|
ARTHREX AMNION MATRIX 4X6
|
Facility
|
OP
|
$3,127.85
|
|
| Hospital Charge Code |
2780064351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,385.32 |
| Max. Negotiated Rate |
$2,971.46 |
| Rate for Payer: Aetna of VT Commercial |
$2,971.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,802.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,385.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,802.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,882.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,658.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,533.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,407.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,486.64
|
| Rate for Payer: Cash Price |
$1,563.92
|
| Rate for Payer: Cigna Commercial |
$2,502.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,502.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,502.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,407.53
|
| Rate for Payer: Multiplan Commercial |
$2,908.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,658.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,407.53
|
| Rate for Payer: United Healthcare Commercial |
$2,971.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,407.53
|
| Rate for Payer: United Healthcare VA CCN |
$1,407.53
|
|
|
ARTHRODESIS ANKLE OPEN
|
Professional
|
Both
|
$3,398.00
|
|
|
Service Code
|
CPT 27870
|
| Hospital Charge Code |
9822787001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$946.29 |
| Max. Negotiated Rate |
$3,194.12 |
| Rate for Payer: Aetna of VT Commercial |
$3,194.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,044.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$974.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,044.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,324.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,573.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,573.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,088.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,573.93
|
| Rate for Payer: Cash Price |
$1,699.00
|
| Rate for Payer: Cash Price |
$1,699.00
|
| Rate for Payer: Cigna Commercial |
$1,795.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,574.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,574.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$946.29
|
| Rate for Payer: Multiplan Commercial |
$3,160.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,343.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$946.29
|
| Rate for Payer: United Healthcare Commercial |
$1,455.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$946.29
|
| Rate for Payer: United Healthcare VA CCN |
$946.29
|
|
|
ARTHRODESIS ANKLE OPEN
|
Facility
|
IP
|
$3,398.00
|
|
|
Service Code
|
CPT 27870
|
| Hospital Charge Code |
9822787001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,514.86 |
| Max. Negotiated Rate |
$3,228.10 |
| Rate for Payer: Aetna of VT Commercial |
$3,228.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,514.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,514.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,888.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,854.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,718.40
|
| Rate for Payer: Cash Price |
$1,699.00
|
| Rate for Payer: Cigna Commercial |
$2,718.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,718.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,718.40
|
| Rate for Payer: Multiplan Commercial |
$3,160.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,888.30
|
| Rate for Payer: United Healthcare Commercial |
$3,228.10
|
|
|
ARTHRODESIS ANKLE OPEN
|
Facility
|
OP
|
$3,398.00
|
|
|
Service Code
|
CPT 27870
|
| Hospital Charge Code |
9822787001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,504.97 |
| Max. Negotiated Rate |
$3,228.10 |
| Rate for Payer: Aetna of VT Commercial |
$3,228.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,044.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,504.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,044.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,045.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,888.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,752.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,529.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,701.41
|
| Rate for Payer: Cash Price |
$1,699.00
|
| Rate for Payer: Cigna Commercial |
$2,718.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,718.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,718.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,529.10
|
| Rate for Payer: Multiplan Commercial |
$3,160.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,888.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,529.10
|
| Rate for Payer: United Healthcare Commercial |
$3,228.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,529.10
|
| Rate for Payer: United Healthcare VA CCN |
$1,529.10
|
|
|
ARTHRODESIS TRIPLE
|
Professional
|
Both
|
$4,396.60
|
|
|
Service Code
|
CPT 28715
|
| Hospital Charge Code |
9822871501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$889.07 |
| Max. Negotiated Rate |
$4,132.80 |
| Rate for Payer: Aetna of VT Commercial |
$4,132.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,938.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$915.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,938.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,244.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,703.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,703.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,022.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,703.45
|
| Rate for Payer: Cash Price |
$2,198.30
|
| Rate for Payer: Cash Price |
$2,198.30
|
| Rate for Payer: Cigna Commercial |
$1,680.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,475.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,475.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$889.07
|
| Rate for Payer: Multiplan Commercial |
$4,088.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,262.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$889.07
|
| Rate for Payer: United Healthcare Commercial |
$1,367.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$889.07
|
| Rate for Payer: United Healthcare VA CCN |
$889.07
|
|
|
ARTHRODESIS TRIPLE
|
Facility
|
IP
|
$4,396.60
|
|
|
Service Code
|
CPT 28715
|
| Hospital Charge Code |
9822871501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$3,253.92 |
| Max. Negotiated Rate |
$4,176.77 |
| Rate for Payer: Aetna of VT Commercial |
