|
EXC S/N/H/F/G MAL+MRG 2.1-3
|
Facility
|
OP
|
$918.00
|
|
|
Service Code
|
CPT 11623
|
| Hospital Charge Code |
9821162301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna of VT Commercial |
$872.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$822.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$406.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$822.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$552.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$780.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$743.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$413.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$729.81
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cigna Commercial |
$734.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$734.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$734.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$413.10
|
| Rate for Payer: Multiplan Commercial |
$853.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$780.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$413.10
|
| Rate for Payer: United Healthcare Commercial |
$872.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$413.10
|
| Rate for Payer: United Healthcare VA CCN |
$413.10
|
|
|
EXC S/N/H/F/G MAL+MRG 2.1-3
|
Professional
|
Both
|
$918.00
|
|
|
Service Code
|
CPT 11623
|
| Hospital Charge Code |
9821162301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$196.91 |
| Max. Negotiated Rate |
$862.92 |
| Rate for Payer: Aetna of VT Commercial |
$862.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$822.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$202.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$822.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$275.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$365.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$365.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$226.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$365.65
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cigna Commercial |
$221.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$457.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$457.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$280.11
|
| Rate for Payer: Multiplan Commercial |
$853.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$279.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$196.91
|
| Rate for Payer: United Healthcare Commercial |
$302.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$196.91
|
| Rate for Payer: United Healthcare VA CCN |
$196.91
|
|
|
EXC S/N/H/F/G MAL+MRG >4 CM
|
Professional
|
Both
|
$1,028.00
|
|
|
Service Code
|
CPT 11626
|
| Hospital Charge Code |
9601162602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$270.26 |
| Max. Negotiated Rate |
$966.32 |
| Rate for Payer: Aetna of VT Commercial |
$966.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$920.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$278.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$920.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$378.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$554.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$554.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$310.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$554.02
|
| Rate for Payer: Cash Price |
$514.00
|
| Rate for Payer: Cash Price |
$514.00
|
| Rate for Payer: Cigna Commercial |
$303.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$627.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$627.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$381.40
|
| Rate for Payer: Multiplan Commercial |
$956.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$383.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$270.26
|
| Rate for Payer: United Healthcare Commercial |
$415.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$270.26
|
| Rate for Payer: United Healthcare VA CCN |
$270.26
|
|
|
EXC S/N/H/F/G MAL+MRG >4 CM
|
Facility
|
OP
|
$1,028.00
|
|
|
Service Code
|
CPT 11626
|
| Hospital Charge Code |
9601162602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$455.30 |
| Max. Negotiated Rate |
$976.60 |
| Rate for Payer: Aetna of VT Commercial |
$976.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$920.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$455.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$920.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$618.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$873.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$832.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$462.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$817.26
|
| Rate for Payer: Cash Price |
$514.00
|
| Rate for Payer: Cigna Commercial |
$822.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$822.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$822.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$462.60
|
| Rate for Payer: Multiplan Commercial |
$956.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$873.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$462.60
|
| Rate for Payer: United Healthcare Commercial |
$976.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$462.60
|
| Rate for Payer: United Healthcare VA CCN |
$462.60
|
|
|
EXC S/N/H/F/G MAL+MRG >4 CM
|
Facility
|
IP
|
$4,043.00
|
|
|
Service Code
|
CPT 11626
|
| Hospital Charge Code |
5101162601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,992.22 |
| Max. Negotiated Rate |
$3,840.85 |
| Rate for Payer: Aetna of VT Commercial |
$3,840.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,992.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,992.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,436.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,396.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,234.40
|
| Rate for Payer: Cash Price |
$2,021.50
|
| Rate for Payer: Cigna Commercial |
$3,234.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,234.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,234.40
|
| Rate for Payer: Multiplan Commercial |
$3,759.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,436.55
