|
RBC LEUKOREDUCED IRRADIATED
|
Facility
|
OP
|
$977.51
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
390P904001
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$432.94 |
| Max. Negotiated Rate |
$928.63 |
| Rate for Payer: Aetna of VT Commercial |
$928.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$875.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$432.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$875.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$588.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$830.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$791.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$439.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$777.12
|
| Rate for Payer: Cash Price |
$488.76
|
| Rate for Payer: Cigna Commercial |
$782.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$782.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$782.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$439.88
|
| Rate for Payer: Multiplan Commercial |
$909.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$830.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$439.88
|
| Rate for Payer: United Healthcare Commercial |
$928.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$439.88
|
| Rate for Payer: United Healthcare VA CCN |
$439.88
|
|
|
RBC LEUKOREDUCED IRRADIATED
|
Facility
|
IP
|
$977.51
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
390P904001
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$723.46 |
| Max. Negotiated Rate |
$928.63 |
| Rate for Payer: Aetna of VT Commercial |
$928.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$723.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$723.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$830.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$821.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$782.01
|
| Rate for Payer: Cash Price |
$488.76
|
| Rate for Payer: Cigna Commercial |
$782.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$782.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$782.01
|
| Rate for Payer: Multiplan Commercial |
$909.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$830.88
|
| Rate for Payer: United Healthcare Commercial |
$928.63
|
|
|
RBC PRETREATMENT SERUM
|
Facility
|
IP
|
$182.91
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
3008697801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.37 |
| Max. Negotiated Rate |
$173.76 |
| Rate for Payer: Aetna of VT Commercial |
$173.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$135.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$135.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$153.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$146.33
|
| Rate for Payer: Cash Price |
$91.46
|
| Rate for Payer: Cigna Commercial |
$146.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$146.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$146.33
|
| Rate for Payer: Multiplan Commercial |
$170.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.47
|
| Rate for Payer: United Healthcare Commercial |
$173.76
|
|
|
RBC PRETREATMENT SERUM
|
Facility
|
OP
|
$182.91
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
3008697801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.01 |
| Max. Negotiated Rate |
$187.44 |
| Rate for Payer: Aetna of VT Commercial |
$173.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$187.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$187.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$110.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$148.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$82.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$145.41
|
| Rate for Payer: Cash Price |
$91.46
|
| Rate for Payer: Cash Price |
$91.46
|
| Rate for Payer: Cigna Commercial |
$146.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$146.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$146.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$82.31
|
| Rate for Payer: Multiplan Commercial |
$170.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$82.31
|
| Rate for Payer: United Healthcare Commercial |
$173.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.31
|
| Rate for Payer: United Healthcare VA CCN |
$82.31
|
|
|
RBC PRETREATMENT SERUM
|
Professional
|
Both
|
$182.91
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
3008697801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.14 |
| Max. Negotiated Rate |
$187.44 |
| Rate for Payer: Aetna of VT Commercial |
$171.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$187.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$187.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$69.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$69.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.67
|
| Rate for Payer: Cash Price |
$91.46
|
| Rate for Payer: Cash Price |
$91.46
|
| Rate for Payer: Cigna Commercial |
$40.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.14
|
| Rate for Payer: Multiplan Commercial |
$170.11
|
| Rate for Payer: United Healthcare Commercial |
$155.47
|
| Rate for Payer: United Healthcare VA CCN |
$77.00
|
|
|
RBC PRETX INCUBATJ W/CHEMICL
|
Professional
|
Both
|
$82.72
|
|
|
Service Code
|
CPT 86970
|
| Hospital Charge Code |
3008697001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.33 |
| Max. Negotiated Rate |
$157.73 |
| Rate for Payer: Aetna of VT Commercial |
$77.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$44.54
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cigna Commercial |
$33.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$23.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$23.33
|
| Rate for Payer: Multiplan Commercial |
$76.93
|
| Rate for Payer: United Healthcare Commercial |
$70.31
|
| Rate for Payer: United Healthcare VA CCN |
$36.00
|
|
|
RBC PRETX INCUBATJ W/CHEMICL
|
Facility
|
OP
|
$82.72
|
|
|
Service Code
|
CPT 86970
|
| Hospital Charge Code |
3008697001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.64 |
| Max. Negotiated Rate |
