|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
CPT 29874
|
| Hospital Charge Code |
9822987401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,651.90 |
| Max. Negotiated Rate |
$2,120.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,120.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,651.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,651.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,897.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,874.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,785.60
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cigna Commercial |
$1,785.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,785.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,785.60
|
| Rate for Payer: Multiplan Commercial |
$2,075.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,897.20
|
| Rate for Payer: United Healthcare Commercial |
$2,120.40
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,522.00
|
|
|
Service Code
|
CPT 29884
|
| Hospital Charge Code |
9822988401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,116.99 |
| Max. Negotiated Rate |
$2,395.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,395.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,259.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,116.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,259.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,518.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,143.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,042.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,134.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,004.99
|
| Rate for Payer: Cash Price |
$1,261.00
|
| Rate for Payer: Cigna Commercial |
$2,017.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,017.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,017.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,134.90
|
| Rate for Payer: Multiplan Commercial |
$2,345.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,143.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,134.90
|
| Rate for Payer: United Healthcare Commercial |
$2,395.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,134.90
|
| Rate for Payer: United Healthcare VA CCN |
$1,134.90
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$3,062.00
|
|
|
Service Code
|
CPT 29882
|
| Hospital Charge Code |
9822988201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$650.53 |
| Max. Negotiated Rate |
$2,878.28 |
| Rate for Payer: Aetna of VT Commercial |
$2,878.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,743.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$670.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,743.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$910.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,229.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,229.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$748.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,229.63
|
| Rate for Payer: Cash Price |
$1,531.00
|
| Rate for Payer: Cash Price |
$1,531.00
|
| Rate for Payer: Cigna Commercial |
$1,232.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,084.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,084.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$650.53
|
| Rate for Payer: Multiplan Commercial |
$2,847.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$923.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$650.53
|
| Rate for Payer: United Healthcare Commercial |
$1,000.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$650.53
|
| Rate for Payer: United Healthcare VA CCN |
$650.53
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$1,359.00
|
|
|
Service Code
|
CPT 29881
|
| Hospital Charge Code |
9822988101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$514.71 |
| Max. Negotiated Rate |
$1,277.46 |
| Rate for Payer: Aetna of VT Commercial |
$1,277.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,217.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$530.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,217.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$720.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,248.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,248.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$591.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,248.05
|
| Rate for Payer: Cash Price |
$679.50
|
| Rate for Payer: Cash Price |
$679.50
|
| Rate for Payer: Cigna Commercial |
$974.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$855.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$855.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$514.72
|
| Rate for Payer: Multiplan Commercial |
$1,263.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$730.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$514.71
|
| Rate for Payer: United Healthcare Commercial |
$791.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$514.71
|
| Rate for Payer: United Healthcare VA CCN |
$514.71
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$1,412.00
|
|
|
Service Code
|
CPT 29880
|
| Hospital Charge Code |
9822988001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$533.48 |
| Max. Negotiated Rate |
$1,327.28 |
| Rate for Payer: Aetna of VT Commercial |
$1,327.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,265.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$549.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,265.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$746.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,293.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,293.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$613.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,293.32
|
| Rate for Payer: Cash Price |
$706.00
|
| Rate for Payer: Cash Price |
$706.00
|
| Rate for Payer: Cigna Commercial |
$1,010.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$887.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$887.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$533.48
|
| Rate for Payer: Multiplan Commercial |
$1,313.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$757.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$533.48
|
| Rate for Payer: United Healthcare Commercial |
$820.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$533.48
|
| Rate for Payer: United Healthcare VA CCN |
$533.48
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$3,449.00
|
|
|
Service Code
|
CPT 29883
|
| Hospital Charge Code |
9822988301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,552.60 |
| Max. Negotiated Rate |
$3,276.55 |
| Rate for Payer: Aetna of VT Commercial |
$3,276.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,552.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,552.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,931.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,897.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,759.20
|
| Rate for Payer: Cash Price |
$1,724.50
|
| Rate for Payer: Cigna Commercial |
$2,759.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,759.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,759.20
|
| Rate for Payer: Multiplan Commercial |
$3,207.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,931.65
|
| Rate for Payer: United Healthcare Commercial |
$3,276.55
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$2,092.00
|
|
|
Service Code
|
CPT 29875
|
| Hospital Charge Code |
9822987501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,548.29 |
| Max. Negotiated Rate |
$1,987.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,987.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,548.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,548.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,778.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,757.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,673.60
|
| Rate for Payer: Cash Price |
$1,046.00
|
| Rate for Payer: Cigna Commercial |
$1,673.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,673.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,673.60
|
| Rate for Payer: Multiplan Commercial |
$1,945.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,778.20
|
| Rate for Payer: United Healthcare Commercial |
$1,987.40
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$3,449.00
|
|
|
Service Code
|
CPT 29883
|
| Hospital Charge Code |
9822988301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$790.10 |
| Max. Negotiated Rate |
$3,242.06 |
| Rate for Payer: Aetna of VT Commercial |
$3,242.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,089.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$813.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,089.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,106.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,460.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,460.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$908.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,460.47
|
| Rate for Payer: Cash Price |
$1,724.50
|
| Rate for Payer: Cash Price |
$1,724.50
|
| Rate for Payer: Cigna Commercial |
$1,503.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,318.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,318.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$790.10
