|
REPAIR OF KNEE CARTILAGE
|
Professional
|
Both
|
$2,540.00
|
|
|
Service Code
|
CPT 27403
|
| Hospital Charge Code |
9822740301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$612.97 |
| Max. Negotiated Rate |
$2,387.60 |
| Rate for Payer: Aetna of VT Commercial |
$2,387.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,275.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$631.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,275.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$858.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,257.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,257.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$704.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,257.17
|
| Rate for Payer: Cash Price |
$1,270.00
|
| Rate for Payer: Cash Price |
$1,270.00
|
| Rate for Payer: Cigna Commercial |
$1,160.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,021.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,021.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$612.97
|
| Rate for Payer: Multiplan Commercial |
$2,362.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$870.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$612.97
|
| Rate for Payer: United Healthcare Commercial |
$942.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$612.97
|
| Rate for Payer: United Healthcare VA CCN |
$612.97
|
|
|
REPAIR OF KNEE CARTILAGE
|
Facility
|
IP
|
$2,540.00
|
|
|
Service Code
|
CPT 27403
|
| Hospital Charge Code |
9822740301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,879.85 |
| Max. Negotiated Rate |
$2,413.00 |
| Rate for Payer: Aetna of VT Commercial |
$2,413.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,879.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,879.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,159.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,133.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,032.00
|
| Rate for Payer: Cash Price |
$1,270.00
|
| Rate for Payer: Cigna Commercial |
$2,032.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,032.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,032.00
|
| Rate for Payer: Multiplan Commercial |
$2,362.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,159.00
|
| Rate for Payer: United Healthcare Commercial |
$2,413.00
|
|
|
REPAIR OF KNEE CARTILAGE
|
Facility
|
OP
|
$2,540.00
|
|
|
Service Code
|
CPT 27403
|
| Hospital Charge Code |
9822740301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,124.97 |
| Max. Negotiated Rate |
$2,413.00 |
| Rate for Payer: Aetna of VT Commercial |
$2,413.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,275.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,124.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,275.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,529.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,159.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,057.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,143.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,019.30
|
| Rate for Payer: Cash Price |
$1,270.00
|
| Rate for Payer: Cigna Commercial |
$2,032.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,032.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,032.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,143.00
|
| Rate for Payer: Multiplan Commercial |
$2,362.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,159.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,143.00
|
| Rate for Payer: United Healthcare Commercial |
$2,413.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,143.00
|
| Rate for Payer: United Healthcare VA CCN |
$1,143.00
|
|
|
REPAIR OF KNEE LIGAMENT
|
Professional
|
Both
|
$2,592.00
|
|
|
Service Code
|
CPT 27405
|
| Hospital Charge Code |
9822740501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$641.21 |
| Max. Negotiated Rate |
$2,436.48 |
| Rate for Payer: Aetna of VT Commercial |
$2,436.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,322.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$660.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,322.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$897.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,048.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,048.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$737.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,048.68
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cigna Commercial |
$1,215.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,067.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,067.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$641.21
|
| Rate for Payer: Multiplan Commercial |
$2,410.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$910.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$641.21
|
| Rate for Payer: United Healthcare Commercial |
$986.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$641.21
|
| Rate for Payer: United Healthcare VA CCN |
$641.21
|
|
|
REPAIR OF KNEE LIGAMENT
|
Facility
|
OP
|
$2,592.00
|
|
|
Service Code
|
CPT 27405
|
| Hospital Charge Code |
9822740501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,148.00 |
| Max. Negotiated Rate |
$2,462.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,462.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,322.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,148.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,322.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,560.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,203.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,099.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,166.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,060.64
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cigna Commercial |
$2,073.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,073.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,073.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,166.40
|
| Rate for Payer: Multiplan Commercial |
$2,410.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,203.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,166.40
|
| Rate for Payer: United Healthcare Commercial |
$2,462.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,166.40
|
| Rate for Payer: United Healthcare VA CCN |
$1,166.40
|
|
|
REPAIR OF KNEE LIGAMENT
|
Facility
|
IP
|
$2,592.00
|
|
|
Service Code
|
CPT 27405
|
| Hospital Charge Code |
9822740501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,918.34 |
| Max. Negotiated Rate |
$2,462.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,462.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,918.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,918.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,203.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,177.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,073.60
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cigna Commercial |
$2,073.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,073.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,073.60
|
| Rate for Payer: Multiplan Commercial |
$2,410.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,203.20
|
| Rate for Payer: United Healthcare Commercial |
$2,462.40
|
|
|
REPAIR OF LEG TENDON EACH
|
Facility
|
OP
|
$1,339.00
|
|
|
Service Code
|
CPT 27658
|
| Hospital Charge Code |
9822765801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$593.04 |
| Max. Negotiated Rate |
