|
KNEE ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$3,439.00
|
|
|
Service Code
|
CPT 29851
|
| Hospital Charge Code |
9822985101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$873.58 |
| Max. Negotiated Rate |
$3,232.66 |
| Rate for Payer: Aetna of VT Commercial |
$3,232.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,081.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$899.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,081.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,223.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,401.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,401.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,004.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,401.17
|
| Rate for Payer: Cash Price |
$1,719.50
|
| Rate for Payer: Cash Price |
$1,719.50
|
| Rate for Payer: Cigna Commercial |
$1,652.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,461.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,461.13
|
| Rate for Payer: Martins Point Health Care Commercial |
$873.58
|
| Rate for Payer: Multiplan Commercial |
$3,198.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,240.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$873.59
|
| Rate for Payer: United Healthcare Commercial |
$1,343.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$873.59
|
| Rate for Payer: United Healthcare VA CCN |
$873.59
|
|
|
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
|
|
|
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
|
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
|
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
|
Professional
|
Both
|
$2,369.00
|
|
|
Service Code
|
CPT 29888
|
| Hospital Charge Code |
9822988801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$2,330.00 |
| Rate for Payer: Aetna of VT Commercial |
$2,226.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,122.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$939.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,122.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,276.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,330.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,330.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,048.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,330.00
|
| Rate for Payer: Cash Price |
$1,184.50
|
| Rate for Payer: Cash Price |
$1,184.50
|
| Rate for Payer: Cigna Commercial |
$1,730.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,522.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,522.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$912.05
|
| Rate for Payer: Multiplan Commercial |
$2,203.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,295.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$912.05
|
| Rate for Payer: United Healthcare Commercial |
$1,403.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$912.05
|
| Rate for Payer: United Healthcare VA CCN |
$912.05
|
|
|
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
|
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
|
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
|
$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
|
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
|
OP
|
$3,439.00
|
|
|
Service Code
|
CPT 29851
|
| Hospital Charge Code |
9822985101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,523.13 |
| Max. Negotiated Rate |
$3,267.05 |
| Rate for Payer: Aetna of VT Commercial |
$3,267.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,081.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,523.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,081.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,070.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,923.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,785.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,547.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,734.01
|
| Rate for Payer: Cash Price |
$1,719.50
|
| Rate for Payer: Cigna Commercial |
$2,751.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,751.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,751.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,547.55
|
| Rate for Payer: Multiplan Commercial |
$3,198.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,923.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,547.55
|
| Rate for Payer: United Healthcare Commercial |
$3,267.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,547.55
|
| Rate for Payer: United Healthcare VA CCN |
$1,547.55
|
|
|
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 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
|
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 1.2X100MM
|
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 1.3MM 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 1.3MM 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 1/6X150MM
|
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
|
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 2.0X150MM
|
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 2.3X230MM
|
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
|
|
