495.90
|
| Rate for Payer: United Healthcare VA CCN |
$495.90
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
OP
|
$1,102.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
9815422002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$488.08 |
| Max. Negotiated Rate |
$1,046.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,046.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$987.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$488.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$987.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$663.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$936.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$892.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$495.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$876.09
|
| Rate for Payer: Cash Price |
$551.00
|
| Rate for Payer: Cigna Commercial |
$881.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$881.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$881.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$495.90
|
| Rate for Payer: Multiplan Commercial |
$1,024.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$936.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$495.90
|
| Rate for Payer: United Healthcare Commercial |
$1,046.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$495.90
|
| Rate for Payer: United Healthcare VA CCN |
$495.90
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
OP
|
$229.55
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
4505422001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.67 |
| Max. Negotiated Rate |
$218.07 |
| Rate for Payer: Aetna of VT Commercial |
$218.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$205.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$101.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$205.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$138.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$185.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$182.49
|
| Rate for Payer: Cash Price |
$114.78
|
| Rate for Payer: Cigna Commercial |
$183.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$103.30
|
| Rate for Payer: Multiplan Commercial |
$213.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.30
|
| Rate for Payer: United Healthcare Commercial |
$218.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.30
|
| Rate for Payer: United Healthcare VA CCN |
$103.30
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
9815422001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$172.73 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Aetna of VT Commercial |
$370.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$349.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$172.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$349.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$234.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$315.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$175.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$310.05
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$312.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$312.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$312.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$175.50
|
| Rate for Payer: Multiplan Commercial |
$362.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$331.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$175.50
|
| Rate for Payer: United Healthcare Commercial |
$370.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$175.50
|
| Rate for Payer: United Healthcare VA CCN |
$175.50
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
9815422001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$288.64 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Aetna of VT Commercial |
$370.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$288.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$288.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$327.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$312.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$312.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$312.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$312.00
|
| Rate for Payer: Multiplan Commercial |
$362.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$331.50
|
| Rate for Payer: United Healthcare Commercial |
$370.50
|
|
|
TREATMENT OF PENIS LESION
|
Professional
|
Both
|
$1,102.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
9825422001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$1,035.88 |
| Rate for Payer: Aetna of VT Commercial |
$1,035.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$987.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$127.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$987.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$173.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$419.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$419.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$419.60
|
| Rate for Payer: Cash Price |
$551.00
|
| Rate for Payer: Cash Price |
$551.00
|
| Rate for Payer: Cigna Commercial |
$216.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$344.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$344.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$209.44
|
| Rate for Payer: Multiplan Commercial |
$1,024.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$176.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$124.00
|
| Rate for Payer: United Healthcare Commercial |
$190.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.00
|
| Rate for Payer: United Healthcare VA CCN |
$124.00
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
IP
|
$1,102.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
9825422001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$815.59 |
| Max. Negotiated Rate |
$1,046.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,046.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$815.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$815.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$936.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$925.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$881.60
|
| Rate for Payer: Cash Price |
$551.00
|
| Rate for Payer: Cigna Commercial |
$881.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$881.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$881.60
|
| Rate for Payer: Multiplan Commercial |
$1,024.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$936.70
|
| Rate for Payer: United Healthcare Commercial |
$1,046.90
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
IP
|
$229.55
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
4505422001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.89 |
| Max. Negotiated Rate |
$218.07 |
| Rate for Payer: Aetna of VT Commercial |
$218.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$169.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$169.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$192.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$183.64
|
| Rate for Payer: Cash Price |
$114.78
|
| Rate for Payer: Cigna Commercial |
$183.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.64
|
| Rate for Payer: Multiplan Commercial |
$213.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.12
|
| Rate for Payer: United Healthcare Commercial |
$218.07
|
|
|
TREATMENT OF PENIS LESION
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
9815422001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$419.60 |
| Rate for Payer: Aetna of VT Commercial |
$366.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$349.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$127.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$349.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$173.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$419.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$419.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$419.60
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$216.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$344.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$344.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$209.44
|
| Rate for Payer: Multiplan Commercial |
$362.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$176.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$124.00
|
| Rate for Payer: United Healthcare Commercial |
$190.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.00
|
| Rate for Payer: United Healthcare VA CCN |
$124.00
|
|