$1,272.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,272.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,199.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$593.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,199.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$806.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,138.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,084.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$602.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,064.51
|
| Rate for Payer: Cash Price |
$669.50
|
| Rate for Payer: Cigna Commercial |
$1,071.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,071.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,071.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$602.55
|
| Rate for Payer: Multiplan Commercial |
$1,245.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,138.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$602.55
|
| Rate for Payer: United Healthcare Commercial |
$1,272.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$602.55
|
| Rate for Payer: United Healthcare VA CCN |
$602.55
|
|
|
REPAIR OF LEG TENDON EACH
|
Professional
|
Both
|
$1,710.00
|
|
|
Service Code
|
CPT 27659
|
| Hospital Charge Code |
9822765901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$450.98 |
| Max. Negotiated Rate |
$1,607.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,607.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,531.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$464.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,531.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$631.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$838.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$838.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$518.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$838.77
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cigna Commercial |
$855.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$742.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$742.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$450.98
|
| Rate for Payer: Multiplan Commercial |
$1,590.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$640.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$450.98
|
| Rate for Payer: United Healthcare Commercial |
$693.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$450.98
|
| Rate for Payer: United Healthcare VA CCN |
$450.98
|
|
|
REPAIR OF LEG TENDON EACH
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
CPT 27659
|
| Hospital Charge Code |
9822765901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$757.36 |
| Max. Negotiated Rate |
$1,624.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,624.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,531.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$757.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,531.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,029.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,453.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,385.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$769.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,359.45
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cigna Commercial |
$1,368.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,368.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,368.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$769.50
|
| Rate for Payer: Multiplan Commercial |
$1,590.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,453.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$769.50
|
| Rate for Payer: United Healthcare Commercial |
$1,624.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$769.50
|
| Rate for Payer: United Healthcare VA CCN |
$769.50
|
|
|
REPAIR OF LEG TENDON EACH
|
Facility
|
OP
|
$1,307.00
|
|
|
Service Code
|
CPT 27664
|
| Hospital Charge Code |
9822766401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$578.87 |
| Max. Negotiated Rate |
$1,241.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,241.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,170.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$578.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,170.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$786.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,110.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,058.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$588.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,039.07
|
| Rate for Payer: Cash Price |
$653.50
|
| Rate for Payer: Cigna Commercial |
$1,045.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,045.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,045.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$588.15
|
| Rate for Payer: Multiplan Commercial |
$1,215.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,110.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$588.15
|
| Rate for Payer: United Healthcare Commercial |
$1,241.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$588.15
|
| Rate for Payer: United Healthcare VA CCN |
$588.15
|
|
|
REPAIR OF LEG TENDON EACH
|
Facility
|
IP
|
$1,307.00
|
|
|
Service Code
|
CPT 27664
|
| Hospital Charge Code |
9822766401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$967.31 |
| Max. Negotiated Rate |
$1,241.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,241.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$967.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$967.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,110.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,097.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,045.60
|
| Rate for Payer: Cash Price |
$653.50
|
| Rate for Payer: Cigna Commercial |
$1,045.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,045.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,045.60
|
| Rate for Payer: Multiplan Commercial |
$1,215.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,110.95
|
| Rate for Payer: United Healthcare Commercial |
$1,241.65
|
|
|
REPAIR OF LEG TENDON EACH
|
Facility
|
IP
|
$1,339.00
|
|
|
Service Code
|
CPT 27658
|
| Hospital Charge Code |
9822765801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$990.99 |
| Max. Negotiated Rate |
$1,272.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,272.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$990.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$990.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,138.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,124.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,071.20
|
| Rate for Payer: Cash Price |
$669.50
|
| Rate for Payer: Cigna Commercial |
$1,071.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,071.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,071.20
|
| Rate for Payer: Multiplan Commercial |
$1,245.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,138.15
|
| Rate for Payer: United Healthcare Commercial |
$1,272.05
|
|
|
REPAIR OF LEG TENDON EACH
|
Professional
|
Both
|
$1,307.00
|
|
|
Service Code
|
CPT 27664
|
| Hospital Charge Code |
9822766401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$342.20 |
| Max. Negotiated Rate |
$1,228.58 |
| Rate for Payer: Aetna of VT Commercial |
$1,228.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,170.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$352.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,170.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$479.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$642.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$642.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$393.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$642.97
