|
EGD REMOVE LESION SNARE
|
Facility
|
OP
|
$927.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
9824325101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$410.57 |
| Max. Negotiated Rate |
$880.65 |
| Rate for Payer: Aetna of VT Commercial |
$880.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$830.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$410.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$830.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$558.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$787.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$750.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$417.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$736.97
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$741.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$741.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$741.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$417.15
|
| Rate for Payer: Multiplan Commercial |
$862.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$787.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$417.15
|
| Rate for Payer: United Healthcare Commercial |
$880.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$417.15
|
| Rate for Payer: United Healthcare VA CCN |
$417.15
|
|
|
EGD REMOVE LESION SNARE
|
Professional
|
Both
|
$927.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
9824325101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$180.48 |
| Max. Negotiated Rate |
$871.38 |
| Rate for Payer: Aetna of VT Commercial |
$871.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$830.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$185.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$830.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$252.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$842.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$842.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$207.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$842.43
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$331.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$744.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$744.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$458.95
|
| Rate for Payer: Multiplan Commercial |
$862.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$256.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$180.48
|
| Rate for Payer: United Healthcare Commercial |
$277.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.48
|
| Rate for Payer: United Healthcare VA CCN |
$180.48
|
|
|
EGD TRANSORAL BX SLG/MULT
|
Professional
|
Both
|
$904.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
9824323901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$127.78 |
| Max. Negotiated Rate |
$849.76 |
| Rate for Payer: Aetna of VT Commercial |
$849.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$809.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$131.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$809.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$178.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$671.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$671.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$146.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$671.79
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cigna Commercial |
$234.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$567.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$567.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$350.70
|
| Rate for Payer: Multiplan Commercial |
$840.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$181.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$127.78
|
| Rate for Payer: United Healthcare Commercial |
$196.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.78
|
| Rate for Payer: United Healthcare VA CCN |
$127.78
|
|
|
EGD TRANSORAL BX SLG/MULT
|
Facility
|
OP
|
$904.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
9824323901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$400.38 |
| Max. Negotiated Rate |
$858.80 |
| Rate for Payer: Aetna of VT Commercial |
$858.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$809.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$400.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$809.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$544.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$768.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$732.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$406.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$718.68
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cigna Commercial |
$723.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$723.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$723.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$406.80
|
| Rate for Payer: Multiplan Commercial |
$840.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$768.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$406.80
|
| Rate for Payer: United Healthcare Commercial |
$858.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$406.80
|
| Rate for Payer: United Healthcare VA CCN |
$406.80
|
|
|
EGD TRANSORAL BX SLG/MULT
|
Facility
|
IP
|
$904.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
9824323901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$669.05 |
| Max. Negotiated Rate |
$858.80 |
| Rate for Payer: Aetna of VT Commercial |
$858.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$669.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$669.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$768.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$759.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$723.20
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cigna Commercial |
$723.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$723.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$723.20
|
| Rate for Payer: Multiplan Commercial |
$840.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$768.40
|
| Rate for Payer: United Healthcare Commercial |
$858.80
|
|
|
EHRLICHA CHAFFEENSIS AMP PRB
|
Facility
|
IP
|
$86.86
|
|
|
Service Code
|
CPT 87484
|
| Hospital Charge Code |
3008748401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.29 |
| Max. Negotiated Rate |
$82.52 |
| Rate for Payer: Aetna of VT Commercial |
$82.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.49
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cigna Commercial |
$69.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.49
