|
IV INF THERAPY/PROPH DX =<1 HR
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
9819636502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$141.29 |
| Max. Negotiated Rate |
$303.05 |
| Rate for Payer: Aetna of VT Commercial |
$303.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$285.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$141.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$285.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$192.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$271.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$258.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$143.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$253.60
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna Commercial |
$255.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$255.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$255.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$143.55
|
| Rate for Payer: Multiplan Commercial |
$296.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$271.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$143.55
|
| Rate for Payer: United Healthcare Commercial |
$303.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$143.55
|
| Rate for Payer: United Healthcare VA CCN |
$143.55
|
|
|
IV INF THERAPY/PROPH DX =<1 HR
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
9819636501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
IV INF THERAPY/PROPH DX =<1 HR
|
Facility
|
IP
|
$649.35
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
2609636501
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$480.58 |
| Max. Negotiated Rate |
$616.88 |
| Rate for Payer: Aetna of VT Commercial |
$616.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$480.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$480.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$551.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$545.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$519.48
|
| Rate for Payer: Cash Price |
$324.68
|
| Rate for Payer: Cigna Commercial |
$519.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$519.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$519.48
|
| Rate for Payer: Multiplan Commercial |
$603.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$551.95
|
| Rate for Payer: United Healthcare Commercial |
$616.88
|
|
|
IV INF THERAPY/PROPH DX =<1 HR
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
9819636501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
IV NACL .9% 50ML
|
Facility
|
OP
|
$8.45
|
|
| Hospital Charge Code |
2720061991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$8.03 |
| Rate for Payer: Aetna of VT Commercial |
$8.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6.72
|
| Rate for Payer: Cash Price |
$4.22
|
| Rate for Payer: Cigna Commercial |
$6.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$3.80
|
| Rate for Payer: Multiplan Commercial |
$7.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3.80
|
| Rate for Payer: United Healthcare Commercial |
$8.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.80
|
| Rate for Payer: United Healthcare VA CCN |
$3.80
|
|
|
IV NACL .9% 50ML
|
Facility
|
IP
|
$8.45
|
|
| Hospital Charge Code |
2720061991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$8.03 |
| Rate for Payer: Aetna of VT Commercial |
$8.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6.76
|
| Rate for Payer: Cash Price |
$4.22
|
| Rate for Payer: Cigna Commercial |
$6.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.76
|
| Rate for Payer: Multiplan Commercial |
$7.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.18
|
| Rate for Payer: United Healthcare Commercial |
$8.03
|
|
|
IV STER WTR INJ 1000ML
|
Facility
|
IP
|
$2.41
|
|
| Hospital Charge Code |
2720058281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna of VT Commercial |
$2.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.93
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Cigna Commercial |
$1.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.93
|
| Rate for Payer: Multiplan Commercial |
$2.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.05
|
| Rate for Payer: United Healthcare Commercial |
$2.29
|
|
|
IV STER WTR INJ 1000ML
|
Facility
|
OP
|
$2.41
|
|
| Hospital Charge Code |
2720058281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna of VT Commercial |
$2.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.92
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Cigna Commercial |
$1.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$2.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$2.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.08
|
| Rate for Payer: United Healthcare VA CCN |
$1.08
|
|
|
JAK2 GENE
|
Facility
|
OP
|
$824.75
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
3008127001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.66 |
| Max. Negotiated Rate |
$783.51 |
| Rate for Payer: Aetna of VT Commercial |
$783.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$451.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$365.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$451.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$496.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$701.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$668.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$371.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$655.68
|
| Rate for Payer: Cash Price |
$412.38
|
| Rate for Payer: Cash Price |
$412.38
|
| Rate for Payer: Cigna Commercial |
$659.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$659.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$659.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$371.14
|
| Rate for Payer: Multiplan Commercial |
