|
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
|
|
|
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
|
$2,232.00
|
|
|
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
|
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
|
$2,693.00
|
|
|
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
|
OP
|
$3,449.00
|
|
|
Service Code
|
CPT 29883
|
| Hospital Charge Code |
9822988301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,527.56 |
| 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 |
$3,089.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,527.56
|
| 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 |
$2,076.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,931.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,793.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,552.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,741.95
|
| 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: Martins Point Health Care Commercial |
$1,552.05
|
| Rate for Payer: Multiplan Commercial |
$3,207.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,931.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,552.05
|
| Rate for Payer: United Healthcare Commercial |
$3,276.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,552.05
|
| Rate for Payer: United Healthcare VA CCN |
$1,552.05
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$2,777.00
|
|
|
Service Code
|
CPT 29886
|
| Hospital Charge Code |
9822988601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$604.74 |
| Max. Negotiated Rate |
$2,610.38 |
| Rate for Payer: Aetna of VT Commercial |
$2,610.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,487.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$622.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,487.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$846.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,069.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,069.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$695.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,069.63
|
| Rate for Payer: Cash Price |
$1,388.50
|
| Rate for Payer: Cash Price |
$1,388.50
|
| Rate for Payer: Cigna Commercial |
$1,143.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,008.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,008.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$604.74
|
| Rate for Payer: Multiplan Commercial |
$2,582.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$858.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$604.74
|
| Rate for Payer: United Healthcare Commercial |
$930.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$604.74
|
| Rate for Payer: United Healthcare VA CCN |
$604.74
|
|
|
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
|
$2,912.00
|
|
|
Service Code
|
CPT 29876
|
| Hospital Charge Code |
9822987601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$618.18 |
| Max. Negotiated Rate |
$2,737.28 |
| Rate for Payer: Aetna of VT Commercial |
$2,737.28
|
| 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 |
$636.73
|
| 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 |
$865.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,079.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,079.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$710.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,079.24
|
| Rate for Payer: Cash Price |
$1,456.00
|
| Rate for Payer: Cash Price |
$1,456.00
|
| Rate for Payer: Cigna Commercial |
$1,170.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,030.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,030.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$618.18
|
| Rate for Payer: Multiplan Commercial |
$2,708.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$877.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$618.18
|
| Rate for Payer: United Healthcare Commercial |
$950.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$618.18
|
| Rate for Payer: United Healthcare VA CCN |
$618.18
|
|
|
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
|
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
|
IP
|
$2,369.00
|
|
|
Service Code
|
CPT 29888
|
| Hospital Charge Code |
9822988801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,753.30 |
| Max. Negotiated Rate |
$2,250.55 |
| Rate for Payer: Aetna of VT Commercial |
$2,250.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,753.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,753.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,013.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,989.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,895.20
|
| Rate for Payer: Cash Price |
$1,184.50
|
| Rate for Payer: Cigna Commercial |
$1,895.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,895.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,895.20
|
| Rate for Payer: Multiplan Commercial |
$2,203.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,013.65
|
| Rate for Payer: United Healthcare Commercial |
$2,250.55
|
|
|
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 FIBERTAK W/FIBERTAPE
|
Facility
|
OP
|
$860.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780074701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$380.89 |
| Max. Negotiated Rate |
$817.00 |
| Rate for Payer: Aetna of VT Commercial |
$817.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$770.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$380.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$770.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$517.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$731.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$696.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$387.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$683.70
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$688.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$688.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$688.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$387.00
|
| Rate for Payer: Multiplan Commercial |
$799.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$731.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$387.00
|
| Rate for Payer: United Healthcare Commercial |
$817.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.00
|
| Rate for Payer: United Healthcare VA CCN |
$387.00
|
|
|
KNEE FIBERTAK W/FIBERTAPE
|
Facility
|
IP
|
$860.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780074701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$636.49 |
| Max. Negotiated Rate |
$817.00 |
| Rate for Payer: Aetna of VT Commercial |
$817.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$636.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$636.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$731.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$722.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$688.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$688.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$688.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$688.00
|
| Rate for Payer: Multiplan Commercial |
$799.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$731.00
|
| Rate for Payer: United Healthcare Commercial |
