|
REVISE FINGER JOINT
|
Facility
|
OP
|
$9,785.00
|
|
|
Service Code
|
CPT 26535
|
| Hospital Charge Code |
9602653501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4,333.78 |
| Max. Negotiated Rate |
$9,295.75 |
| Rate for Payer: Aetna of VT Commercial |
$9,295.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8,766.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4,333.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8,766.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5,890.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8,317.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7,925.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4,403.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,779.07
|
| Rate for Payer: Cash Price |
$4,892.50
|
| Rate for Payer: Cigna Commercial |
$7,828.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,828.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,828.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$4,403.25
|
| Rate for Payer: Multiplan Commercial |
$9,100.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,317.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4,403.25
|
| Rate for Payer: United Healthcare Commercial |
$9,295.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,403.25
|
| Rate for Payer: United Healthcare VA CCN |
$4,403.25
|
|
|
REVISE FINGER JOINT
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
CPT 26535
|
| Hospital Charge Code |
9602653502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$425.89 |
| Max. Negotiated Rate |
$1,304.72 |
| Rate for Payer: Aetna of VT Commercial |
$1,304.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,243.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$438.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,243.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$596.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$772.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$772.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$489.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$772.15
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cigna Commercial |
$799.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$704.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$704.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$425.89
|
| Rate for Payer: Multiplan Commercial |
$1,290.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$604.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$425.89
|
| Rate for Payer: United Healthcare Commercial |
$655.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$425.89
|
| Rate for Payer: United Healthcare VA CCN |
$425.89
|
|
|
REVISE FINGER JOINT
|
Facility
|
OP
|
$1,388.00
|
|
|
Service Code
|
CPT 26535
|
| Hospital Charge Code |
9602653502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$614.75 |
| Max. Negotiated Rate |
$1,318.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,318.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,243.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$614.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,243.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$835.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,179.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,124.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$624.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,103.46
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cigna Commercial |
$1,110.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,110.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,110.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$624.60
|
| Rate for Payer: Multiplan Commercial |
$1,290.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,179.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$624.60
|
| Rate for Payer: United Healthcare Commercial |
$1,318.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$624.60
|
| Rate for Payer: United Healthcare VA CCN |
$624.60
|
|
|
REVISE FINGER JOINT
|
Facility
|
IP
|
$1,388.00
|
|
|
Service Code
|
CPT 26535
|
| Hospital Charge Code |
9822653501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,027.26 |
| Max. Negotiated Rate |
$1,318.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,318.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,027.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,027.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,179.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,165.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,110.40
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cigna Commercial |
$1,110.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,110.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,110.40
|
| Rate for Payer: Multiplan Commercial |
$1,290.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,179.80
|
| Rate for Payer: United Healthcare Commercial |
$1,318.60
|
|
|
REVISE FINGER JOINT
|
Professional
|
Both
|
$8,398.00
|
|
|
Service Code
|
CPT 26535
|
| Hospital Charge Code |
5102653501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$425.89 |
| Max. Negotiated Rate |
$7,894.12 |
| Rate for Payer: Aetna of VT Commercial |
$7,894.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7,523.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$438.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7,523.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$596.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$772.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$772.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$489.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$772.15
|
| Rate for Payer: Cash Price |
$4,199.00
|
| Rate for Payer: Cash Price |
$4,199.00
|
| Rate for Payer: Cigna Commercial |
$799.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$704.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$704.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$425.89
|
| Rate for Payer: Multiplan Commercial |
$7,810.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$604.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$425.89