|
| Rate for Payer: Multiplan Commercial |
$3,207.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,121.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$790.10
|
| Rate for Payer: United Healthcare Commercial |
$1,215.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$790.10
|
| Rate for Payer: United Healthcare VA CCN |
$790.10
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$2,072.00
|
|
|
Service Code
|
CPT 29873
|
| Hospital Charge Code |
9822987301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,533.49 |
| Max. Negotiated Rate |
$1,968.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,968.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,533.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,533.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,761.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,740.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,657.60
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cigna Commercial |
$1,657.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,657.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,657.60
|
| Rate for Payer: Multiplan Commercial |
$1,926.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,761.20
|
| Rate for Payer: United Healthcare Commercial |
$1,968.40
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$2,522.00
|
|
|
Service Code
|
CPT 29884
|
| Hospital Charge Code |
9822988401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,866.53 |
| Max. Negotiated Rate |
$2,395.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,395.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,866.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,866.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,143.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,118.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,017.60
|
| Rate for Payer: Cash Price |
$1,261.00
|
| Rate for Payer: Cigna Commercial |
$2,017.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,017.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,017.60
|
| Rate for Payer: Multiplan Commercial |
$2,345.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,143.70
|
| Rate for Payer: United Healthcare Commercial |
$2,395.90
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,092.00
|
|
|
Service Code
|
CPT 29875
|
| Hospital Charge Code |
9822987501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$926.55 |
| Max. Negotiated Rate |
$1,987.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,987.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,874.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$926.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,874.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,259.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,778.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,694.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$941.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,663.14
|
| Rate for Payer: Cash Price |
$1,046.00
|
| Rate for Payer: Cigna Commercial |
$1,673.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,673.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,673.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$941.40
|
| Rate for Payer: Multiplan Commercial |
$1,945.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,778.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$941.40
|
| Rate for Payer: United Healthcare Commercial |
$1,987.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$941.40
|
| Rate for Payer: United Healthcare VA CCN |
$941.40
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,412.00
|
|
|
Service Code
|
CPT 29880
|
| Hospital Charge Code |
9822988001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,045.02 |
| Max. Negotiated Rate |
$1,341.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,341.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,045.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,045.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,200.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,186.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,129.60
|
| Rate for Payer: Cash Price |
$706.00
|
| Rate for Payer: Cigna Commercial |
$1,129.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,129.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,129.60
|
| Rate for Payer: Multiplan Commercial |
$1,313.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,200.20
|
| Rate for Payer: United Healthcare Commercial |
$1,341.40
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$3,062.00
|
|
|
Service Code
|
CPT 29882
|
| Hospital Charge Code |
9822988201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,356.16 |
| 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 |
$2,743.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,356.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,743.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,843.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,602.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,480.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,377.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,434.29
|
| 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: Martins Point Health Care Commercial |
$1,377.90
|
| Rate for Payer: Multiplan Commercial |
$2,847.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,602.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,377.90
|
| Rate for Payer: United Healthcare Commercial |
$2,908.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,377.90
|
| Rate for Payer: United Healthcare VA CCN |
$1,377.90
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,512.00
|
|
|
Service Code
|
CPT 29877
|
| Hospital Charge Code |
9822987701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,112.56 |
| Max. Negotiated Rate |
$2,386.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,386.40
|
| 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 |
$1,112.56
|
| 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 |
$1,512.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,135.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,034.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,130.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,997.04
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cigna Commercial |
$2,009.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,009.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,009.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,130.40
|
| Rate for Payer: Multiplan Commercial |
$2,336.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,135.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,130.40
|
| Rate for Payer: United Healthcare Commercial |
$2,386.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,130.40
|
| Rate for Payer: United Healthcare VA CCN |
$1,130.40
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$2,693.00
|
|
|
Service Code
|
CPT 29879
|
| Hospital Charge Code |
9822987901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$626.41 |
| Max. Negotiated Rate |
$2,531.42 |
| Rate for Payer: Aetna of VT Commercial |
$2,531.42
|
| 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 |
$645.21
|
| 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 |
$876.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,136.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,136.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$720.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,136.96
|
| Rate for Payer: Cash Price |
$1,346.50
|
| Rate for Payer: Cash Price |
$1,346.50
|
| Rate for Payer: Cigna Commercial |
$1,185.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,044.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,044.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$626.41
|
| Rate for Payer: Multiplan Commercial |
$2,504.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$889.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$626.42
|
| Rate for Payer: United Healthcare Commercial |
$963.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$626.42
|
| Rate for Payer: United Healthcare VA CCN |
$626.42
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$2,232.00
|
|
|
Service Code
|
CPT 29874
|
| Hospital Charge Code |
9822987401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$508.66 |
| Max. Negotiated Rate |
$2,098.08 |
| Rate for Payer: Aetna of VT Commercial |
$2,098.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,999.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$523.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,999.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$712.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$977.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$977.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$584.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$977.53
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cigna Commercial |
$967.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$846.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$846.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$508.66
|
| Rate for Payer: Multiplan Commercial |
