|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
5101176501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.38 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna of VT Commercial |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$82.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$111.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$158.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$83.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$147.87
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.70
|
| Rate for Payer: Multiplan Commercial |
$172.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.70
|
| Rate for Payer: United Healthcare Commercial |
$176.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.70
|
| Rate for Payer: United Healthcare VA CCN |
$83.70
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Professional
|
Both
|
$399.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
9811176501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$89.32 |
| Max. Negotiated Rate |
$375.06 |
| Rate for Payer: Aetna of VT Commercial |
$375.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$357.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$357.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$102.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$204.20
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$163.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$254.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$254.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$157.41
|
| Rate for Payer: Multiplan Commercial |
$371.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$89.32
|
| Rate for Payer: United Healthcare Commercial |
$137.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.32
|
| Rate for Payer: United Healthcare VA CCN |
$89.32
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
OP
|
$585.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
9601176501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$259.10 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: Aetna of VT Commercial |
$555.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$524.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$259.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$524.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$352.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$497.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$473.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$263.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$465.07
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$468.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$468.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$468.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$263.25
|
| Rate for Payer: Multiplan Commercial |
$544.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$497.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$263.25
|
| Rate for Payer: United Healthcare Commercial |
$555.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$263.25
|
| Rate for Payer: United Healthcare VA CCN |
$263.25
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
9811176502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$176.72 |
| Max. Negotiated Rate |
$379.05 |
| Rate for Payer: Aetna of VT Commercial |
$379.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$357.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$176.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$357.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$240.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$339.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$323.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$179.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$317.20
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$319.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$319.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$319.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$179.55
|
| Rate for Payer: Multiplan Commercial |
$371.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$339.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$179.55
|
| Rate for Payer: United Healthcare Commercial |
$379.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.55
|
| Rate for Payer: United Healthcare VA CCN |
$179.55
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
9601176502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$295.30 |
| Max. Negotiated Rate |
$379.05 |
| Rate for Payer: Aetna of VT Commercial |
$379.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$295.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$295.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$339.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$335.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$319.20
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$319.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$319.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$319.20
|
| Rate for Payer: Multiplan Commercial |
$371.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$339.15
|
| Rate for Payer: United Healthcare Commercial |
$379.05
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
5101176501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.32 |
| Max. Negotiated Rate |
$254.07 |
| Rate for Payer: Aetna of VT Commercial |
$174.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$102.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$204.20
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$163.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$254.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$254.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$157.41
|
| Rate for Payer: Multiplan Commercial |
$172.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$89.32
|
| Rate for Payer: United Healthcare Commercial |
$137.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.32
|
| Rate for Payer: United Healthcare VA CCN |
$89.32
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
9811176501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$176.72 |
| Max. Negotiated Rate |
$379.05 |
| Rate for Payer: Aetna of VT Commercial |
$379.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$357.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$176.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$357.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$240.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$339.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$323.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$179.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$317.20
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$319.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$319.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$319.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$179.55
|
| Rate for Payer: Multiplan Commercial |
$371.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$339.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$179.55
|
| Rate for Payer: United Healthcare Commercial |
$379.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.55
|
| Rate for Payer: United Healthcare VA CCN |
$179.55
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Professional
|
Both
|
$399.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
9601176502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$89.32 |
| Max. Negotiated Rate |
$375.06 |
| Rate for Payer: Aetna of VT Commercial |
$375.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$357.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$357.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$102.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$204.20
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$163.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$254.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$254.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$157.41
|
| Rate for Payer: Multiplan Commercial |
$371.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$89.32
|
| Rate for Payer: United Healthcare Commercial |
$137.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.32
|
| Rate for Payer: United Healthcare VA CCN |