|
| Rate for Payer: Multiplan Commercial |
$80.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.83
|
| Rate for Payer: United Healthcare Commercial |
$82.52
|
|
|
EHRLICHA CHAFFEENSIS AMP PRB
|
Facility
|
OP
|
$86.86
|
|
|
Service Code
|
CPT 87484
|
| Hospital Charge Code |
3008748401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$82.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.05
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cigna Commercial |
$69.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$39.09
|
| Rate for Payer: Multiplan Commercial |
$80.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.09
|
| Rate for Payer: United Healthcare Commercial |
$82.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$39.09
|
|
|
EHRLICHA CHAFFEENSIS AMP PRB
|
Professional
|
Both
|
$86.86
|
|
|
Service Code
|
CPT 87484
|
| Hospital Charge Code |
3008748401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$81.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.35
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cigna Commercial |
$42.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$48.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$48.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.60
|
| Rate for Payer: Multiplan Commercial |
$80.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$53.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$35.09
|
|
|
EL-1 FECAL QUANTITATIVE
|
Professional
|
Both
|
$220.24
|
|
|
Service Code
|
CPT 82653
|
| Hospital Charge Code |
3008265301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.65 |
| Max. Negotiated Rate |
$207.03 |
| Rate for Payer: Aetna of VT Commercial |
$207.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$27.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$27.08
|
| Rate for Payer: Cash Price |
$110.12
|
| Rate for Payer: Cash Price |
$110.12
|
| Rate for Payer: Cigna Commercial |
$27.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$22.65
|
| Rate for Payer: Multiplan Commercial |
$204.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.97
|
| Rate for Payer: United Healthcare Commercial |
$35.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.97
|
| Rate for Payer: United Healthcare VA CCN |
$22.97
|
|
|
EL-1 FECAL QUANTITATIVE
|
Facility
|
OP
|
$220.24
|
|
|
Service Code
|
CPT 82653
|
| Hospital Charge Code |
3008265301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.97 |
| Max. Negotiated Rate |
$209.23 |
| Rate for Payer: Aetna of VT Commercial |
$209.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$97.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$132.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$178.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$175.09
|
| Rate for Payer: Cash Price |
$110.12
|
| Rate for Payer: Cash Price |
$110.12
|
| Rate for Payer: Cigna Commercial |
$176.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$99.11
|
| Rate for Payer: Multiplan Commercial |
$204.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.11
|
| Rate for Payer: United Healthcare Commercial |
$209.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.97
|
| Rate for Payer: United Healthcare VA CCN |
$99.11
|
|
|
EL-1 FECAL QUANTITATIVE
|
Facility
|
IP
|
$220.24
|
|
|
Service Code
|
CPT 82653
|
| Hospital Charge Code |
3008265301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.00 |
| Max. Negotiated Rate |
$209.23 |
| Rate for Payer: Aetna of VT Commercial |
$209.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$185.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.19
|
| Rate for Payer: Cash Price |
$110.12
|
| Rate for Payer: Cigna Commercial |
$176.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.19
|
| Rate for Payer: Multiplan Commercial |
$204.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.20
|
| Rate for Payer: United Healthcare Commercial |
$209.23
|
|
|
ELBOW ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$2,685.00
|
|
|
Service Code
|
CPT 29838
|
| Hospital Charge Code |
9822983801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,987.17 |
| Max. Negotiated Rate |
$2,550.75 |
| Rate for Payer: Aetna of VT Commercial |
$2,550.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,987.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,987.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,282.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,255.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,148.00
|
| Rate for Payer: Cash Price |
$1,342.50
|
| Rate for Payer: Cigna Commercial |
$2,148.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,148.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,148.00
|
| Rate for Payer: Multiplan Commercial |
$2,497.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,282.25
|
| Rate for Payer: United Healthcare Commercial |
$2,550.75
|
|
|
ELBOW ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$2,685.00
|
|
|
Service Code
|
CPT 29838
|
| Hospital Charge Code |
9822983801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$565.43 |
| Max. Negotiated Rate |
$2,523.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,523.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,405.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$582.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,405.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$791.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$859.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$859.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$650.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$859.18
|
| Rate for Payer: Cash Price |
$1,342.50
|
| Rate for Payer: Cash Price |
$1,342.50
|
| Rate for Payer: Cigna Commercial |
$1,070.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$940.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$940.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$565.43
|
| Rate for Payer: Multiplan Commercial |
$2,497.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$802.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$565.43
|
| Rate for Payer: United Healthcare Commercial |
$869.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$565.43
|
| Rate for Payer: United Healthcare VA CCN |
$565.43
|
|
|
ELBOW ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,685.00
|
|
|
Service Code
|
CPT 29838
|
| Hospital Charge Code |
9822983801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,189.19 |
| Max. Negotiated Rate |
$2,550.75 |
| Rate for Payer: Aetna of VT Commercial |