|
| Rate for Payer: United Healthcare Commercial |
$655.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$425.89
|
| Rate for Payer: United Healthcare VA CCN |
$425.89
|
|
|
REVISE FINGER JOINT
|
Facility
|
OP
|
$8,398.00
|
|
|
Service Code
|
CPT 26535
|
| Hospital Charge Code |
5102653501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,719.47 |
| Max. Negotiated Rate |
$7,978.10 |
| Rate for Payer: Aetna of VT Commercial |
$7,978.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7,523.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,719.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7,523.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5,055.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7,138.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,802.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,779.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,676.41
|
| Rate for Payer: Cash Price |
$4,199.00
|
| Rate for Payer: Cigna Commercial |
$6,718.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,718.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,718.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,779.10
|
| Rate for Payer: Multiplan Commercial |
$7,810.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,138.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,779.10
|
| Rate for Payer: United Healthcare Commercial |
$7,978.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,779.10
|
| Rate for Payer: United Healthcare VA CCN |
$3,779.10
|
|
|
REVISE FINGER JOINT
|
Professional
|
Both
|
$9,785.00
|
|
|
Service Code
|
CPT 26535
|
| Hospital Charge Code |
9602653501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$425.89 |
| Max. Negotiated Rate |
$9,197.90 |
| Rate for Payer: Aetna of VT Commercial |
$9,197.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8,766.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$438.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8,766.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$596.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$772.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$772.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$489.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$772.15
|
| Rate for Payer: Cash Price |
$4,892.50
|
| Rate for Payer: Cash Price |
$4,892.50
|
| Rate for Payer: Cigna Commercial |
$799.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$704.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$704.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$425.89
|
| Rate for Payer: Multiplan Commercial |
$9,100.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$604.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$425.89
|
| Rate for Payer: United Healthcare Commercial |
$655.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$425.89
|
| Rate for Payer: United Healthcare VA CCN |
$425.89
|
|
|
REVISE FINGER JOINT
|
Facility
|
IP
|
$8,398.00
|
|
|
Service Code
|
CPT 26535
|
| Hospital Charge Code |
5102653501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6,215.36 |
| Max. Negotiated Rate |
$7,978.10 |
| Rate for Payer: Aetna of VT Commercial |
$7,978.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,215.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,215.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7,138.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7,054.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,718.40
|
| Rate for Payer: Cash Price |
$4,199.00
|
| Rate for Payer: Cigna Commercial |
$6,718.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,718.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,718.40
|
| Rate for Payer: Multiplan Commercial |
$7,810.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,138.30
|
| Rate for Payer: United Healthcare Commercial |
$7,978.10
|
|
|
REVISE FINGER JOINT
|
Facility
|
IP
|
$1,388.00
|
|
|
Service Code
|
CPT 26535
|
| Hospital Charge Code |
9602653502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,027.26 |
| Max. Negotiated Rate |
$1,318.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,318.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,027.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,027.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,179.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,165.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,110.40
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cigna Commercial |
$1,110.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,110.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,110.40
|
| Rate for Payer: Multiplan Commercial |
$1,290.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,179.80
|
| Rate for Payer: United Healthcare Commercial |
$1,318.60
|
|
|
REVISE FINGER JOINT
|
Facility
|
OP
|
$1,388.00
|
|
|
Service Code
|
CPT 26535
|
| Hospital Charge Code |
9822653501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$614.75 |
| Max. Negotiated Rate |
$1,318.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,318.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,243.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$614.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,243.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$835.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,179.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,124.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$624.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,103.46
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cigna Commercial |
$1,110.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,110.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,110.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$624.60
|
| Rate for Payer: Multiplan Commercial |
$1,290.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,179.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$624.60
|
| Rate for Payer: United Healthcare Commercial |
$1,318.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$624.60
|
| Rate for Payer: United Healthcare VA CCN |
$624.60
|
|
|