$89.32
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
OP
|
$185.73
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
4501176501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.26 |
| Max. Negotiated Rate |
$176.44 |
| Rate for Payer: Aetna of VT Commercial |
$176.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$166.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$82.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$166.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$157.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$83.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$147.66
|
| Rate for Payer: Cash Price |
$92.86
|
| Rate for Payer: Cigna Commercial |
$148.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.58
|
| Rate for Payer: Multiplan Commercial |
$172.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$157.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.58
|
| Rate for Payer: United Healthcare Commercial |
$176.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.58
|
| Rate for Payer: United Healthcare VA CCN |
$83.58
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Professional
|
Both
|
$585.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
9601176501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$89.32 |
| Max. Negotiated Rate |
$549.90 |
| Rate for Payer: Aetna of VT Commercial |
$549.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$524.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$524.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$102.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$204.20
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$163.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$254.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$254.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$157.41
|
| Rate for Payer: Multiplan Commercial |
$544.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$89.32
|
| Rate for Payer: United Healthcare Commercial |
$137.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.32
|
| Rate for Payer: United Healthcare VA CCN |
$89.32
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
IP
|
$185.73
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
4501176501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.46 |
| Max. Negotiated Rate |
$176.44 |
| Rate for Payer: Aetna of VT Commercial |
$176.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$157.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$156.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$148.58
|
| Rate for Payer: Cash Price |
$92.86
|
| Rate for Payer: Cigna Commercial |
$148.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.58
|
| Rate for Payer: Multiplan Commercial |
$172.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$157.87
|
| Rate for Payer: United Healthcare Commercial |
$176.44
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
9811176501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$295.30 |
| Max. Negotiated Rate |
$379.05 |
| Rate for Payer: Aetna of VT Commercial |
$379.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$295.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$295.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$339.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$335.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$319.20
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$319.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$319.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$319.20
|
| Rate for Payer: Multiplan Commercial |
$371.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$339.15
|
| Rate for Payer: United Healthcare Commercial |
$379.05
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
9601176502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$176.72 |
| Max. Negotiated Rate |
$379.05 |
| Rate for Payer: Aetna of VT Commercial |
$379.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$357.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$176.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$357.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$240.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$339.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$323.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$179.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$317.20
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$319.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$319.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$319.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$179.55
|
| Rate for Payer: Multiplan Commercial |
$371.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$339.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$179.55
|
| Rate for Payer: United Healthcare Commercial |
$379.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.55
|
| Rate for Payer: United Healthcare VA CCN |
$179.55
|
|
|
WEDGING OF CAST
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
9602974002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$182.06 |
| Max. Negotiated Rate |
$233.70 |
| Rate for Payer: Aetna of VT Commercial |
$233.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$182.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$182.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$206.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.80
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$196.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.80
|
| Rate for Payer: Multiplan Commercial |
$228.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.10
|
| Rate for Payer: United Healthcare Commercial |
$233.70
|
|
|
WEDGING OF CAST
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
5102974001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$125.82 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Aetna of VT Commercial |
$161.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$136.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.00
|
| Rate for Payer: Multiplan Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$144.50
|
| Rate for Payer: United Healthcare Commercial |
$161.50
|
|
|
WEDGING OF CAST
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
5102974001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.29 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Aetna of VT Commercial |
$161.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$75.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$102.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$137.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.15
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.50
|
| Rate for Payer: Multiplan Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$144.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.50
|
| Rate for Payer: United Healthcare Commercial |
$161.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.50
|
| Rate for Payer: United Healthcare VA CCN |
$76.50
|
|
|
WEDGING OF CAST
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
9602974001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$307.88 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Aetna of VT Commercial |
$395.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$307.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$307.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$353.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$349.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$332.80
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cigna Commercial |
$332.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$332.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$332.80
|
| Rate for Payer: Multiplan Commercial |
$386.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$353.60
|
| Rate for Payer: United Healthcare Commercial |
$395.20
|
|
|
WEDGING OF CAST
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
9602974001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$184.25 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Aetna of VT Commercial |
