|
KIT SUTURE REMVAL
|
Facility
|
OP
|
$1.14
|
|
| Hospital Charge Code |
2720030431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna of VT Commercial |
$1.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.91
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna Commercial |
$0.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.51
|
| Rate for Payer: United Healthcare Commercial |
$1.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.51
|
| Rate for Payer: United Healthcare VA CCN |
$0.51
|
|
|
KIT SUTURE REMVAL
|
Facility
|
IP
|
$1.14
|
|
| Hospital Charge Code |
2720030431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna of VT Commercial |
$1.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.91
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna Commercial |
$0.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.97
|
| Rate for Payer: United Healthcare Commercial |
$1.08
|
|
|
KIWI TRACTION FORCE INDICATOR
|
Facility
|
OP
|
$27.67
|
|
| Hospital Charge Code |
2720017261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$26.29 |
| Rate for Payer: Aetna of VT Commercial |
$26.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$24.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$24.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$23.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.00
|
| Rate for Payer: Cash Price |
$13.84
|
| Rate for Payer: Cigna Commercial |
$22.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.45
|
| Rate for Payer: Multiplan Commercial |
$25.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.45
|
| Rate for Payer: United Healthcare Commercial |
$26.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.45
|
| Rate for Payer: United Healthcare VA CCN |
$12.45
|
|
|
KIWI TRACTION FORCE INDICATOR
|
Facility
|
IP
|
$27.67
|
|
| Hospital Charge Code |
2720017261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$26.29 |
| Rate for Payer: Aetna of VT Commercial |
$26.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$20.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$20.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$23.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$23.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.14
|
| Rate for Payer: Cash Price |
$13.84
|
| Rate for Payer: Cigna Commercial |
$22.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.14
|
| Rate for Payer: Multiplan Commercial |
$25.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.52
|
| Rate for Payer: United Healthcare Commercial |
$26.29
|
|
|
KLEENSPEC SIGMOIDOSCOPE 19MM
|
Facility
|
IP
|
$18.97
|
|
| Hospital Charge Code |
2720075381
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$18.02 |
| Rate for Payer: Aetna of VT Commercial |
$18.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$14.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$14.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$15.18
|
| Rate for Payer: Cash Price |
$9.48
|
| Rate for Payer: Cigna Commercial |
$15.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$15.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$17.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.12
|
| Rate for Payer: United Healthcare Commercial |
$18.02
|
|
|
KLEENSPEC SIGMOIDOSCOPE 19MM
|
Facility
|
OP
|
$18.97
|
|
| Hospital Charge Code |
2720075381
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$18.02 |
| Rate for Payer: Aetna of VT Commercial |
$18.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$17.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$17.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$15.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$8.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$15.08
|
| Rate for Payer: Cash Price |
$9.48
|
| Rate for Payer: Cigna Commercial |
$15.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$15.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$15.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.54
|
| Rate for Payer: Multiplan Commercial |
$17.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.54
|
| Rate for Payer: United Healthcare Commercial |
$18.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.54
|
| Rate for Payer: United Healthcare VA CCN |
$8.54
|
|
|
KNEE ARTHROSCOPY/DRAINAGE
|
Facility
|
OP
|
$1,554.00
|
|
|
Service Code
|
CPT 29871
|
| Hospital Charge Code |
9822987101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$688.27 |
| Max. Negotiated Rate |
$1,476.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,476.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,392.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$688.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,392.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$935.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,320.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,258.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$699.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,235.43
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cigna Commercial |
$1,243.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,243.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,243.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$699.30
|
| Rate for Payer: Multiplan Commercial |
$1,445.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,320.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$699.30
|
| Rate for Payer: United Healthcare Commercial |
$1,476.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$699.30
|
| Rate for Payer: United Healthcare VA CCN |
$699.30
|
|
|
KNEE ARTHROSCOPY/DRAINAGE
|
Facility
|
IP
|
$1,554.00
|
|
|
Service Code
|
CPT 29871
|
| Hospital Charge Code |
9822987101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,150.12 |
| Max. Negotiated Rate |
$1,476.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,476.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,150.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,150.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,320.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,305.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,243.20
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cigna Commercial |
$1,243.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,243.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,243.20
|
| Rate for Payer: Multiplan Commercial |
$1,445.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,320.90
|
| Rate for Payer: United Healthcare Commercial |
$1,476.30
|
|
|
KNEE ARTHROSCOPY/DRAINAGE
|
Professional
|
Both
|
$1,554.00
|
|
|
Service Code
|
CPT 29871
|
| Hospital Charge Code |
9822987101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$490.52 |