$4,176.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,253.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,253.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,737.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,693.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,517.28
|
| Rate for Payer: Cash Price |
$2,198.30
|
| Rate for Payer: Cigna Commercial |
$3,517.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,517.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,517.28
|
| Rate for Payer: Multiplan Commercial |
$4,088.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,737.11
|
| Rate for Payer: United Healthcare Commercial |
$4,176.77
|
|
|
ARTHRODESIS TRIPLE
|
Facility
|
OP
|
$4,396.60
|
|
|
Service Code
|
CPT 28715
|
| Hospital Charge Code |
9822871501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,947.25 |
| Max. Negotiated Rate |
$4,176.77 |
| Rate for Payer: Aetna of VT Commercial |
$4,176.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,938.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,947.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,938.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,646.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,737.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,561.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,978.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,495.30
|
| Rate for Payer: Cash Price |
$2,198.30
|
| Rate for Payer: Cigna Commercial |
$3,517.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,517.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,517.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,978.47
|
| Rate for Payer: Multiplan Commercial |
$4,088.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,737.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,978.47
|
| Rate for Payer: United Healthcare Commercial |
$4,176.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,978.47
|
| Rate for Payer: United Healthcare VA CCN |
$1,978.47
|
|
|
ARTHROPLASTY KNEE TIBIAL PLATE
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 27440
|
| Hospital Charge Code |
9822744001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$606.14 |
| Max. Negotiated Rate |
$778.05 |
| Rate for Payer: Aetna of VT Commercial |
$778.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$606.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$606.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$696.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$687.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$655.20
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: Cigna Commercial |
$655.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$655.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$655.20
|
| Rate for Payer: Multiplan Commercial |
$761.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$696.15
|
| Rate for Payer: United Healthcare Commercial |
$778.05
|
|
|
ARTHROPLASTY KNEE TIBIAL PLATE
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 27440
|
| Hospital Charge Code |
9822744001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$362.74 |
| Max. Negotiated Rate |
$778.05 |
| Rate for Payer: Aetna of VT Commercial |
$778.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$733.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$362.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$733.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$493.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$696.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$663.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$368.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$651.11
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: Cigna Commercial |
$655.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$655.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$655.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$368.55
|
| Rate for Payer: Multiplan Commercial |
$761.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$696.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$368.55
|
| Rate for Payer: United Healthcare Commercial |
$778.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$368.55
|
| Rate for Payer: United Healthcare VA CCN |
$368.55
|
|
|
ARTHROPLASTY KNEE TIBIAL PLATE
|
Facility
|
IP
|
$15,318.71
|
|
|
Service Code
|
CPT 27440
|
| Hospital Charge Code |
3602744001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,337.38 |
| Max. Negotiated Rate |
$14,552.77 |
| Rate for Payer: Aetna of VT Commercial |
$14,552.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$11,337.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$11,337.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13,020.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12,867.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$12,254.97
|
| Rate for Payer: Cash Price |
$7,659.35
|
| Rate for Payer: Cigna Commercial |
$12,254.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12,254.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12,254.97
|
| Rate for Payer: Multiplan Commercial |
$14,246.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13,020.90
|
| Rate for Payer: United Healthcare Commercial |
$14,552.77
|
|
|
ARTHROPLASTY KNEE TIBIAL PLATE
|
Professional
|
Both
|
$819.00
|
|
|
Service Code
|
CPT 55100
|
| Hospital Charge Code |
9822744001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$159.16 |
| Max. Negotiated Rate |
$769.86 |
| Rate for Payer: Aetna of VT Commercial |
$769.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$733.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$163.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$733.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$222.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$401.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$401.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$183.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$401.44
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: Cigna Commercial |
$276.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$358.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$358.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$218.91
|
| Rate for Payer: Multiplan Commercial |
$761.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$226.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$159.16
|
| Rate for Payer: United Healthcare Commercial |
$244.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.16
|
| Rate for Payer: United Healthcare VA CCN |
$159.16
|
|
|
ARTHROPLASTY KNEE TIBIAL PLATE
|
Facility
|
OP
|
$15,318.71
|
|
|
Service Code
|
CPT 27440
|
| Hospital Charge Code |
3602744001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,784.66 |
| Max. Negotiated Rate |
$14,552.77 |
