|
EXC THIGH/KNEE LES SC 3 CM/>
|
Facility
|
IP
|
$1,009.00
|
|
|
Service Code
|
CPT 27337
|
| Hospital Charge Code |
9602733702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$746.76 |
| 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 |
$746.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$746.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$857.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$847.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$807.20
|
| 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: Multiplan Commercial |
$938.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$857.65
|
| Rate for Payer: United Healthcare Commercial |
$958.55
|
|
|
EXC THIGH/KNEE LES SC 3 CM/>
|
Professional
|
Both
|
$1,009.00
|
|
|
Service Code
|
CPT 27337
|
| Hospital Charge Code |
9602733702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$393.67 |
| Max. Negotiated Rate |
$948.46 |
| Rate for Payer: Aetna of VT Commercial |
$948.46
|
| 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 |
$405.48
|
| 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 |
$551.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$496.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$496.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$452.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$496.31
|
| Rate for Payer: Cash Price |
$504.50
|
| Rate for Payer: Cash Price |
$504.50
|
| Rate for Payer: Cigna Commercial |
$744.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$661.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$661.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$393.67
|
| Rate for Payer: Multiplan Commercial |
$938.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$559.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$393.67
|
| Rate for Payer: United Healthcare Commercial |
$605.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$393.67
|
| Rate for Payer: United Healthcare VA CCN |
$393.67
|
|
|
EXC THIGH/KNEE LES SC 3 CM/>
|
Facility
|
IP
|
$1,009.00
|
|
|
Service Code
|
CPT 27337
|
| Hospital Charge Code |
9822733701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$746.76 |
| 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 |
$746.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$746.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$857.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$847.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$807.20
|
| 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: Multiplan Commercial |
$938.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$857.65
|
| Rate for Payer: United Healthcare Commercial |
$958.55
|
|
|
EXC THIGH/KNEE LES SC 3 CM/>
|
Facility
|
OP
|
$4,446.00
|
|
|
Service Code
|
CPT 27337
|
| Hospital Charge Code |
9602733701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,969.13 |
| Max. Negotiated Rate |
$4,223.70 |
| Rate for Payer: Aetna of VT Commercial |
$4,223.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,983.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,969.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,983.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,676.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,779.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,601.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,000.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,534.57
|
| Rate for Payer: Cash Price |
$2,223.00
|
| Rate for Payer: Cigna Commercial |
$3,556.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,556.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,556.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,000.70
|
| Rate for Payer: Multiplan Commercial |
$4,134.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,779.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,000.70
|
| Rate for Payer: United Healthcare Commercial |
$4,223.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,000.70
|
| Rate for Payer: United Healthcare VA CCN |
$2,000.70
|
|
|
EXC THIGH/KNEE LES SC 3 CM/>
|
Professional
|
Both
|
$1,009.00
|
|
|
Service Code
|
CPT 27337
|
| Hospital Charge Code |
9822733701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$393.67 |
| Max. Negotiated Rate |
$948.46 |
| Rate for Payer: Aetna of VT Commercial |
$948.46
|
| 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 |
$405.48
|
| 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 |
$551.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$496.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$496.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$452.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$496.31
|
| Rate for Payer: Cash Price |
$504.50
|
| Rate for Payer: Cash Price |
$504.50
|
| Rate for Payer: Cigna Commercial |
$744.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$661.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$661.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$393.67
|
| Rate for Payer: Multiplan Commercial |
$938.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$559.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$393.67
|
| Rate for Payer: United Healthcare Commercial |
$605.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$393.67
|
| Rate for Payer: United Healthcare VA CCN |
$393.67
|
|
|
EXC THIGH/KNEE LES SC 3 CM/>
|
Professional
|
Both
|
$4,446.00
|
|
|
Service Code
|
CPT 27337
|
| Hospital Charge Code |
9602733701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$393.67 |
| Max. Negotiated Rate |
$4,179.24 |
| Rate for Payer: Aetna of VT Commercial |
$4,179.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,983.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$405.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,983.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$551.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$496.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$496.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$452.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$496.31
|
| Rate for Payer: Cash Price |
$2,223.00
|
| Rate for Payer: Cash Price |
$2,223.00
|
| Rate for Payer: Cigna Commercial |
$744.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$661.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$661.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$393.67
|
| Rate for Payer: Multiplan Commercial |
$4,134.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$559.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$393.67
|