|
| Rate for Payer: United Healthcare Commercial |
$3,840.85
|
|
|
EXC S/N/H/F/G MAL+MRG >4 CM
|
Facility
|
OP
|
$5,071.00
|
|
|
Service Code
|
CPT 11626
|
| Hospital Charge Code |
9601162601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,245.95 |
| Max. Negotiated Rate |
$4,817.45 |
| Rate for Payer: Aetna of VT Commercial |
$4,817.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,543.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,245.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,543.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,052.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,310.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,107.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,281.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,031.45
|
| Rate for Payer: Cash Price |
$2,535.50
|
| Rate for Payer: Cigna Commercial |
$4,056.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,056.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,056.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,281.95
|
| Rate for Payer: Multiplan Commercial |
$4,716.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,310.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,281.95
|
| Rate for Payer: United Healthcare Commercial |
$4,817.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,281.95
|
| Rate for Payer: United Healthcare VA CCN |
$2,281.95
|
|
|
EXC S/N/H/F/G MAL+MRG >4 CM
|
Professional
|
Both
|
$4,043.00
|
|
|
Service Code
|
CPT 11626
|
| Hospital Charge Code |
5101162601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$270.26 |
| Max. Negotiated Rate |
$3,800.42 |
| Rate for Payer: Aetna of VT Commercial |
$3,800.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,622.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$278.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,622.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$378.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$554.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$554.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$310.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$554.02
|
| Rate for Payer: Cash Price |
$2,021.50
|
| Rate for Payer: Cash Price |
$2,021.50
|
| Rate for Payer: Cigna Commercial |
$303.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$627.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$627.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$381.40
|
| Rate for Payer: Multiplan Commercial |
$3,759.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$383.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$270.26
|
| Rate for Payer: United Healthcare Commercial |
$415.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$270.26
|
| Rate for Payer: United Healthcare VA CCN |
$270.26
|
|
|
EXC S/N/H/F/G MAL+MRG >4 CM
|
Facility
|
IP
|
$1,028.00
|
|
|
Service Code
|
CPT 11626
|
| Hospital Charge Code |
9601162602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$760.82 |
| Max. Negotiated Rate |
$976.60 |
| Rate for Payer: Aetna of VT Commercial |
$976.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$760.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$760.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$873.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$863.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$822.40
|
| Rate for Payer: Cash Price |
$514.00
|
| Rate for Payer: Cigna Commercial |
$822.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$822.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$822.40
|
| Rate for Payer: Multiplan Commercial |
$956.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$873.80
|
| Rate for Payer: United Healthcare Commercial |
$976.60
|
|
|
EXC S/N/H/F/G MAL+MRG >4 CM
|
Facility
|
IP
|
$5,071.00
|
|
|
Service Code
|
CPT 11626
|
| Hospital Charge Code |
9601162601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,753.05 |
| Max. Negotiated Rate |
$4,817.45 |
| Rate for Payer: Aetna of VT Commercial |
$4,817.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,753.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,753.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,310.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,259.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,056.80
|
| Rate for Payer: Cash Price |
$2,535.50
|
| Rate for Payer: Cigna Commercial |
$4,056.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,056.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,056.80
|
| Rate for Payer: Multiplan Commercial |
$4,716.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,310.35
|
| Rate for Payer: United Healthcare Commercial |
$4,817.45
|
|
|
EXC S/N/H/F/G MAL+MRG >4 CM
|
Facility
|
OP
|
$4,043.00
|
|
|
Service Code
|
CPT 11626
|
| Hospital Charge Code |
5101162601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,790.64 |
| Max. Negotiated Rate |
$3,840.85 |
| Rate for Payer: Aetna of VT Commercial |
$3,840.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,622.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,790.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,622.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,433.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,436.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,274.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,819.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,214.18
|
| Rate for Payer: Cash Price |
$2,021.50
|
| Rate for Payer: Cigna Commercial |
$3,234.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,234.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,234.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,819.35
|
| Rate for Payer: Multiplan Commercial |
$3,759.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,436.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,819.35
|
| Rate for Payer: United Healthcare Commercial |
$3,840.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,819.35
|
| Rate for Payer: United Healthcare VA CCN |
$1,819.35
|
|
|
EXC S/N/H/F/G MAL+MRG >4 CM
|
Professional
|
Both
|
$5,071.00
|
|
|
Service Code
|