$767.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$701.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$371.14
|
| Rate for Payer: United Healthcare Commercial |
$783.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.66
|
| Rate for Payer: United Healthcare VA CCN |
$371.14
|
|
|
JAK2 GENE
|
Professional
|
Both
|
$824.75
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
3008127001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.38 |
| Max. Negotiated Rate |
$775.26 |
| Rate for Payer: Aetna of VT Commercial |
$775.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$451.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$94.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$451.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$128.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$156.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$156.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$105.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$156.68
|
| Rate for Payer: Cash Price |
$412.38
|
| Rate for Payer: Cash Price |
$412.38
|
| Rate for Payer: Cigna Commercial |
$111.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$90.38
|
| Rate for Payer: Multiplan Commercial |
$767.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.66
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$91.66
|
| Rate for Payer: United Healthcare Commercial |
$141.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.66
|
| Rate for Payer: United Healthcare VA CCN |
$91.66
|
|
|
JAK2 GENE
|
Facility
|
IP
|
$824.75
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
3008127001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$610.40 |
| Max. Negotiated Rate |
$783.51 |
| Rate for Payer: Aetna of VT Commercial |
$783.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$610.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$610.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$701.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$692.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$659.80
|
| Rate for Payer: Cash Price |
$412.38
|
| Rate for Payer: Cigna Commercial |
$659.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$659.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$659.80
|
| Rate for Payer: Multiplan Commercial |
$767.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$701.04
|
| Rate for Payer: United Healthcare Commercial |
$783.51
|
|
|
KA FEMORAL S1+ INSTRUMENT SET
|
Facility
|
OP
|
$78.00
|
|
| Hospital Charge Code |
2720074671
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.55 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.01
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.10
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare VA CCN |
$35.10
|
|
|
KA FEMORAL S1+ INSTRUMENT SET
|
Facility
|
IP
|
$78.00
|
|
| Hospital Charge Code |
2720074671
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.73 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$57.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$57.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.40
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
|
|
KA FEMORAL S2 INSTRUMENT SET
|
Facility
|
IP
|
$318.75
|
|
| Hospital Charge Code |
2720074071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.91 |
| Max. Negotiated Rate |
$302.81 |
| Rate for Payer: Aetna of VT Commercial |
$302.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$235.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$235.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$270.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$255.00
|
| Rate for Payer: Cash Price |
$159.38
|
| Rate for Payer: Cigna Commercial |
$255.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$255.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$255.00
|
| Rate for Payer: Multiplan Commercial |
$296.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$270.94
|
| Rate for Payer: United Healthcare Commercial |
$302.81
|
|
|
KA FEMORAL S2 INSTRUMENT SET
|
Facility
|
OP
|
$318.75
|
|
| Hospital Charge Code |
2720074071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.17 |
| Max. Negotiated Rate |
$302.81 |
| Rate for Payer: Aetna of VT Commercial |
$302.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$285.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$141.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$285.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$191.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$270.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$258.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$143.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$253.41
|
| Rate for Payer: Cash Price |
$159.38
|
| Rate for Payer: Cigna Commercial |
$255.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$255.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$255.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$143.44
|
| Rate for Payer: Multiplan Commercial |
$296.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$270.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$143.44
|
| Rate for Payer: United Healthcare Commercial |
$302.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$143.44
|
| Rate for Payer: United Healthcare VA CCN |
$143.44
|
|
|
KA FEMORAL S3 INSTRUMENT SET
|
Facility
|
IP
|
$110.63
|
|
| Hospital Charge Code |
2720073661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.88 |
| Max. Negotiated Rate |
$105.10 |
| Rate for Payer: Aetna of VT Commercial |
$105.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.50
|
| Rate for Payer: Cash Price |
$55.31
|
| Rate for Payer: Cigna Commercial |
$88.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.50
|
| Rate for Payer: Multiplan Commercial |
$102.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.04
|
| Rate for Payer: United Healthcare Commercial |
$105.10
|
|
|