$157.73 |
| Rate for Payer: Aetna of VT Commercial |
$78.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$67.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.76
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cigna Commercial |
$66.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.22
|
| Rate for Payer: Multiplan Commercial |
$76.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.22
|
| Rate for Payer: United Healthcare Commercial |
$78.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.22
|
| Rate for Payer: United Healthcare VA CCN |
$37.22
|
|
|
RBC PRETX INCUBATJ W/CHEMICL
|
Facility
|
IP
|
$82.72
|
|
|
Service Code
|
CPT 86970
|
| Hospital Charge Code |
3008697001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.22 |
| Max. Negotiated Rate |
$78.58 |
| Rate for Payer: Aetna of VT Commercial |
$78.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$69.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.18
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cigna Commercial |
$66.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.18
|
| Rate for Payer: Multiplan Commercial |
$76.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.31
|
| Rate for Payer: United Healthcare Commercial |
$78.58
|
|
|
RBC PRETX INCUBATJ W/ENZYMES
|
Facility
|
IP
|
$109.60
|
|
|
Service Code
|
CPT 86971
|
| Hospital Charge Code |
3008697101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.11 |
| Max. Negotiated Rate |
$104.12 |
| Rate for Payer: Aetna of VT Commercial |
$104.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$93.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.68
|
| Rate for Payer: Cash Price |
$54.80
|
| Rate for Payer: Cigna Commercial |
$87.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$87.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$87.68
|
| Rate for Payer: Multiplan Commercial |
$101.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.16
|
| Rate for Payer: United Healthcare Commercial |
$104.12
|
|
|
RBC PRETX INCUBATJ W/ENZYMES
|
Facility
|
OP
|
$109.60
|
|
|
Service Code
|
CPT 86971
|
| Hospital Charge Code |
3008697101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.54 |
| Max. Negotiated Rate |
$126.19 |
| Rate for Payer: Aetna of VT Commercial |
$104.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$65.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$93.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$88.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.13
|
| Rate for Payer: Cash Price |
$54.80
|
| Rate for Payer: Cash Price |
$54.80
|
| Rate for Payer: Cigna Commercial |
$87.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$87.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$87.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.32
|
| Rate for Payer: Multiplan Commercial |
$101.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.32
|
| Rate for Payer: United Healthcare Commercial |
$104.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.32
|
| Rate for Payer: United Healthcare VA CCN |
$49.32
|
|
|
RBC PRETX INCUBATJ W/ENZYMES
|
Professional
|
Both
|
$109.60
|
|
|
Service Code
|
CPT 86971
|
| Hospital Charge Code |
3008697101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.89 |
| Max. Negotiated Rate |
$126.19 |
| Rate for Payer: Aetna of VT Commercial |
$103.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.84
|
| Rate for Payer: Cash Price |
$54.80
|
| Rate for Payer: Cash Price |
$54.80
|
| Rate for Payer: Cigna Commercial |
$26.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.89
|
| Rate for Payer: Multiplan Commercial |
$101.93
|
| Rate for Payer: United Healthcare Commercial |
$93.16
|
| Rate for Payer: United Healthcare VA CCN |
$78.00
|
|
|
RBC SED RATE AUTOMATED
|
Facility
|
IP
|
$42.39
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
3008565201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.37 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna of VT Commercial |
$40.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.91
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Cigna Commercial |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.91
|
| Rate for Payer: Multiplan Commercial |
$39.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.03
|
| Rate for Payer: United Healthcare Commercial |
$40.27
|
|
|
RBC SED RATE AUTOMATED
|
Facility
|
OP
|
$42.39
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
3008565201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna of VT Commercial |
$40.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$13.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$13.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.70
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Cigna Commercial |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.08
|
| Rate for Payer: Multiplan Commercial |
$39.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.08
|
| Rate for Payer: United Healthcare Commercial |
$40.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.70
|
| Rate for Payer: United Healthcare VA CCN |
$19.08
|
|
|
RECONSTRUCTION KNEE
|
Facility
|
IP
|
$4,591.00
|
|
|
Service Code
|
CPT 27428
|
| Hospital Charge Code |
9822742801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$3,397.80 |
| Max. Negotiated Rate |
$4,361.45 |
| Rate for Payer: Aetna of VT Commercial |
$4,361.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,397.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,397.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,902.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,856.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,672.80
|
| Rate for Payer: Cash Price |
$2,295.50
|
| Rate for Payer: Cigna Commercial |
$3,672.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,672.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,672.80
|
| Rate for Payer: Multiplan Commercial |
$4,269.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,902.35
|
| Rate for Payer: United Healthcare Commercial |
$4,361.45
|
|
|
RECONSTRUCTION KNEE