REVISE FINGER JOINT
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
CPT 26535
|
| Hospital Charge Code |
9822653501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$425.89 |
| Max. Negotiated Rate |
$1,304.72 |
| Rate for Payer: Aetna of VT Commercial |
$1,304.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,243.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$438.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,243.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$596.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$772.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$772.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$489.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$772.15
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cigna Commercial |
$799.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$704.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$704.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$425.89
|
| Rate for Payer: Multiplan Commercial |
$1,290.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$604.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$425.89
|
| Rate for Payer: United Healthcare Commercial |
$655.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$425.89
|
| Rate for Payer: United Healthcare VA CCN |
$425.89
|
|
|
REVISE FINGER JOINT
|
Facility
|
IP
|
$9,785.00
|
|
|
Service Code
|
CPT 26535
|
| Hospital Charge Code |
9602653501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$7,241.88 |
| Max. Negotiated Rate |
$9,295.75 |
| Rate for Payer: Aetna of VT Commercial |
$9,295.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7,241.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7,241.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8,317.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8,219.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,828.00
|
| Rate for Payer: Cash Price |
$4,892.50
|
| Rate for Payer: Cigna Commercial |
$7,828.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,828.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,828.00
|
| Rate for Payer: Multiplan Commercial |
$9,100.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,317.25
|
| Rate for Payer: United Healthcare Commercial |
$9,295.75
|
|
|
REVISE HIP JOINT REPLACEMENT
|
Facility
|
OP
|
$4,804.00
|
|
|
Service Code
|
CPT 27134
|
| Hospital Charge Code |
9822713401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,127.69 |
| Max. Negotiated Rate |
$4,563.80 |
| Rate for Payer: Aetna of VT Commercial |
$4,563.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,303.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,127.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,303.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,892.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,083.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,891.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,161.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,819.18
|
| Rate for Payer: Cash Price |
$2,402.00
|
| Rate for Payer: Cigna Commercial |
$3,843.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,843.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,843.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,161.80
|
| Rate for Payer: Multiplan Commercial |
$4,467.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,083.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,161.80
|
| Rate for Payer: United Healthcare Commercial |
$4,563.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,161.80
|
| Rate for Payer: United Healthcare VA CCN |
$2,161.80
|
|
|
REVISE HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$4,804.00
|
|
|
Service Code
|
CPT 27134
|
| Hospital Charge Code |
9822713401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$3,555.44 |
| Max. Negotiated Rate |
$4,563.80 |
| Rate for Payer: Aetna of VT Commercial |
$4,563.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,555.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,555.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,083.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,035.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,843.20
|
| Rate for Payer: Cash Price |
$2,402.00
|
| Rate for Payer: Cigna Commercial |
$3,843.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,843.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,843.20
|
| Rate for Payer: Multiplan Commercial |
$4,467.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,083.40
|
| Rate for Payer: United Healthcare Commercial |
$4,563.80
|
|
|
REVISE HIP JOINT REPLACEMENT
|
Professional
|
Both
|
$4,804.00
|
|
|
Service Code
|
CPT 27134
|
| Hospital Charge Code |
9822713401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,757.68 |
| Max. Negotiated Rate |
$4,515.76 |
| Rate for Payer: Aetna of VT Commercial |
$4,515.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,303.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,810.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,303.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,460.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,545.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,545.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,021.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,545.33
|
| Rate for Payer: Cash Price |
$2,402.00
|
| Rate for Payer: Cash Price |
$2,402.00
|
| Rate for Payer: Cigna Commercial |
$3,331.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,955.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,955.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,757.68
|
| Rate for Payer: Multiplan Commercial |
$4,467.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,495.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,757.68
|
| Rate for Payer: United Healthcare Commercial |
$2,703.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,757.68
|
| Rate for Payer: United Healthcare VA CCN |
$1,757.68
|
|
|
REVISE/REMOVE SLING REPAIR
|
Facility
|
IP
|
$1,696.00
|
|
|
Service Code
|
CPT 57287
|
| Hospital Charge Code |