|
| Rate for Payer: Cash Price |
$653.50
|
| Rate for Payer: Cash Price |
$653.50
|
| Rate for Payer: Cigna Commercial |
$657.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$563.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$563.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$342.20
|
| Rate for Payer: Multiplan Commercial |
$1,215.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$485.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$342.20
|
| Rate for Payer: United Healthcare Commercial |
$526.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$342.20
|
| Rate for Payer: United Healthcare VA CCN |
$342.20
|
|
|
REPAIR OF LEG TENDON EACH
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
CPT 27659
|
| Hospital Charge Code |
9822765901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,265.57 |
| Max. Negotiated Rate |
$1,624.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,624.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,265.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,265.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,453.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,436.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,368.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cigna Commercial |
$1,368.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,368.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,368.00
|
| Rate for Payer: Multiplan Commercial |
$1,590.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,453.50
|
| Rate for Payer: United Healthcare Commercial |
$1,624.50
|
|
|
REPAIR OF LEG TENDON EACH
|
Professional
|
Both
|
$1,339.00
|
|
|
Service Code
|
CPT 27658
|
| Hospital Charge Code |
9822765801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$355.47 |
| Max. Negotiated Rate |
$1,258.66 |
| Rate for Payer: Aetna of VT Commercial |
$1,258.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,199.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$366.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,199.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$497.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$659.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$659.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$408.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$659.19
|
| Rate for Payer: Cash Price |
$669.50
|
| Rate for Payer: Cash Price |
$669.50
|
| Rate for Payer: Cigna Commercial |
$670.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$585.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$585.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$355.47
|
| Rate for Payer: Multiplan Commercial |
$1,245.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$504.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$355.47
|
| Rate for Payer: United Healthcare Commercial |
$546.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.47
|
| Rate for Payer: United Healthcare VA CCN |
$355.47
|
|
|
REPAIR OF METATARSALS
|
Facility
|
IP
|
$1,805.00
|
|
|
Service Code
|
CPT 28322
|
| Hospital Charge Code |
9822832201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,335.88 |
| Max. Negotiated Rate |
$1,714.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,714.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,335.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,335.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,534.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,516.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,444.00
|
| Rate for Payer: Cash Price |
$902.50
|
| Rate for Payer: Cigna Commercial |
$1,444.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,444.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,444.00
|
| Rate for Payer: Multiplan Commercial |
$1,678.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,534.25
|
| Rate for Payer: United Healthcare Commercial |
$1,714.75
|
|
|
REPAIR OF METATARSALS
|
Facility
|
OP
|
$1,805.00
|
|
|
Service Code
|
CPT 28322
|
| Hospital Charge Code |
9822832201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$799.43 |
| Max. Negotiated Rate |
$1,714.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,714.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,617.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$799.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,617.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,086.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,534.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,462.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$812.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,434.97
|
| Rate for Payer: Cash Price |
$902.50
|
| Rate for Payer: Cigna Commercial |
$1,444.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,444.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,444.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$812.25
|
| Rate for Payer: Multiplan Commercial |
$1,678.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,534.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$812.25
|
| Rate for Payer: United Healthcare Commercial |
$1,714.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$812.25
|
| Rate for Payer: United Healthcare VA CCN |
$812.25
|
|
|
REPAIR OF METATARSALS
|
Professional
|
Both
|
$1,805.00
|
|
|
Service Code
|
CPT 28322
|
| Hospital Charge Code |
9822832201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$548.22 |
| Max. Negotiated Rate |
$1,696.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,696.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,617.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$564.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,617.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$767.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,288.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,288.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$630.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,288.90
|
| Rate for Payer: Cash Price |
$902.50
|
| Rate for Payer: Cash Price |
$902.50
|
| Rate for Payer: Cigna Commercial |
$1,041.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,214.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,214.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$740.62
|
| Rate for Payer: Multiplan Commercial |
$1,678.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$778.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$548.22
|
| Rate for Payer: United Healthcare Commercial |
$843.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$548.22
|
| Rate for Payer: United Healthcare VA CCN |
$548.22
|
|
|
REPAIR OF RUPTURED TENDON
|
Facility
|
IP
|
$1,775.00
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
9822434201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,313.68 |
| Max. Negotiated Rate |
$1,686.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,686.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,313.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,313.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,508.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,491.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,420.00
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,420.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,420.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,420.00
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,508.75
|