$2,550.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,405.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,189.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,405.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,616.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,282.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,174.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,208.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,134.57
|
| Rate for Payer: Cash Price |
$1,342.50
|
| Rate for Payer: Cigna Commercial |
$2,148.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,148.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,148.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,208.25
|
| Rate for Payer: Multiplan Commercial |
$2,497.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,282.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,208.25
|
| Rate for Payer: United Healthcare Commercial |
$2,550.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,208.25
|
| Rate for Payer: United Healthcare VA CCN |
$1,208.25
|
|
|
ELBOW ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$2,161.00
|
|
|
Service Code
|
CPT 29834
|
| Hospital Charge Code |
9822983401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,599.36 |
| Max. Negotiated Rate |
$2,052.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,052.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,599.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,599.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,836.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,815.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,728.80
|
| Rate for Payer: Cash Price |
$1,080.50
|
| Rate for Payer: Cigna Commercial |
$1,728.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,728.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,728.80
|
| Rate for Payer: Multiplan Commercial |
$2,009.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,836.85
|
| Rate for Payer: United Healthcare Commercial |
$2,052.95
|
|
|
ELBOW ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$2,161.00
|
|
|
Service Code
|
CPT 29834
|
| Hospital Charge Code |
9822983401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$471.76 |
| Max. Negotiated Rate |
$2,031.34 |
| Rate for Payer: Aetna of VT Commercial |
$2,031.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,936.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$485.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,936.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$660.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$773.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$773.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$542.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$773.43
|
| Rate for Payer: Cash Price |
$1,080.50
|
| Rate for Payer: Cash Price |
$1,080.50
|
| Rate for Payer: Cigna Commercial |
$886.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$783.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$783.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$471.76
|
| Rate for Payer: Multiplan Commercial |
$2,009.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$669.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$471.76
|
| Rate for Payer: United Healthcare Commercial |
$725.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$471.76
|
| Rate for Payer: United Healthcare VA CCN |
$471.76
|
|
|
ELBOW ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$2,196.00
|
|
|
Service Code
|
CPT 29837
|
| Hospital Charge Code |
9822983701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,625.26 |
| Max. Negotiated Rate |
$2,086.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,086.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,625.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,625.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,866.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,844.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,756.80
|
| Rate for Payer: Cash Price |
$1,098.00
|
| Rate for Payer: Cigna Commercial |
$1,756.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,756.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,756.80
|
| Rate for Payer: Multiplan Commercial |
$2,042.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,866.60
|
| Rate for Payer: United Healthcare Commercial |
$2,086.20
|
|
|
ELBOW ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$2,196.00
|
|
|
Service Code
|
CPT 29837
|
| Hospital Charge Code |
9822983701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$495.24 |
| Max. Negotiated Rate |
$2,064.24 |
| Rate for Payer: Aetna of VT Commercial |
$2,064.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,967.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$510.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,967.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$693.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$966.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$966.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$569.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$966.88
|
| Rate for Payer: Cash Price |
$1,098.00
|
| Rate for Payer: Cash Price |
$1,098.00
|
| Rate for Payer: Cigna Commercial |
$944.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$823.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$823.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$495.24
|
| Rate for Payer: Multiplan Commercial |
$2,042.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$703.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$495.24
|
| Rate for Payer: United Healthcare Commercial |
$761.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$495.24
|
| Rate for Payer: United Healthcare VA CCN |
$495.24
|
|
|
ELBOW ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,161.00
|
|
|
Service Code
|
CPT 29834
|
| Hospital Charge Code |
9822983401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$957.11 |
| Max. Negotiated Rate |
$2,052.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,052.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,936.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$957.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,936.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,300.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,836.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,750.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$972.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,717.99
|
| Rate for Payer: Cash Price |