| Rate for Payer: Aetna of VT Commercial |
$14,552.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$13,724.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$6,784.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$13,724.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$9,221.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13,020.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12,408.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6,893.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$12,178.37
|
| Rate for Payer: Cash Price |
$7,659.35
|
| Rate for Payer: Cigna Commercial |
$12,254.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12,254.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12,254.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$6,893.42
|
| Rate for Payer: Multiplan Commercial |
$14,246.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,578.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6,893.42
|
| Rate for Payer: United Healthcare Commercial |
$14,552.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,893.42
|
| Rate for Payer: United Healthcare VA CCN |
$6,893.42
|
|
|
ARTHRT KNE W/EXPL DRG/RMVL FB
|
Facility
|
OP
|
$2,450.00
|
|
|
Service Code
|
CPT 27310
|
| Hospital Charge Code |
9822731001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,085.11 |
| Max. Negotiated Rate |
$2,327.50 |
| Rate for Payer: Aetna of VT Commercial |
$2,327.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,194.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,085.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,194.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,474.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,082.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,984.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,102.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,947.75
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$1,960.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,960.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,960.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,102.50
|
| Rate for Payer: Multiplan Commercial |
$2,278.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,082.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,102.50
|
| Rate for Payer: United Healthcare Commercial |
$2,327.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,102.50
|
| Rate for Payer: United Healthcare VA CCN |
$1,102.50
|
|
|
ARTHRT KNE W/EXPL DRG/RMVL FB
|
Facility
|
IP
|
$2,450.00
|
|
|
Service Code
|
CPT 27310
|
| Hospital Charge Code |
9822731001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,813.24 |
| Max. Negotiated Rate |
$2,327.50 |
| Rate for Payer: Aetna of VT Commercial |
$2,327.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,813.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,813.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,082.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,058.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,960.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$1,960.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,960.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,960.00
|
| Rate for Payer: Multiplan Commercial |
$2,278.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,082.50
|
| Rate for Payer: United Healthcare Commercial |
$2,327.50
|
|
|
ARTHRT KNE W/EXPL DRG/RMVL FB
|
Professional
|
Both
|
$2,450.00
|
|
|
Service Code
|
CPT 27310
|
| Hospital Charge Code |
9822731001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$693.29 |
| Max. Negotiated Rate |
$2,303.00 |
| Rate for Payer: Aetna of VT Commercial |
$2,303.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,194.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$714.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,194.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$970.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$982.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$982.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$797.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$982.92
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$1,312.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,156.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,156.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$693.29
|
| Rate for Payer: Multiplan Commercial |
$2,278.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$984.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$693.29
|
| Rate for Payer: United Healthcare Commercial |
$1,066.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$693.29
|
| Rate for Payer: United Healthcare VA CCN |
$693.29
|
|
|
ASAY OF INTERLEUKIN-6 (IL-6)
|
Facility
|
IP
|
$179.24
|
|
|
Service Code
|
CPT 83529
|
| Hospital Charge Code |
3008352901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$132.66 |
| Max. Negotiated Rate |
$170.28 |
| Rate for Payer: Aetna of VT Commercial |
$170.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$132.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$132.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.39
|
| Rate for Payer: Cash Price |
$89.62
|
| Rate for Payer: Cigna Commercial |
$143.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.39
|
| Rate for Payer: Multiplan Commercial |
$166.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.35
|
| Rate for Payer: United Healthcare Commercial |
$170.28
|
|
|
ASAY OF INTERLEUKIN-6 (IL-6)
|
Professional
|
Both
|
$179.24
|
|
|
Service Code
|
CPT 83529
|
| Hospital Charge Code |
3008352901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$168.49 |
| Rate for Payer: Aetna of VT Commercial |
$168.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$85.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$17.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$85.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$24.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.36
|
| Rate for Payer: Cash Price |
$89.62
|
| Rate for Payer: Cash Price |
$89.62
|
| Rate for Payer: Cigna Commercial |
$21.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$17.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$17.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.03
|
| Rate for Payer: Multiplan Commercial |
$166.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$26.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare VA CCN |
$17.27
|
|
|
ASAY OF INTERLEUKIN-6 (IL-6)
|
Facility
|
OP
|
$179.24
|
|
|
Service Code
|
CPT 83529
|
| Hospital Charge Code |
3008352901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$170.28 |
| Rate for Payer: Aetna of VT Commercial |