$817.00
|
|
|
KWIRE TEMP FIX 1.2X100MM
|
Facility
|
IP
|
$52.70
|
|
| Hospital Charge Code |
2720073591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$50.06 |
| Rate for Payer: Aetna of VT Commercial |
$50.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.16
|
| Rate for Payer: Cash Price |
$26.35
|
| Rate for Payer: Cigna Commercial |
$42.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.16
|
| Rate for Payer: Multiplan Commercial |
$49.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.80
|
| Rate for Payer: United Healthcare Commercial |
$50.06
|
|
|
KWIRE TEMP FIX 1.2X100MM
|
Facility
|
OP
|
$52.70
|
|
| Hospital Charge Code |
2720073591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.34 |
| Max. Negotiated Rate |
$50.06 |
| Rate for Payer: Aetna of VT Commercial |
$50.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$47.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$47.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$42.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$41.90
|
| Rate for Payer: Cash Price |
$26.35
|
| Rate for Payer: Cigna Commercial |
$42.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$23.71
|
| Rate for Payer: Multiplan Commercial |
$49.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.71
|
| Rate for Payer: United Healthcare Commercial |
$50.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.71
|
| Rate for Payer: United Healthcare VA CCN |
$23.71
|
|
|
KWIRE TEMP FIX 1.3MM SMOOTH
|
Facility
|
IP
|
$142.12
|
|
| Hospital Charge Code |
2720073601
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.18 |
| Max. Negotiated Rate |
$135.01 |
| Rate for Payer: Aetna of VT Commercial |
$135.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$119.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.70
|
| Rate for Payer: Cash Price |
$71.06
|
| Rate for Payer: Cigna Commercial |
$113.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.70
|
| Rate for Payer: Multiplan Commercial |
$132.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.80
|
| Rate for Payer: United Healthcare Commercial |
$135.01
|
|
|
KWIRE TEMP FIX 1.3MM SMOOTH
|
Facility
|
OP
|
$142.12
|
|
| Hospital Charge Code |
2720073601
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.94 |
| Max. Negotiated Rate |
$135.01 |
| Rate for Payer: Aetna of VT Commercial |
$135.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$127.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$127.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$85.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$115.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.99
|
| Rate for Payer: Cash Price |
$71.06
|
| Rate for Payer: Cigna Commercial |
$113.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.95
|
| Rate for Payer: Multiplan Commercial |
$132.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.95
|
| Rate for Payer: United Healthcare Commercial |
$135.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.95
|
| Rate for Payer: United Healthcare VA CCN |
$63.95
|
|
|
KWIRE TEMP FIX 1/6X150MM
|
Facility
|
OP
|
$35.79
|
|
| Hospital Charge Code |
2720074231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.85 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna of VT Commercial |
$34.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$21.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.45
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cigna Commercial |
$28.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.63
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.11
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.11
|
| Rate for Payer: United Healthcare Commercial |
$34.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.11
|
| Rate for Payer: United Healthcare VA CCN |
$16.11
|
|
|
KWIRE TEMP FIX 1/6X150MM
|
Facility
|
IP
|
$35.79
|
|
| Hospital Charge Code |
2720074231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.49 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna of VT Commercial |
$34.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$26.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$26.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.63
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cigna Commercial |
$28.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.63
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.42
|
| Rate for Payer: United Healthcare Commercial |
$34.00
|
|
|
KWIRE TEMP FIX 2.0X150MM
|
Facility
|
IP
|
$35.79
|
|
| Hospital Charge Code |
2720074241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.49 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna of VT Commercial |
$34.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$26.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$26.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.63
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cigna Commercial |
$28.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.63
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.42
|
| Rate for Payer: United Healthcare Commercial |
$34.00
|
|
|
KWIRE TEMP FIX 2.0X150MM
|
Facility
|
OP
|
$35.79
|
|
| Hospital Charge Code |
2720074241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.85 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna of VT Commercial |
$34.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$21.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.45
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cigna Commercial |
$28.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.63
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.11
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.11
|
| Rate for Payer: United Healthcare Commercial |
$34.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.11
|
| Rate for Payer: United Healthcare VA CCN |
$16.11
|
|
|
KWIRE TEMP FIX 2.3X230MM
|
Facility
|
IP
|
$35.79
|
|
| Hospital Charge Code |
2720074201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.49 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna of VT Commercial |
$34.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$26.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$26.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.63
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cigna Commercial |
$28.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.63
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.42
|
| Rate for Payer: United Healthcare Commercial |
$34.00
|
|
|
KWIRE TEMP FIX 2.3X230MM
|
Facility
|
OP
|
$35.79
|
|
| Hospital Charge Code |
2720074201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.85 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna of VT Commercial |
$34.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$21.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.45
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cigna Commercial |
$28.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.63
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.11
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.11
|
| Rate for Payer: United Healthcare Commercial |
$34.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.11
|
| Rate for Payer: United Healthcare VA CCN |
$16.11
|
|