CPT 11626
|
| Hospital Charge Code |
9601162601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$270.26 |
| Max. Negotiated Rate |
$4,766.74 |
| Rate for Payer: Aetna of VT Commercial |
$4,766.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,543.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$278.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,543.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$378.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$554.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$554.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$310.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$554.02
|
| Rate for Payer: Cash Price |
$2,535.50
|
| Rate for Payer: Cash Price |
$2,535.50
|
| Rate for Payer: Cigna Commercial |
$303.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$627.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$627.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$381.40
|
| Rate for Payer: Multiplan Commercial |
$4,716.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$383.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$270.26
|
| Rate for Payer: United Healthcare Commercial |
$415.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$270.26
|
| Rate for Payer: United Healthcare VA CCN |
$270.26
|
|
|
EXC THIGH/KNEE LES SC < 3 CM
|
Facility
|
IP
|
$4,680.00
|
|
|
Service Code
|
CPT 27327
|
| Hospital Charge Code |
9602732701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,463.67 |
| Max. Negotiated Rate |
$4,446.00 |
| Rate for Payer: Aetna of VT Commercial |
$4,446.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,463.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,463.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,978.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,931.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,744.00
|
| Rate for Payer: Cash Price |
$2,340.00
|
| Rate for Payer: Cigna Commercial |
$3,744.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,744.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,744.00
|
| Rate for Payer: Multiplan Commercial |
$4,352.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,978.00
|
| Rate for Payer: United Healthcare Commercial |
$4,446.00
|
|
|
EXC THIGH/KNEE LES SC < 3 CM
|
Professional
|
Both
|
$4,680.00
|
|
|
Service Code
|
CPT 27327
|
| Hospital Charge Code |
9602732701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$298.44 |
| Max. Negotiated Rate |
$4,399.20 |
| Rate for Payer: Aetna of VT Commercial |
$4,399.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,192.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$307.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,192.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$417.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$624.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$624.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$343.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$624.88
|
| Rate for Payer: Cash Price |
$2,340.00
|
| Rate for Payer: Cash Price |
$2,340.00
|
| Rate for Payer: Cigna Commercial |
$566.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$768.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$768.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$468.03
|
| Rate for Payer: Multiplan Commercial |
$4,352.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$423.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$298.44
|
| Rate for Payer: United Healthcare Commercial |
$459.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$298.44
|
| Rate for Payer: United Healthcare VA CCN |
$298.44
|
|
|
EXC THIGH/KNEE LES SC < 3 CM
|
Professional
|
Both
|
$3,618.00
|
|
|
Service Code
|
CPT 27327
|
| Hospital Charge Code |
5102732701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$298.44 |
| Max. Negotiated Rate |
$3,400.92 |
| Rate for Payer: Aetna of VT Commercial |
$3,400.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,241.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$307.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,241.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$417.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$624.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$624.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$343.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$624.88
|
| Rate for Payer: Cash Price |
$1,809.00
|
| Rate for Payer: Cash Price |
$1,809.00
|
| Rate for Payer: Cigna Commercial |
$566.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$768.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$768.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$468.03
|
| Rate for Payer: Multiplan Commercial |
$3,364.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$423.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$298.44
|
| Rate for Payer: United Healthcare Commercial |
$459.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$298.44
|
| Rate for Payer: United Healthcare VA CCN |
$298.44
|
|
|
EXC THIGH/KNEE LES SC < 3 CM
|
Facility
|
OP
|
$4,680.00
|
|
|
Service Code
|
CPT 27327
|
| Hospital Charge Code |
9602732701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,072.77 |
| Max. Negotiated Rate |
$4,446.00 |
| Rate for Payer: Aetna of VT Commercial |
$4,446.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,192.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,072.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,192.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,817.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,978.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,790.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,106.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,720.60
|
| Rate for Payer: Cash Price |
$2,340.00
|
| Rate for Payer: Cigna Commercial |
$3,744.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,744.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,744.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,106.00
|
| Rate for Payer: Multiplan Commercial |
$4,352.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,978.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,106.00