$170.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$85.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$85.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$142.50
|
| Rate for Payer: Cash Price |
$89.62
|
| Rate for Payer: Cash Price |
$89.62
|
| Rate for Payer: Cigna Commercial |
$143.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.66
|
| Rate for Payer: Multiplan Commercial |
$166.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.66
|
| Rate for Payer: United Healthcare Commercial |
$170.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare VA CCN |
$80.66
|
|
|
ASPIRATE PLEURA W/ IMAGING
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
9823255501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$100.39 |
| Max. Negotiated Rate |
$561.62 |
| Rate for Payer: Aetna of VT Commercial |
$498.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$474.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$474.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$140.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$561.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$561.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$115.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$561.62
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$182.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$472.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$472.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$292.47
|
| Rate for Payer: Multiplan Commercial |
$492.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.39
|
| Rate for Payer: United Healthcare Commercial |
$154.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.39
|
| Rate for Payer: United Healthcare VA CCN |
$100.39
|
|
|
ASPIRATE PLEURA W/ IMAGING
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
9823255501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$392.25 |
| Max. Negotiated Rate |
$503.50 |
| Rate for Payer: Aetna of VT Commercial |
$503.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$392.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$392.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$450.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$445.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$424.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$424.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$424.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$424.00
|
| Rate for Payer: Multiplan Commercial |
$492.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$450.50
|
| Rate for Payer: United Healthcare Commercial |
$503.50
|
|
|
ASPIRATE PLEURA W/ IMAGING
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
9823255501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$234.74 |
| Max. Negotiated Rate |
$503.50 |
| Rate for Payer: Aetna of VT Commercial |
$503.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$474.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$234.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$474.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$319.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$450.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$429.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$421.35
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$424.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$424.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$424.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$238.50
|
| Rate for Payer: Multiplan Commercial |
$492.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$450.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$238.50
|
| Rate for Payer: United Healthcare Commercial |
$503.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$238.50
|
| Rate for Payer: United Healthcare VA CCN |
$238.50
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
9813255401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$81.02 |
| Max. Negotiated Rate |
$400.03 |
| Rate for Payer: Aetna of VT Commercial |
$399.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$83.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$113.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$400.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$400.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$400.03
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$147.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$353.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$353.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$217.85
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$81.02
|
| Rate for Payer: United Healthcare Commercial |
$124.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.02
|
| Rate for Payer: United Healthcare VA CCN |
$81.02
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
9603255402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$314.54 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna of VT Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$314.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$314.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$361.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$340.00
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.00
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$361.25
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
9813255401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$188.23 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna of VT Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$188.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$255.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$361.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$344.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.88
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$361.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$191.25
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.25
|
| Rate for Payer: United Healthcare VA CCN |
$191.25
|
|
|
ASPIRATE PLEURA W/O IMAGING
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
9823255401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$188.23 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna of VT Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$188.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$255.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$361.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$344.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.88
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$361.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$191.25
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.25
|
| Rate for Payer: United Healthcare VA CCN |
$191.25
|
|