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
CPT 27427
|
| Hospital Charge Code |
9822742701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,405.32 |
| Max. Negotiated Rate |
$3,087.50 |
| Rate for Payer: Aetna of VT Commercial |
$3,087.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,405.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,405.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,762.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,730.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,600.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,600.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,600.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,600.00
|
| Rate for Payer: Multiplan Commercial |
$3,022.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,762.50
|
| Rate for Payer: United Healthcare Commercial |
$3,087.50
|
|
|
RECONSTRUCTION KNEE
|
Professional
|
Both
|
$3,250.00
|
|
|
Service Code
|
CPT 27427
|
| Hospital Charge Code |
9822742701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$670.66 |
| Max. Negotiated Rate |
$3,055.00 |
| Rate for Payer: Aetna of VT Commercial |
$3,055.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,911.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$690.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,911.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$938.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,343.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,343.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$771.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,343.98
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$1,270.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,116.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,116.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$670.66
|
| Rate for Payer: Multiplan Commercial |
$3,022.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$952.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$670.66
|
| Rate for Payer: United Healthcare Commercial |
$1,031.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$670.66
|
| Rate for Payer: United Healthcare VA CCN |
$670.66
|
|
|
RECONSTRUCTION KNEE
|
Professional
|
Both
|
$4,591.00
|
|
|
Service Code
|
CPT 27428
|
| Hospital Charge Code |
9822742801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,051.40 |
| Max. Negotiated Rate |
$4,315.54 |
| Rate for Payer: Aetna of VT Commercial |
$4,315.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,113.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,082.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,113.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,471.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,881.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,881.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,209.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,881.60
|
| Rate for Payer: Cash Price |
$2,295.50
|
| Rate for Payer: Cash Price |
$2,295.50
|
| Rate for Payer: Cigna Commercial |
$1,989.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,755.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,755.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,051.40
|
| Rate for Payer: Multiplan Commercial |
$4,269.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,492.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,051.40
|
| Rate for Payer: United Healthcare Commercial |
$1,617.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,051.40
|
| Rate for Payer: United Healthcare VA CCN |
$1,051.40
|
|
|
RECONSTRUCTION KNEE
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
CPT 27427
|
| Hospital Charge Code |
9822742701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,439.42 |
| Max. Negotiated Rate |
$3,087.50 |
| Rate for Payer: Aetna of VT Commercial |
$3,087.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,911.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,439.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,911.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,956.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,762.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,632.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,462.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,600.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,600.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,600.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$3,022.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,762.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,462.50
|
| Rate for Payer: United Healthcare Commercial |
$3,087.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,462.50
|
| Rate for Payer: United Healthcare VA CCN |
$1,462.50
|
|
|
RECONSTRUCTION KNEE
|
Facility
|
OP
|
$4,591.00
|
|
|
Service Code
|
CPT 27428
|
| Hospital Charge Code |
9822742801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,033.35 |
| Max. Negotiated Rate |
$4,361.45 |
| Rate for Payer: Aetna of VT Commercial |
$4,361.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,113.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,033.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,113.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,763.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,902.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,718.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,065.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,649.84
|
| Rate for Payer: Cash Price |
$2,295.50
|
| Rate for Payer: Cigna Commercial |
$3,672.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,672.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,672.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,065.95
|
| Rate for Payer: Multiplan Commercial |
$4,269.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,902.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,065.95
|
| Rate for Payer: United Healthcare Commercial |
$4,361.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,065.95
|