|
| Rate for Payer: United Healthcare Commercial |
$4,446.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,106.00
|
| Rate for Payer: United Healthcare VA CCN |
$2,106.00
|
|
|
EXC THIGH/KNEE LES SC < 3 CM
|
Facility
|
OP
|
$1,062.00
|
|
|
Service Code
|
CPT 27327
|
| Hospital Charge Code |
9602732702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$470.36 |
| Max. Negotiated Rate |
$1,008.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,008.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$951.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$470.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$951.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$639.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$902.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$860.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$477.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$844.29
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$849.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$849.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$849.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$477.90
|
| Rate for Payer: Multiplan Commercial |
$987.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$902.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$477.90
|
| Rate for Payer: United Healthcare Commercial |
$1,008.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$477.90
|
| Rate for Payer: United Healthcare VA CCN |
$477.90
|
|
|
EXC THIGH/KNEE LES SC < 3 CM
|
Facility
|
IP
|
$1,062.00
|
|
|
Service Code
|
CPT 27327
|
| Hospital Charge Code |
9602732702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$785.99 |
| Max. Negotiated Rate |
$1,008.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,008.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$785.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$785.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$902.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$892.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$849.60
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$849.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$849.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$849.60
|
| Rate for Payer: Multiplan Commercial |
$987.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$902.70
|
| Rate for Payer: United Healthcare Commercial |
$1,008.90
|
|
|
EXC THIGH/KNEE LES SC < 3 CM
|
Facility
|
OP
|
$3,618.00
|
|
|
Service Code
|
CPT 27327
|
| Hospital Charge Code |
5102732701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,602.41 |
| Max. Negotiated Rate |
$3,437.10 |
| Rate for Payer: Aetna of VT Commercial |
$3,437.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,241.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,602.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,241.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,178.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,075.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,930.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,628.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,876.31
|
| Rate for Payer: Cash Price |
$1,809.00
|
| Rate for Payer: Cigna Commercial |
$2,894.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,894.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,894.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,628.10
|
| Rate for Payer: Multiplan Commercial |
$3,364.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,075.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,628.10
|
| Rate for Payer: United Healthcare Commercial |
$3,437.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,628.10
|
| Rate for Payer: United Healthcare VA CCN |
$1,628.10
|
|
|
EXC THIGH/KNEE LES SC < 3 CM
|
Professional
|
Both
|
$1,062.00
|
|
|
Service Code
|
CPT 27327
|
| Hospital Charge Code |
9602732702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$298.44 |
| Max. Negotiated Rate |
$998.28 |
| Rate for Payer: Aetna of VT Commercial |
$998.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$951.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$307.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$951.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$417.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$624.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$624.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$343.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$624.88
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$566.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$768.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$768.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$468.03
|
| Rate for Payer: Multiplan Commercial |
$987.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$423.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$298.44
|
| Rate for Payer: United Healthcare Commercial |
$459.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$298.44
|
| Rate for Payer: United Healthcare VA CCN |
$298.44
|
|
|
EXC THIGH/KNEE LES SC < 3 CM
|
Facility
|
IP
|
$1,062.00
|
|
|
Service Code
|
CPT 27327
|
| Hospital Charge Code |
9822732701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$785.99 |
| Max. Negotiated Rate |
$1,008.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,008.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$785.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$785.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$902.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$892.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$849.60
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$849.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$849.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$849.60
|
| Rate for Payer: Multiplan Commercial |
$987.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$902.70
|
| Rate for Payer: United Healthcare Commercial |
$1,008.90
|
|
|
EXC THIGH/KNEE LES SC < 3 CM
|
Facility
|
IP
|
$3,618.00
|
|
|
Service Code
|
CPT 27327
|
| Hospital Charge Code |