$1,080.50
|
| Rate for Payer: Cigna Commercial |
$1,728.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,728.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,728.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$972.45
|
| Rate for Payer: Multiplan Commercial |
$2,009.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,836.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$972.45
|
| Rate for Payer: United Healthcare Commercial |
$2,052.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$972.45
|
| Rate for Payer: United Healthcare VA CCN |
$972.45
|
|
|
ELBOW ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,196.00
|
|
|
Service Code
|
CPT 29837
|
| Hospital Charge Code |
9822983701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$972.61 |
| Max. Negotiated Rate |
$2,086.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,086.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,967.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$972.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,967.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,321.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,866.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,778.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$988.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,745.82
|
| Rate for Payer: Cash Price |
$1,098.00
|
| Rate for Payer: Cigna Commercial |
$1,756.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,756.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,756.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$988.20
|
| Rate for Payer: Multiplan Commercial |
$2,042.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,866.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$988.20
|
| Rate for Payer: United Healthcare Commercial |
$2,086.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$988.20
|
| Rate for Payer: United Healthcare VA CCN |
$988.20
|
|
|
ELEC STIM OTHER THAN WOUND
|
Facility
|
OP
|
$51.70
|
|
|
Service Code
|
HCPCS G0283 GP
|
| Hospital Charge Code |
4200028301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.90 |
| Max. Negotiated Rate |
$49.12 |
| Rate for Payer: Aetna of VT Commercial |
$49.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$46.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$46.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$43.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$41.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$41.10
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Cigna Commercial |
$41.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$41.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$41.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$23.27
|
| Rate for Payer: Multiplan Commercial |
$48.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.27
|
| Rate for Payer: United Healthcare Commercial |
$49.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.27
|
| Rate for Payer: United Healthcare VA CCN |
$23.27
|
|
|
ELEC STIM OTHER THAN WOUND
|
Facility
|
OP
|
$51.70
|
|
|
Service Code
|
HCPCS G0283 GO
|
| Hospital Charge Code |
4300028301
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$22.90 |
| Max. Negotiated Rate |
$49.12 |
| Rate for Payer: Aetna of VT Commercial |
$49.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$46.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$46.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$43.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$41.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$41.10
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Cigna Commercial |
$41.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$41.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$41.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$23.27
|
| Rate for Payer: Multiplan Commercial |
$48.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.27
|
| Rate for Payer: United Healthcare Commercial |
$49.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.27
|
| Rate for Payer: United Healthcare VA CCN |
$23.27
|
|
|
ELEC STIM OTHER THAN WOUND
|
Facility
|
IP
|
$51.70
|
|
|
Service Code
|
HCPCS G0283 GO
|
| Hospital Charge Code |
4300028301
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$38.26 |
| Max. Negotiated Rate |
$49.12 |
| Rate for Payer: Aetna of VT Commercial |
$49.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$43.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$43.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$41.36
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Cigna Commercial |
$41.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$41.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$41.36
|
| Rate for Payer: Multiplan Commercial |
$48.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$43.95
|
| Rate for Payer: United Healthcare Commercial |
$49.12
|
|
|
ELEC STIM OTHER THAN WOUND
|
Facility
|
IP
|
$51.70
|
|
|
Service Code
|
HCPCS G0283 GP
|
| Hospital Charge Code |
4200028301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$38.26 |
| Max. Negotiated Rate |
$49.12 |
| Rate for Payer: Aetna of VT Commercial |
$49.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$43.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$43.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$41.36
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Cigna Commercial |
$41.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$41.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$41.36
|
| Rate for Payer: Multiplan Commercial |
$48.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$43.95
|
| Rate for Payer: United Healthcare Commercial |
$49.12
|
|
|
ELECTRICAL STIMULATION
|
Facility
|
IP
|
$47.56
|
|
|
Service Code
|
CPT 97032 GP
|
| Hospital Charge Code |
9409703201
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$45.18 |
| Rate for Payer: Aetna of VT Commercial |
$45.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$35.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$35.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$40.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$39.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$38.05
|
| Rate for Payer: Cash Price |
$23.78
|
| Rate for Payer: Cigna Commercial |
$38.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$38.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$38.05
|
| Rate for Payer: Multiplan Commercial |
$44.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.43
|
| Rate for Payer: United Healthcare Commercial |
$45.18
|
|