KA FEMORAL S3 INSTRUMENT SET
|
Facility
|
OP
|
$110.63
|
|
| Hospital Charge Code |
2720073661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$105.10 |
| Rate for Payer: Aetna of VT Commercial |
$105.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$66.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.95
|
| Rate for Payer: Cash Price |
$55.31
|
| Rate for Payer: Cigna Commercial |
$88.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.78
|
| Rate for Payer: Multiplan Commercial |
$102.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.78
|
| Rate for Payer: United Healthcare Commercial |
$105.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.78
|
| Rate for Payer: United Healthcare VA CCN |
$49.78
|
|
|
KA FEMORAL S3+ INSTRUMENT SET
|
Facility
|
OP
|
$337.50
|
|
| Hospital Charge Code |
2720075591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.48 |
| Max. Negotiated Rate |
$320.62 |
| Rate for Payer: Aetna of VT Commercial |
$320.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$302.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$302.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$203.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$273.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$151.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$268.31
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cigna Commercial |
$270.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$270.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$270.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$151.88
|
| Rate for Payer: Multiplan Commercial |
$313.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$151.88
|
| Rate for Payer: United Healthcare Commercial |
$320.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.88
|
| Rate for Payer: United Healthcare VA CCN |
$151.88
|
|
|
KA FEMORAL S3+ INSTRUMENT SET
|
Facility
|
IP
|
$337.50
|
|
| Hospital Charge Code |
2720075591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$249.78 |
| Max. Negotiated Rate |
$320.62 |
| Rate for Payer: Aetna of VT Commercial |
$320.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$249.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$249.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$270.00
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cigna Commercial |
$270.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$270.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$313.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.88
|
| Rate for Payer: United Healthcare Commercial |
$320.62
|
|
|
KA FEMORAL S4 INSTRUMENT SET
|
Facility
|
IP
|
$78.56
|
|
| Hospital Charge Code |
2720074131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.14 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna of VT Commercial |
$74.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.85
|
| Rate for Payer: Cash Price |
$39.28
|
| Rate for Payer: Cigna Commercial |
$62.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.85
|
| Rate for Payer: Multiplan Commercial |
$73.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.78
|
| Rate for Payer: United Healthcare Commercial |
$74.63
|
|
|
KA FEMORAL S4 INSTRUMENT SET
|
Facility
|
OP
|
$78.56
|
|
| Hospital Charge Code |
2720074131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.79 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna of VT Commercial |
$74.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.46
|
| Rate for Payer: Cash Price |
$39.28
|
| Rate for Payer: Cigna Commercial |
$62.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.35
|
| Rate for Payer: Multiplan Commercial |
$73.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.35
|
| Rate for Payer: United Healthcare Commercial |
$74.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.35
|
| Rate for Payer: United Healthcare VA CCN |
$35.35
|
|
|
KA FEMORAL S4+ INSTRUMENT SET
|
Facility
|
IP
|
$78.56
|
|
| Hospital Charge Code |
2720074141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.14 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna of VT Commercial |
$74.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.85
|
| Rate for Payer: Cash Price |
$39.28
|
| Rate for Payer: Cigna Commercial |
$62.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.85
|
| Rate for Payer: Multiplan Commercial |
$73.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.78
|
| Rate for Payer: United Healthcare Commercial |
$74.63
|
|
|
KA FEMORAL S4+ INSTRUMENT SET
|
Facility
|
OP
|
$78.56
|
|
| Hospital Charge Code |
2720074141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.79 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna of VT Commercial |
$74.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.46
|
| Rate for Payer: Cash Price |
$39.28
|
| Rate for Payer: Cigna Commercial |
$62.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.35
|
| Rate for Payer: Multiplan Commercial |
$73.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.35
|
| Rate for Payer: United Healthcare Commercial |
$74.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.35
|
| Rate for Payer: United Healthcare VA CCN |
$35.35
|
|
|
KA FEMORAL S5 INST SET
|
Facility
|
OP
|
$78.00
|
|
| Hospital Charge Code |
2720074551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.55 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.01
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.10
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare VA CCN |
$35.10
|
|
|
KA FEMORAL S5 INST SET
|
Facility
|
IP
|
$78.00
|
|
| Hospital Charge Code |
2720074551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.73 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$57.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$57.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.40
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
|