5102732701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,677.68 |
| Max. Negotiated Rate |
$3,437.10 |
| Rate for Payer: Aetna of VT Commercial |
$3,437.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,677.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,677.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,075.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,039.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,894.40
|
| Rate for Payer: Cash Price |
$1,809.00
|
| Rate for Payer: Cigna Commercial |
$2,894.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,894.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,894.40
|
| Rate for Payer: Multiplan Commercial |
$3,364.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,075.30
|
| Rate for Payer: United Healthcare Commercial |
$3,437.10
|
|
|
EXC THIGH/KNEE LES SC < 3 CM
|
Professional
|
Both
|
$1,062.00
|
|
|
Service Code
|
CPT 27327
|
| Hospital Charge Code |
9822732701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$298.44 |
| Max. Negotiated Rate |
$998.28 |
| Rate for Payer: Aetna of VT Commercial |
$998.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$951.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$307.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$951.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$417.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$624.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$624.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$343.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$624.88
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$566.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$768.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$768.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$468.03
|
| Rate for Payer: Multiplan Commercial |
$987.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$423.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$298.44
|
| Rate for Payer: United Healthcare Commercial |
$459.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$298.44
|
| Rate for Payer: United Healthcare VA CCN |
$298.44
|
|
|
EXC THIGH/KNEE LES SC < 3 CM
|
Facility
|
OP
|
$1,062.00
|
|
|
Service Code
|
CPT 27327
|
| Hospital Charge Code |
9822732701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$470.36 |
| Max. Negotiated Rate |
$1,008.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,008.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$951.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$470.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$951.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$639.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$902.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$860.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$477.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$844.29
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$849.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$849.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$849.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$477.90
|
| Rate for Payer: Multiplan Commercial |
$987.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$902.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$477.90
|
| Rate for Payer: United Healthcare Commercial |
$1,008.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$477.90
|
| Rate for Payer: United Healthcare VA CCN |
$477.90
|
|
|
EXC THIGH/KNEE LES SC 3 CM/>
|
Facility
|
OP
|
$3,437.00
|
|
|
Service Code
|
CPT 27337
|
| Hospital Charge Code |
5102733701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,522.25 |
| Max. Negotiated Rate |
$3,265.15 |
| Rate for Payer: Aetna of VT Commercial |
$3,265.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,079.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,522.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,079.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,069.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,921.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,783.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,546.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,732.41
|
| Rate for Payer: Cash Price |
$1,718.50
|
| Rate for Payer: Cigna Commercial |
$2,749.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,749.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,749.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,546.65
|
| Rate for Payer: Multiplan Commercial |
$3,196.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,921.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,546.65
|
| Rate for Payer: United Healthcare Commercial |
$3,265.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,546.65
|
| Rate for Payer: United Healthcare VA CCN |
$1,546.65
|
|
|
EXC THIGH/KNEE LES SC 3 CM/>
|
Facility
|
OP
|
$1,009.00
|
|
|
Service Code
|
CPT 27337
|
| Hospital Charge Code |
9602733702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$446.89 |
| Max. Negotiated Rate |
$958.55 |
| Rate for Payer: Aetna of VT Commercial |
$958.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$903.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$446.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$903.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$607.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$857.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$817.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$454.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$802.15
|
| Rate for Payer: Cash Price |
$504.50
|
| Rate for Payer: Cigna Commercial |
$807.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$807.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$807.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$454.05
|
| Rate for Payer: Multiplan Commercial |
$938.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$857.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$454.05
|
| Rate for Payer: United Healthcare Commercial |
$958.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$454.05
|
| Rate for Payer: United Healthcare VA CCN |
$454.05
|
|