| Max. Negotiated Rate |
$1,460.76 |
| Rate for Payer: Aetna of VT Commercial |
$1,460.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,392.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$505.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,392.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$686.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$777.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$777.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$564.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$777.69
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cigna Commercial |
$928.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$816.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$816.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$490.52
|
| Rate for Payer: Multiplan Commercial |
$1,445.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$696.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$490.52
|
| Rate for Payer: United Healthcare Commercial |
$754.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$490.52
|
| Rate for Payer: United Healthcare VA CCN |
$490.52
|
|
|
KNEE ARTHROSCOPY DX
|
Facility
|
OP
|
$1,610.00
|
|
|
Service Code
|
CPT 29870
|
| Hospital Charge Code |
9602987002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$713.07 |
| Max. Negotiated Rate |
$1,529.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,529.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,442.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$713.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,442.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$969.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,368.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,304.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$724.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,279.95
|
| Rate for Payer: Cash Price |
$805.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,288.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,288.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$724.50
|
| Rate for Payer: Multiplan Commercial |
$1,497.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,368.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$724.50
|
| Rate for Payer: United Healthcare Commercial |
$1,529.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$724.50
|
| Rate for Payer: United Healthcare VA CCN |
$724.50
|
|
|
KNEE ARTHROSCOPY DX
|
Professional
|
Both
|
$1,519.00
|
|
|
Service Code
|
CPT 29870
|
| Hospital Charge Code |
5102987001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$395.51 |
| Max. Negotiated Rate |
$1,427.86 |
| Rate for Payer: Aetna of VT Commercial |
$1,427.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,360.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$407.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,360.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$553.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$736.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$736.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$454.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$736.34
|
| Rate for Payer: Cash Price |
$759.50
|
| Rate for Payer: Cash Price |
$759.50
|
| Rate for Payer: Cigna Commercial |
$741.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$872.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$872.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$530.42
|
| Rate for Payer: Multiplan Commercial |
$1,412.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$561.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$395.51
|
| Rate for Payer: United Healthcare Commercial |
$608.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$395.51
|
| Rate for Payer: United Healthcare VA CCN |
$395.51
|
|
|
KNEE ARTHROSCOPY DX
|
Professional
|
Both
|
$1,610.00
|
|
|
Service Code
|
CPT 29870
|
| Hospital Charge Code |
9822987001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$395.51 |
| Max. Negotiated Rate |
$1,513.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,513.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,442.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$407.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,442.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$553.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$736.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$736.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$454.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$736.34
|
| Rate for Payer: Cash Price |
$805.00
|
| Rate for Payer: Cash Price |
$805.00
|
| Rate for Payer: Cigna Commercial |
$741.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$872.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$872.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$530.42
|
| Rate for Payer: Multiplan Commercial |
$1,497.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$561.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$395.51
|
| Rate for Payer: United Healthcare Commercial |
$608.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$395.51
|
| Rate for Payer: United Healthcare VA CCN |
$395.51
|
|
|
KNEE ARTHROSCOPY DX
|
Facility
|
IP
|
$1,610.00
|
|
|
Service Code
|
CPT 29870
|
| Hospital Charge Code |
9602987002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,191.56 |
| Max. Negotiated Rate |
$1,529.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,529.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,191.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,191.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,368.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,352.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,288.00
|
| Rate for Payer: Cash Price |
$805.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,288.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,288.00
|
| Rate for Payer: Multiplan Commercial |
$1,497.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,368.50
|
| Rate for Payer: United Healthcare Commercial |
$1,529.50
|
|
|
KNEE ARTHROSCOPY DX
|
Facility
|
OP
|
$1,519.00
|
|
|
Service Code
|
CPT 29870
|
| Hospital Charge Code |
5102987001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$672.77 |
| Max. Negotiated Rate |
$1,443.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,443.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,360.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$672.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,360.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$914.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,291.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,230.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$683.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,207.61