9825728701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,255.21 |
| Max. Negotiated Rate |
$1,611.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,611.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,255.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,255.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,441.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,424.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,356.80
|
| Rate for Payer: Cash Price |
$848.00
|
| Rate for Payer: Cigna Commercial |
$1,356.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,356.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,356.80
|
| Rate for Payer: Multiplan Commercial |
$1,577.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,441.60
|
| Rate for Payer: United Healthcare Commercial |
$1,611.20
|
|
|
REVISE/REMOVE SLING REPAIR
|
Professional
|
Both
|
$1,696.00
|
|
|
Service Code
|
CPT 57287
|
| Hospital Charge Code |
9825728701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$694.43 |
| Max. Negotiated Rate |
$1,594.24 |
| Rate for Payer: Aetna of VT Commercial |
$1,594.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,519.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$715.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,519.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$972.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,105.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,105.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$798.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,105.34
|
| Rate for Payer: Cash Price |
$848.00
|
| Rate for Payer: Cash Price |
$848.00
|
| Rate for Payer: Cigna Commercial |
$1,229.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,148.95
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,148.95
|
| Rate for Payer: Martins Point Health Care Commercial |
$694.43
|
| Rate for Payer: Multiplan Commercial |
$1,577.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$986.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$694.43
|
| Rate for Payer: United Healthcare Commercial |
$1,068.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$694.43
|
| Rate for Payer: United Healthcare VA CCN |
$694.43
|
|
|
REVISE/REMOVE SLING REPAIR
|
Facility
|
OP
|
$1,696.00
|
|
|
Service Code
|
CPT 57287
|
| Hospital Charge Code |
9825728701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$751.16 |
| Max. Negotiated Rate |
$1,611.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,611.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,519.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$751.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,519.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,020.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,441.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,373.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$763.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,348.32
|
| Rate for Payer: Cash Price |
$848.00
|
| Rate for Payer: Cigna Commercial |
$1,356.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,356.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,356.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$763.20
|
| Rate for Payer: Multiplan Commercial |
$1,577.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,441.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$763.20
|
| Rate for Payer: United Healthcare Commercial |
$1,611.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$763.20
|
| Rate for Payer: United Healthcare VA CCN |
$763.20
|
|
|
REVISE/REPLACE KNEE JOINT
|
Professional
|
Both
|
$4,769.00
|
|
|
Service Code
|
CPT 27486
|
| Hospital Charge Code |
9822748601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,307.03 |
| Max. Negotiated Rate |
$4,482.86 |
| Rate for Payer: Aetna of VT Commercial |
$4,482.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,272.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,346.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,272.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,829.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,967.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,967.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,503.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,967.09
|
| Rate for Payer: Cash Price |
$2,384.50
|
| Rate for Payer: Cash Price |
$2,384.50
|
| Rate for Payer: Cigna Commercial |
$2,474.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,190.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,190.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,307.03
|
| Rate for Payer: Multiplan Commercial |
$4,435.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,855.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,307.03
|
| Rate for Payer: United Healthcare Commercial |
$2,010.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,307.03
|
| Rate for Payer: United Healthcare VA CCN |
$1,307.03
|
|
|
REVISE/REPLACE KNEE JOINT
|
Facility
|
OP
|
$6,681.00
|
|
|
Service Code
|
CPT 27487
|
| Hospital Charge Code |
9822748701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,959.01 |
| Max. Negotiated Rate |
$6,346.95 |
| Rate for Payer: Aetna of VT Commercial |
$6,346.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,985.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,959.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,985.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,021.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,678.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,411.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,006.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,311.40
|
| Rate for Payer: Cash Price |
$3,340.50
|
| Rate for Payer: Cigna Commercial |
$5,344.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,344.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,344.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,006.45
|
| Rate for Payer: Multiplan Commercial |
$6,213.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,678.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,006.45
|