| Rate for Payer: United Healthcare VA CCN |
$2,065.95
|
|
|
RECONSTRUCT SHOULDER JOINT
|
Facility
|
IP
|
$5,294.00
|
|
|
Service Code
|
CPT 23472
|
| Hospital Charge Code |
9822347201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$3,918.09 |
| Max. Negotiated Rate |
$5,029.30 |
| Rate for Payer: Aetna of VT Commercial |
$5,029.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,918.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,918.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,499.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,446.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,235.20
|
| Rate for Payer: Cash Price |
$2,647.00
|
| Rate for Payer: Cigna Commercial |
$4,235.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,235.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,235.20
|
| Rate for Payer: Multiplan Commercial |
$4,923.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,499.90
|
| Rate for Payer: United Healthcare Commercial |
$5,029.30
|
|
|
RECONSTRUCT SHOULDER JOINT
|
Facility
|
OP
|
$5,294.00
|
|
|
Service Code
|
CPT 23472
|
| Hospital Charge Code |
9822347201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,344.71 |
| Max. Negotiated Rate |
$5,029.30 |
| Rate for Payer: Aetna of VT Commercial |
$5,029.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,742.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,344.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,742.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,186.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,499.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,288.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,382.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,208.73
|
| Rate for Payer: Cash Price |
$2,647.00
|
| Rate for Payer: Cigna Commercial |
$4,235.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,235.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,235.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,382.30
|
| Rate for Payer: Multiplan Commercial |
$4,923.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,499.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,382.30
|
| Rate for Payer: United Healthcare Commercial |
$5,029.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,382.30
|
| Rate for Payer: United Healthcare VA CCN |
$2,382.30
|
|
|
RECONSTRUCT SHOULDER JOINT
|
Professional
|
Both
|
$5,294.00
|
|
|
Service Code
|
CPT 23472
|
| Hospital Charge Code |
9822347201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,343.26 |
| Max. Negotiated Rate |
$4,976.36 |
| Rate for Payer: Aetna of VT Commercial |
$4,976.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,742.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,383.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,742.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,880.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,691.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,691.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,544.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,691.36
|
| Rate for Payer: Cash Price |
$2,647.00
|
| Rate for Payer: Cash Price |
$2,647.00
|
| Rate for Payer: Cigna Commercial |
$2,546.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,249.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,249.56
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,343.26
|
| Rate for Payer: Multiplan Commercial |
$4,923.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,907.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,343.26
|
| Rate for Payer: United Healthcare Commercial |
$2,066.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,343.26
|
| Rate for Payer: United Healthcare VA CCN |
$1,343.26
|
|
|
RECOVERY SERVICES - PHASE 1
|
Facility
|
IP
|
$20.68
|
|
| Hospital Charge Code |
7100000001
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Aetna of VT Commercial |
$19.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$15.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$15.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$17.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$17.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.54
|
| Rate for Payer: Cash Price |
$10.34
|
| Rate for Payer: Cigna Commercial |
$16.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.54
|
| Rate for Payer: Multiplan Commercial |
$19.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.58
|
| Rate for Payer: United Healthcare Commercial |
$19.65
|
|
|
RECOVERY SERVICES - PHASE 1
|
Facility
|
OP
|
$20.68
|
|
| Hospital Charge Code |
7100000001
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Aetna of VT Commercial |
$19.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$18.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$18.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$12.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$17.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$16.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.44
|
| Rate for Payer: Cash Price |
$10.34
|
| Rate for Payer: Cigna Commercial |
$16.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.31
|
| Rate for Payer: Multiplan Commercial |
$19.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.31
|
| Rate for Payer: United Healthcare Commercial |
$19.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.31
|
| Rate for Payer: United Healthcare VA CCN |
$9.31
|
|
|
RECOVERY SERVICES - PHASE 2
|
Facility
|
OP
|
$7.24
|
|
| Hospital Charge Code |
7100000002
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: Aetna of VT Commercial |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5.76
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cigna Commercial |
$5.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$3.26
|
| Rate for Payer: Multiplan Commercial |
$6.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3.26
|
| Rate for Payer: United Healthcare Commercial |
$6.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.26
|
| Rate for Payer: United Healthcare VA CCN |
$3.26
|
|