|
| Rate for Payer: Cash Price |
$759.50
|
| Rate for Payer: Cigna Commercial |
$1,215.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,215.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,215.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$683.55
|
| Rate for Payer: Multiplan Commercial |
$1,412.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,291.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$683.55
|
| Rate for Payer: United Healthcare Commercial |
$1,443.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$683.55
|
| Rate for Payer: United Healthcare VA CCN |
$683.55
|
|
|
KNEE ARTHROSCOPY DX
|
Facility
|
IP
|
$1,610.00
|
|
|
Service Code
|
CPT 29870
|
| Hospital Charge Code |
9822987001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,191.56 |
| Max. Negotiated Rate |
$1,529.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,529.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,191.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,191.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,368.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,352.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,288.00
|
| Rate for Payer: Cash Price |
$805.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,288.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,288.00
|
| Rate for Payer: Multiplan Commercial |
$1,497.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,368.50
|
| Rate for Payer: United Healthcare Commercial |
$1,529.50
|
|
|
KNEE ARTHROSCOPY DX
|
Facility
|
IP
|
$1,519.00
|
|
|
Service Code
|
CPT 29870
|
| Hospital Charge Code |
5102987001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,124.21 |
| Max. Negotiated Rate |
$1,443.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,443.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,124.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,124.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,291.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,275.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,215.20
|
| Rate for Payer: Cash Price |
$759.50
|
| Rate for Payer: Cigna Commercial |
$1,215.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,215.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,215.20
|
| Rate for Payer: Multiplan Commercial |
$1,412.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,291.15
|
| Rate for Payer: United Healthcare Commercial |
$1,443.05
|
|
|
KNEE ARTHROSCOPY DX
|
Facility
|
OP
|
$1,610.00
|
|
|
Service Code
|
CPT 29870
|
| Hospital Charge Code |
9822987001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$713.07 |
| Max. Negotiated Rate |
$1,529.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,529.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,442.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$713.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,442.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$969.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,368.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,304.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$724.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,279.95
|
| Rate for Payer: Cash Price |
$805.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,288.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,288.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$724.50
|
| Rate for Payer: Multiplan Commercial |
$1,497.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,368.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$724.50
|
| Rate for Payer: United Healthcare Commercial |
$1,529.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$724.50
|
| Rate for Payer: United Healthcare VA CCN |
$724.50
|
|
|
KNEE ARTHROSCOPY DX
|
Professional
|
Both
|
$3,128.00
|
|
|
Service Code
|
CPT 29870
|
| Hospital Charge Code |
9602987001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$395.51 |
| Max. Negotiated Rate |
$2,940.32 |
| Rate for Payer: Aetna of VT Commercial |
$2,940.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,802.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$407.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,802.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$553.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$736.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$736.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$454.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$736.34
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cigna Commercial |
$741.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$872.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$872.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$530.42
|
| Rate for Payer: Multiplan Commercial |
$2,909.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$561.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$395.51
|
| Rate for Payer: United Healthcare Commercial |
$608.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$395.51
|
| Rate for Payer: United Healthcare VA CCN |
$395.51
|
|
|
KNEE ARTHROSCOPY DX
|
Facility
|
OP
|
$3,128.00
|
|
|
Service Code
|
CPT 29870
|
| Hospital Charge Code |
9602987001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,385.39 |
| Max. Negotiated Rate |
$2,971.60 |
| Rate for Payer: Aetna of VT Commercial |
$2,971.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,802.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,385.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,802.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,883.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,658.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,533.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,407.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,486.76
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cigna Commercial |
$2,502.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,502.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,502.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,407.60
|
| Rate for Payer: Multiplan Commercial |
$2,909.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,658.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,407.60
|
| Rate for Payer: United Healthcare Commercial |
$2,971.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,407.60
|
| Rate for Payer: United Healthcare VA CCN |
$1,407.60
|
|
|
KNEE ARTHROSCOPY DX
|
Facility
|
IP
|
$3,128.00
|
|
|
Service Code
|
CPT 29870
|
| Hospital Charge Code |
9602987001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,315.03 |