| Rate for Payer: United Healthcare Commercial |
$605.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$393.67
|
| Rate for Payer: United Healthcare VA CCN |
$393.67
|
|
|
EXC THIGH/KNEE LES SC 3 CM/>
|
Facility
|
IP
|
$4,446.00
|
|
|
Service Code
|
CPT 27337
|
| Hospital Charge Code |
9602733701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,290.48 |
| Max. Negotiated Rate |
$4,223.70 |
| Rate for Payer: Aetna of VT Commercial |
$4,223.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,290.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,290.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,779.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,734.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,556.80
|
| Rate for Payer: Cash Price |
$2,223.00
|
| Rate for Payer: Cigna Commercial |
$3,556.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,556.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,556.80
|
| Rate for Payer: Multiplan Commercial |
$4,134.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,779.10
|
| Rate for Payer: United Healthcare Commercial |
$4,223.70
|
|
|
EXC THIGH/KNEE LES SC 3 CM/>
|
Facility
|
IP
|
$3,437.00
|
|
|
Service Code
|
CPT 27337
|
| Hospital Charge Code |
5102733701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,543.72 |
| 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 |
$2,543.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,543.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,921.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,887.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,749.60
|
| 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: Multiplan Commercial |
$3,196.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,921.45
|
| Rate for Payer: United Healthcare Commercial |
$3,265.15
|
|
|
EXC THIGH/KNEE LES SC 3 CM/>
|
Professional
|
Both
|
$3,437.00
|
|
|
Service Code
|
CPT 27337
|
| Hospital Charge Code |
5102733701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$393.67 |
| Max. Negotiated Rate |
$3,230.78 |
| Rate for Payer: Aetna of VT Commercial |
$3,230.78
|
| 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 |
$405.48
|
| 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 |
$551.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$496.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$496.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$452.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$496.31
|
| Rate for Payer: Cash Price |
$1,718.50
|
| Rate for Payer: Cash Price |
$1,718.50
|
| Rate for Payer: Cigna Commercial |
$744.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$661.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$661.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$393.67
|
| Rate for Payer: Multiplan Commercial |
$3,196.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$559.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$393.67
|
| Rate for Payer: United Healthcare Commercial |
$605.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$393.67
|
| Rate for Payer: United Healthcare VA CCN |
$393.67
|
|
|
EXC THIGH/KNEE LES SC 3 CM/>
|
Facility
|
OP
|
$1,009.00
|
|
|
Service Code
|
CPT 27337
|
| Hospital Charge Code |
9822733701
|
|
Hospital Revenue Code
|
982
|
| 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
|
|
|
EXC THIGH/KNEE TUM DEEP <5CM
|
Facility
|
IP
|
$1,735.00
|
|
|
Service Code
|
CPT 27328
|
| Hospital Charge Code |
9822732801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,284.07 |
| Max. Negotiated Rate |
$1,648.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,648.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,284.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,284.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,474.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,457.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,388.00
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,388.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,388.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,388.00
|
| Rate for Payer: Multiplan Commercial |
$1,613.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,474.75
|
| Rate for Payer: United Healthcare Commercial |
$1,648.25
|
|
|
EXC THIGH/KNEE TUM DEEP <5CM
|
Professional
|
Both
|
$1,735.00
|
|
|
Service Code
|
CPT 27328
|
| Hospital Charge Code |
9822732801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$583.62 |
| Max. Negotiated Rate |
$1,630.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,630.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,554.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$601.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,554.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$817.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$736.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$736.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$671.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$736.54
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,108.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$979.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$979.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$583.62
|
| Rate for Payer: Multiplan Commercial |
$1,613.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$828.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$583.62
|
| Rate for Payer: United Healthcare Commercial |
$897.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$583.62
|
| Rate for Payer: United Healthcare VA CCN |
$583.62
|
|
|
EXC THIGH/KNEE TUM DEEP <5CM
|
Facility
|
OP
|
$1,735.00
|
|
|
Service Code
|
CPT 27328
|
| Hospital Charge Code |
9822732801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$768.43 |
| Max. Negotiated Rate |
$1,648.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,648.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,554.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$768.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,554.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,044.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,474.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,405.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$780.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,379.33
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,388.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,388.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,388.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$780.75
|