$2,075.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$722.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$508.66
|
| Rate for Payer: United Healthcare Commercial |
$782.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$508.66
|
| Rate for Payer: United Healthcare VA CCN |
$508.66
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
CPT 29874
|
| Hospital Charge Code |
9822987401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$988.55 |
| Max. Negotiated Rate |
$2,120.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,120.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,999.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$988.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,999.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,343.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,897.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,807.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,004.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,774.44
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cigna Commercial |
$1,785.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,785.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,785.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,004.40
|
| Rate for Payer: Multiplan Commercial |
$2,075.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,897.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,004.40
|
| Rate for Payer: United Healthcare Commercial |
$2,120.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,004.40
|
| Rate for Payer: United Healthcare VA CCN |
$1,004.40
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,072.00
|
|
|
Service Code
|
CPT 29873
|
| Hospital Charge Code |
9822987301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$917.69 |
| Max. Negotiated Rate |
$1,968.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,968.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,856.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$917.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,856.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,247.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,761.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,678.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$932.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,647.24
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cigna Commercial |
$1,657.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,657.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,657.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$932.40
|
| Rate for Payer: Multiplan Commercial |
$1,926.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,761.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$932.40
|
| Rate for Payer: United Healthcare Commercial |
$1,968.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$932.40
|
| Rate for Payer: United Healthcare VA CCN |
$932.40
|
|
|
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
|
$1,359.00
|
|
|
Service Code
|
CPT 29881
|
| Hospital Charge Code |
9822988101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$601.90 |
| Max. Negotiated Rate |
$1,291.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,291.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,217.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$601.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,217.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$818.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,155.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,100.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$611.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,080.40
|
| Rate for Payer: Cash Price |
$679.50
|
| Rate for Payer: Cigna Commercial |
$1,087.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,087.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,087.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$611.55
|
| Rate for Payer: Multiplan Commercial |
$1,263.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,155.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$611.55
|
| Rate for Payer: United Healthcare Commercial |
$1,291.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$611.55
|
| Rate for Payer: United Healthcare VA CCN |
$611.55
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$2,072.00
|
|
|
Service Code
|
CPT 29873
|
| Hospital Charge Code |
9822987301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$514.44 |
| Max. Negotiated Rate |
$1,947.68 |
| Rate for Payer: Aetna of VT Commercial |
$1,947.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,856.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$529.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,856.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$720.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$736.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$736.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$591.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$736.94
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cigna Commercial |
$974.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$852.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$852.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$514.44
|
| Rate for Payer: Multiplan Commercial |
$1,926.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$730.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$514.44
|
| Rate for Payer: United Healthcare Commercial |
$791.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$514.44
|
| Rate for Payer: United Healthcare VA CCN |
$514.44
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,412.00
|
|
|
Service Code
|
CPT 29880
|
| Hospital Charge Code |
9822988001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$625.37 |
| Max. Negotiated Rate |
$1,341.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,341.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,265.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$625.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,265.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$850.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,200.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,143.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$635.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,122.54
|
| Rate for Payer: Cash Price |
$706.00
|
| Rate for Payer: Cigna Commercial |
$1,129.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,129.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,129.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$635.40
|
| Rate for Payer: Multiplan Commercial |
$1,313.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,200.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$635.40
|
| Rate for Payer: United Healthcare Commercial |
$1,341.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$635.40
|
| Rate for Payer: United Healthcare VA CCN |
$635.40
|
|
|
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
|
$2,512.00
|
|
|
Service Code
|
CPT 29877
|
| Hospital Charge Code |
9822987701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,859.13 |
| Max. Negotiated Rate |
$2,386.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,386.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,859.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,859.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,135.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,110.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,009.60
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cigna Commercial |
$2,009.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,009.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,009.60
|
| Rate for Payer: Multiplan Commercial |
$2,336.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,135.20
|
| Rate for Payer: United Healthcare Commercial |
$2,386.40
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,912.00
|
|
|
Service Code
|
CPT 29876
|
| Hospital Charge Code |
9822987601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,289.72 |
| Max. Negotiated Rate |
$2,766.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,766.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,608.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,289.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,608.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,753.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,475.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,358.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,310.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,315.04
|
| Rate for Payer: Cash Price |
$1,456.00
|
| Rate for Payer: Cigna Commercial |
$2,329.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,329.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,329.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,310.40
|
| Rate for Payer: Multiplan Commercial |
$2,708.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,475.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,310.40
|
| Rate for Payer: United Healthcare Commercial |
$2,766.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,310.40
|
| Rate for Payer: United Healthcare VA CCN |
$1,310.40
|
|