$395.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$372.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$184.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$372.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$250.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$353.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$336.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$187.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$330.72
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cigna Commercial |
$332.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$332.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$332.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$386.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$353.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$187.20
|
| Rate for Payer: United Healthcare Commercial |
$395.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$187.20
|
| Rate for Payer: United Healthcare VA CCN |
$187.20
|
|
|
WEDGING OF CAST
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
9602974001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$391.04 |
| Rate for Payer: Aetna of VT Commercial |
$391.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$372.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$65.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$372.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$88.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$137.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$137.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$72.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$137.03
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cigna Commercial |
$120.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$157.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$157.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$95.16
|
| Rate for Payer: Multiplan Commercial |
$386.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.36
|
| Rate for Payer: United Healthcare Commercial |
$97.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.36
|
| Rate for Payer: United Healthcare VA CCN |
$63.36
|
|
|
WEDGING OF CAST
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
9602974002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$231.24 |
| Rate for Payer: Aetna of VT Commercial |
$231.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$220.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$65.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$220.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$88.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$137.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$137.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$72.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$137.03
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$120.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$157.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$157.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$95.16
|
| Rate for Payer: Multiplan Commercial |
$228.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.36
|
| Rate for Payer: United Healthcare Commercial |
$97.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.36
|
| Rate for Payer: United Healthcare VA CCN |
$63.36
|
|
|
WEDGING OF CAST
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
5102974001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$159.80 |
| Rate for Payer: Aetna of VT Commercial |
$159.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$65.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$88.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$137.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$137.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$72.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$137.03
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$120.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$157.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$157.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$95.16
|
| Rate for Payer: Multiplan Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.36
|
| Rate for Payer: United Healthcare Commercial |
$97.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.36
|
| Rate for Payer: United Healthcare VA CCN |
$63.36
|
|
|
WEDGING OF CAST
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
9602974002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$108.95 |
| Max. Negotiated Rate |
$233.70 |
| Rate for Payer: Aetna of VT Commercial |
$233.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$220.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$108.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$220.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$148.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$199.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$110.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$195.57
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$196.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$110.70
|
| Rate for Payer: Multiplan Commercial |
$228.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$110.70
|
| Rate for Payer: United Healthcare Commercial |
$233.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.70
|
| Rate for Payer: United Healthcare VA CCN |
$110.70
|
|
|
WHIRLPOOL THERAPY
|
Facility
|
OP
|
$295.72
|
|
|
Service Code
|
CPT 97022 GP
|
| Hospital Charge Code |
4209702201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$130.97 |
| Max. Negotiated Rate |
$280.93 |
| Rate for Payer: Aetna of VT Commercial |
$280.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$264.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$264.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$178.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$251.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$239.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$133.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$235.10
|
| Rate for Payer: Cash Price |
$147.86
|
| Rate for Payer: Cigna Commercial |
$236.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$133.07
|
| Rate for Payer: Multiplan Commercial |
$275.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$133.07
|
| Rate for Payer: United Healthcare Commercial |
$280.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$133.07
|
| Rate for Payer: United Healthcare VA CCN |
$133.07
|
|
|
WHIRLPOOL THERAPY
|
Facility
|
IP
|
$295.72
|
|
|
Service Code
|
CPT 97022 GP
|
| Hospital Charge Code |
4209702201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$218.86 |
| Max. Negotiated Rate |
$280.93 |
| Rate for Payer: Aetna of VT Commercial |
$280.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$218.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$218.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$251.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$248.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$236.58
|
| Rate for Payer: Cash Price |
$147.86
|
| Rate for Payer: Cigna Commercial |
$236.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.58
|
| Rate for Payer: Multiplan Commercial |
$275.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$251.36
|
| Rate for Payer: United Healthcare Commercial |
$280.93
|
|
|
WHIRLPOOL THERAPY
|
Facility
|
OP
|
$295.72
|
|
|
Service Code
|
CPT 97022 GO
|
| Hospital Charge Code |
4309702201
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$130.97 |
| Max. Negotiated Rate |
$280.93 |
| Rate for Payer: Aetna of VT Commercial |
$280.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$264.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$264.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$178.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$251.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$239.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$133.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$235.10
|
| Rate for Payer: Cash Price |
$147.86
|
| Rate for Payer: Cigna Commercial |
$236.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$133.07
|
| Rate for Payer: Multiplan Commercial |
$275.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$133.07
|
| Rate for Payer: United Healthcare Commercial |
$280.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$133.07
|
| Rate for Payer: United Healthcare VA CCN |
$133.07
|
|