| Max. Negotiated Rate |
$2,971.60 |
| Rate for Payer: Aetna of VT Commercial |
$2,971.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,315.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,315.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,658.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,627.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,502.40
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cigna Commercial |
$2,502.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,502.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,502.40
|
| Rate for Payer: Multiplan Commercial |
$2,909.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,658.80
|
| Rate for Payer: United Healthcare Commercial |
$2,971.60
|
|
|
KNEE ARTHROSCOPY DX
|
Professional
|
Both
|
$1,610.00
|
|
|
Service Code
|
CPT 29870
|
| Hospital Charge Code |
9602987002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$395.51 |
| Max. Negotiated Rate |
$1,513.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,513.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,442.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$407.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,442.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$553.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$736.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$736.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$454.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$736.34
|
| Rate for Payer: Cash Price |
$805.00
|
| Rate for Payer: Cash Price |
$805.00
|
| Rate for Payer: Cigna Commercial |
$741.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$872.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$872.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$530.42
|
| Rate for Payer: Multiplan Commercial |
$1,497.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$561.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$395.51
|
| Rate for Payer: United Healthcare Commercial |
$608.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$395.51
|
| Rate for Payer: United Healthcare VA CCN |
$395.51
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$3,062.00
|
|
|
Service Code
|
CPT 29882
|
| Hospital Charge Code |
9822988201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,266.19 |
| Max. Negotiated Rate |
$2,908.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,908.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,266.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,266.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,602.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,572.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,449.60
|
| Rate for Payer: Cash Price |
$1,531.00
|
| Rate for Payer: Cigna Commercial |
$2,449.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,449.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,449.60
|
| Rate for Payer: Multiplan Commercial |
$2,847.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,602.70
|
| Rate for Payer: United Healthcare Commercial |
$2,908.90
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,693.00
|
|
|
Service Code
|
CPT 29879
|
| Hospital Charge Code |
9822987901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,192.73 |
| Max. Negotiated Rate |
$2,558.35 |
| Rate for Payer: Aetna of VT Commercial |
$2,558.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,412.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,192.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,412.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,621.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,289.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,181.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,211.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,140.93
|
| Rate for Payer: Cash Price |
$1,346.50
|
| Rate for Payer: Cigna Commercial |
$2,154.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,154.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,154.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,211.85
|
| Rate for Payer: Multiplan Commercial |
$2,504.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,289.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,211.85
|
| Rate for Payer: United Healthcare Commercial |
$2,558.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,211.85
|
| Rate for Payer: United Healthcare VA CCN |
$1,211.85
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$2,693.00
|
|
|
Service Code
|
CPT 29879
|
| Hospital Charge Code |
9822987901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,993.09 |
| Max. Negotiated Rate |
$2,558.35 |
| Rate for Payer: Aetna of VT Commercial |
$2,558.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,993.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,993.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,289.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,262.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,154.40
|
| Rate for Payer: Cash Price |
$1,346.50
|
| Rate for Payer: Cigna Commercial |
$2,154.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,154.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,154.40
|
| Rate for Payer: Multiplan Commercial |
$2,504.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,289.05
|
| Rate for Payer: United Healthcare Commercial |
$2,558.35
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$2,512.00
|
|
|
Service Code
|
CPT 29877
|
| Hospital Charge Code |
9822987701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$588.89 |
| Max. Negotiated Rate |
$2,361.28 |
| Rate for Payer: Aetna of VT Commercial |
$2,361.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,250.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$606.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,250.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$824.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,120.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,120.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$677.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,120.99
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cigna Commercial |
$1,114.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$980.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$980.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$588.89
|
| Rate for Payer: Multiplan Commercial |
$2,336.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$836.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$588.89
|
| Rate for Payer: United Healthcare Commercial |
$905.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$588.89
|
| Rate for Payer: United Healthcare VA CCN |
$588.89
|
|