| Rate for Payer: United Healthcare Commercial |
$1,686.25
|
|
|
REPAIR OF RUPTURED TENDON
|
Facility
|
OP
|
$1,775.00
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
9822434201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$786.15 |
| Max. Negotiated Rate |
$1,686.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,686.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,590.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$786.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,590.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,068.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,508.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,437.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$798.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,411.12
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,420.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,420.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,420.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$798.75
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,508.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$798.75
|
| Rate for Payer: United Healthcare Commercial |
$1,686.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$798.75
|
| Rate for Payer: United Healthcare VA CCN |
$798.75
|
|
|
REPAIR OF RUPTURED TENDON
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
9822434201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$731.61 |
| Max. Negotiated Rate |
$1,668.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,668.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,590.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$753.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,590.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,024.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,129.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,129.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$841.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,129.99
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,385.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,219.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,219.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$731.61
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,038.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$731.61
|
| Rate for Payer: United Healthcare Commercial |
$1,125.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$731.61
|
| Rate for Payer: United Healthcare VA CCN |
$731.61
|
|
|
REPAIR OF STOMACH LESION
|
Facility
|
OP
|
$3,119.00
|
|
|
Service Code
|
CPT 43840
|
| Hospital Charge Code |
9824384001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,381.41 |
| Max. Negotiated Rate |
$2,963.05 |
| Rate for Payer: Aetna of VT Commercial |
$2,963.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,794.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,381.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,794.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,877.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,651.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,526.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,403.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,479.61
|
| Rate for Payer: Cash Price |
$1,559.50
|
| Rate for Payer: Cigna Commercial |
$2,495.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,495.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,495.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,403.55
|
| Rate for Payer: Multiplan Commercial |
$2,900.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,651.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,403.55
|
| Rate for Payer: United Healthcare Commercial |
$2,963.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,403.55
|
| Rate for Payer: United Healthcare VA CCN |
$1,403.55
|
|
|
REPAIR OF STOMACH LESION
|
Facility
|
IP
|
$3,119.00
|
|
|
Service Code
|
CPT 43840
|
| Hospital Charge Code |
9824384001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,308.37 |
| Max. Negotiated Rate |
$2,963.05 |
| Rate for Payer: Aetna of VT Commercial |
$2,963.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,308.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,308.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,651.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,619.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,495.20
|
| Rate for Payer: Cash Price |
$1,559.50
|
| Rate for Payer: Cigna Commercial |
$2,495.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,495.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,495.20
|
| Rate for Payer: Multiplan Commercial |
$2,900.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,651.15
|
| Rate for Payer: United Healthcare Commercial |
$2,963.05
|
|
|
REPAIR OF STOMACH LESION
|
Professional
|
Both
|
$3,119.00
|
|
|
Service Code
|
CPT 43840
|
| Hospital Charge Code |
9824384001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,237.18 |
| Max. Negotiated Rate |
$2,931.86 |
| Rate for Payer: Aetna of VT Commercial |
$2,931.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,794.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,274.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,794.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,732.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,587.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,587.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,422.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,587.36
|
| Rate for Payer: Cash Price |
$1,559.50
|
| Rate for Payer: Cash Price |
$1,559.50
|
| Rate for Payer: Cigna Commercial |
$2,261.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,110.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,110.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,237.18
|
| Rate for Payer: Multiplan Commercial |
$2,900.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,756.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,237.18
|
| Rate for Payer: United Healthcare Commercial |
$1,903.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,237.18
|
| Rate for Payer: United Healthcare VA CCN |
$1,237.18
|
|
|
REPAIR OF THIGH MUSCLE
|
Facility
|
OP
|
$1,191.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
9602738502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$527.49 |
| Max. Negotiated Rate |
$1,131.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,131.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,067.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$527.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,067.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$716.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,012.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$964.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$535.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$946.85
|
| Rate for Payer: Cash Price |
$595.50
|
| Rate for Payer: Cigna Commercial |
$952.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$952.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$952.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$535.95
|
| Rate for Payer: Multiplan Commercial |
$1,107.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,012.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$535.95
|
| Rate for Payer: United Healthcare Commercial |
$1,131.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$535.95
|
| Rate for Payer: United Healthcare VA CCN |
$535.95
|
|