| Rate for Payer: United Healthcare Commercial |
$6,346.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,006.45
|
| Rate for Payer: United Healthcare VA CCN |
$3,006.45
|
|
|
REVISE/REPLACE KNEE JOINT
|
Facility
|
IP
|
$6,681.00
|
|
|
Service Code
|
CPT 27487
|
| Hospital Charge Code |
9822748701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$4,944.61 |
| Max. Negotiated Rate |
$6,346.95 |
| Rate for Payer: Aetna of VT Commercial |
$6,346.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,944.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,944.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,678.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,612.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,344.80
|
| Rate for Payer: Cash Price |
$3,340.50
|
| Rate for Payer: Cigna Commercial |
$5,344.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,344.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,344.80
|
| Rate for Payer: Multiplan Commercial |
$6,213.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,678.85
|
| Rate for Payer: United Healthcare Commercial |
$6,346.95
|
|
|
REVISE/REPLACE KNEE JOINT
|
Facility
|
IP
|
$4,769.00
|
|
|
Service Code
|
CPT 27486
|
| Hospital Charge Code |
9822748601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$3,529.54 |
| Max. Negotiated Rate |
$4,530.55 |
| Rate for Payer: Aetna of VT Commercial |
$4,530.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,529.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,529.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,053.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,005.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,815.20
|
| Rate for Payer: Cash Price |
$2,384.50
|
| Rate for Payer: Cigna Commercial |
$3,815.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,815.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,815.20
|
| Rate for Payer: Multiplan Commercial |
$4,435.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,053.65
|
| Rate for Payer: United Healthcare Commercial |
$4,530.55
|
|
|
REVISE/REPLACE KNEE JOINT
|
Facility
|
OP
|
$4,769.00
|
|
|
Service Code
|
CPT 27486
|
| Hospital Charge Code |
9822748601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,112.19 |
| Max. Negotiated Rate |
$4,530.55 |
| Rate for Payer: Aetna of VT Commercial |
$4,530.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,272.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,112.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,272.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,870.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,053.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,862.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,146.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,791.36
|
| Rate for Payer: Cash Price |
$2,384.50
|
| Rate for Payer: Cigna Commercial |
$3,815.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,815.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,815.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,146.05
|
| Rate for Payer: Multiplan Commercial |
$4,435.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,053.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,146.05
|
| Rate for Payer: United Healthcare Commercial |
$4,530.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,146.05
|
| Rate for Payer: United Healthcare VA CCN |
$2,146.05
|
|
|
REVISE/REPLACE KNEE JOINT
|
Professional
|
Both
|
$6,681.00
|
|
|
Service Code
|
CPT 27487
|
| Hospital Charge Code |
9822748701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,623.68 |
| Max. Negotiated Rate |
$6,280.14 |
| Rate for Payer: Aetna of VT Commercial |
$6,280.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,985.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,672.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,985.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,273.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,321.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,321.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,867.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,321.88
|
| Rate for Payer: Cash Price |
$3,340.50
|
| Rate for Payer: Cash Price |
$3,340.50
|
| Rate for Payer: Cigna Commercial |
$3,077.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,725.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,725.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,623.68
|
| Rate for Payer: Multiplan Commercial |
$6,213.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,305.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,623.69
|
| Rate for Payer: United Healthcare Commercial |
$2,497.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,623.69
|
| Rate for Payer: United Healthcare VA CCN |
$1,623.69
|
|
|
REVISE ULNAR NERVE AT ELBOW
|
Facility
|
OP
|
$2,503.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
9606471802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,108.58 |
| Max. Negotiated Rate |
$2,377.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,377.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,242.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,108.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,242.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,506.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,127.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,027.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,126.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,989.88
|
| Rate for Payer: Cash Price |
$1,251.50
|
| Rate for Payer: Cigna Commercial |
$2,002.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,002.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,002.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,126.35
|
| Rate for Payer: Multiplan Commercial |
$2,327.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,127.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,126.35
|
| Rate for Payer: United Healthcare Commercial |
$2,377.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,126.35
|
| Rate for Payer: United Healthcare VA CCN |
$1,126.35
|
|