| Rate for Payer: Multiplan Commercial |
$1,613.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,474.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$780.75
|
| Rate for Payer: United Healthcare Commercial |
$1,648.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$780.75
|
| Rate for Payer: United Healthcare VA CCN |
$780.75
|
|
|
EXC TR-EXT B9+MARG 0.5 CM<
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
9601140001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$80.75 |
| Max. Negotiated Rate |
$419.24 |
| Rate for Payer: Aetna of VT Commercial |
$419.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$399.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$83.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$399.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$113.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$176.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$176.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.08
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$90.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$197.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$197.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.55
|
| Rate for Payer: Multiplan Commercial |
$414.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.75
|
| Rate for Payer: United Healthcare Commercial |
$124.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.75
|
| Rate for Payer: United Healthcare VA CCN |
$80.75
|
|
|
EXC TR-EXT B9+MARG 0.5 CM<
|
Facility
|
IP
|
$446.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
9601140001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$330.08 |
| Max. Negotiated Rate |
$423.70 |
| Rate for Payer: Aetna of VT Commercial |
$423.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$330.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$330.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$379.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$374.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$356.80
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$356.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$356.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$356.80
|
| Rate for Payer: Multiplan Commercial |
$414.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$379.10
|
| Rate for Payer: United Healthcare Commercial |
$423.70
|
|
|
EXC TR-EXT B9+MARG 0.5 CM<
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
5101140001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$129.52 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Aetna of VT Commercial |
$166.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$129.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$129.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$148.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$140.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$148.75
|
| Rate for Payer: United Healthcare Commercial |
$166.25
|
|
|
EXC TR-EXT B9+MARG 0.5 CM<
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
9601140002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$120.03 |
| Max. Negotiated Rate |
$257.45 |
| Rate for Payer: Aetna of VT Commercial |
$257.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$242.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$120.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$242.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$163.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$230.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$219.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$121.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$215.44
|
| Rate for Payer: Cash Price |
$135.50
|
| Rate for Payer: Cigna Commercial |
$216.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$216.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$216.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.95
|
| Rate for Payer: Multiplan Commercial |
$252.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$230.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.95
|
| Rate for Payer: United Healthcare Commercial |
$257.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.95
|
| Rate for Payer: United Healthcare VA CCN |
$121.95
|
|
|
EXC TR-EXT B9+MARG 0.5 CM<
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
5101140001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.51 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Aetna of VT Commercial |
$166.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$156.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$77.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$156.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$105.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$148.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$141.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$139.12
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$140.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$78.75
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$148.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$78.75
|
| Rate for Payer: United Healthcare Commercial |
$166.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.75
|
| Rate for Payer: United Healthcare VA CCN |
$78.75
|
|
|
EXC TR-EXT B9+MARG 0.5 CM<
|
Facility
|
OP
|
$446.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
9601140001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$197.53 |
| Max. Negotiated Rate |
$423.70 |
| Rate for Payer: Aetna of VT Commercial |
$423.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$399.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$399.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$268.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$379.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$361.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$200.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$354.57
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$356.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$356.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$356.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$200.70
|
| Rate for Payer: Multiplan Commercial |
$414.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$379.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$200.70
|
| Rate for Payer: United Healthcare Commercial |
$423.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.70
|
| Rate for Payer: United Healthcare VA CCN |
$200.70
|
|
|
EXC TR-EXT B9+MARG 0.5 CM<
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
9821140001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$80.75 |
| Max. Negotiated Rate |
$254.74 |
| Rate for Payer: Aetna of VT Commercial |
$254.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$242.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$83.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$242.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$113.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$176.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$176.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.08
|
| Rate for Payer: Cash Price |
$135.50
|
| Rate for Payer: Cash Price |
$135.50
|
| Rate for Payer: Cigna Commercial |
$90.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$197.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$197.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.55
|
| Rate for Payer: Multiplan Commercial |
$252.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.75
|
| Rate for Payer: United Healthcare Commercial |
$124.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.75
|
| Rate for Payer: United Healthcare VA CCN |
$80.75
|
|
|
EXC TR-EXT B9+MARG 0.5 CM<
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
9821140001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$120.03 |
| Max. Negotiated Rate |
$257.45 |
| Rate for Payer: Aetna of VT Commercial |
$257.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$242.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$120.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$242.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$163.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$230.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$219.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$121.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$215.44
|
| Rate for Payer: Cash Price |
$135.50
|
| Rate for Payer: Cigna Commercial |
$216.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$216.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$216.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.95
|
| Rate for Payer: Multiplan Commercial |
$252.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$230.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.95
|
| Rate for Payer: United Healthcare Commercial |
$257.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.95
|
| Rate for Payer: United Healthcare VA CCN |
$121.95
|
|
|
EXC TR-EXT B9+MARG 0.5 CM<
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
9821140001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$200.57 |
| Max. Negotiated Rate |
$257.45 |
| Rate for Payer: Aetna of VT Commercial |
$257.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$200.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$200.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$230.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$227.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.80
|
| Rate for Payer: Cash Price |
$135.50
|
| Rate for Payer: Cigna Commercial |
$216.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$216.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$216.80
|
| Rate for Payer: Multiplan Commercial |
$252.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$230.35
|
| Rate for Payer: United Healthcare Commercial |
$257.45
|
|
|
EXC TR-EXT B9+MARG 0.5 CM<
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
9601140002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$200.57 |
| Max. Negotiated Rate |
$257.45 |
| Rate for Payer: Aetna of VT Commercial |
$257.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$200.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$200.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$230.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$227.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.80
|
| Rate for Payer: Cash Price |
$135.50
|
| Rate for Payer: Cigna Commercial |
$216.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$216.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$216.80
|
| Rate for Payer: Multiplan Commercial |
$252.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$230.35
|
| Rate for Payer: United Healthcare Commercial |
$257.45
|
|
|
EXC TR-EXT B9+MARG 0.5 CM<
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
9601140002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$80.75 |
| Max. Negotiated Rate |
$254.74 |
| Rate for Payer: Aetna of VT Commercial |
$254.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$242.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$83.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$242.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$113.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$176.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$176.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.08
|
| Rate for Payer: Cash Price |
$135.50
|
| Rate for Payer: Cash Price |
$135.50
|
| Rate for Payer: Cigna Commercial |
$90.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$197.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$197.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.55
|
| Rate for Payer: Multiplan Commercial |
$252.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.75
|
| Rate for Payer: United Healthcare Commercial |
$124.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.75
|
| Rate for Payer: United Healthcare VA CCN |
$80.75
|
|
|
EXC TR-EXT B9+MARG 0.5 CM<
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
5101140001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.75 |
| Max. Negotiated Rate |
$197.50 |
| Rate for Payer: Aetna of VT Commercial |
$164.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$156.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$83.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$156.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$113.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$176.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$176.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.08
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$90.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$197.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$197.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.55
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.75
|
| Rate for Payer: United Healthcare Commercial |
$124.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.75
|
| Rate for Payer: United Healthcare VA CCN |
$80.75
|
|
