|
SBSQ NURSING DAY NEW PROB 25 M
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 99309
|
| Hospital Charge Code |
9699930901
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$93.99 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Aetna of VT Commercial |
$120.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$107.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$101.60
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Cigna Commercial |
$101.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$101.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$101.60
|
| Rate for Payer: Multiplan Commercial |
$118.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.95
|
| Rate for Payer: United Healthcare Commercial |
$120.65
|
|
|
SBSQ NURSING DAY NEW PROB 25 M
|
Professional
|
Both
|
$127.00
|
|
|
Service Code
|
CPT 99309
|
| Hospital Charge Code |
9699930901
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$101.86 |
| Max. Negotiated Rate |
$165.61 |
| Rate for Payer: Aetna of VT Commercial |
$119.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$133.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$104.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$133.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$142.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$138.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$138.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$117.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$138.36
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Cigna Commercial |
$110.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$165.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$165.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$101.87
|
| Rate for Payer: Multiplan Commercial |
$118.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$144.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$101.86
|
| Rate for Payer: United Healthcare Commercial |
$156.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$101.86
|
| Rate for Payer: United Healthcare VA CCN |
$101.86
|
|
|
SBSQ NURSING DAY NEW PROB 25 M
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 99309
|
| Hospital Charge Code |
9699930901
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Aetna of VT Commercial |
$120.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$56.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$76.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$107.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$102.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$57.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$100.97
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Cigna Commercial |
$101.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$101.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$101.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$57.15
|
| Rate for Payer: Multiplan Commercial |
$118.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.15
|
| Rate for Payer: United Healthcare Commercial |
$120.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.15
|
| Rate for Payer: United Healthcare VA CCN |
$57.15
|
|
|
SBSQ OBSERVATION CARE/DAY 15 M
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
CPT 99224
|
| Hospital Charge Code |
9829922401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$171.08 |
| Rate for Payer: Aetna of VT Commercial |
$171.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.05
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Multiplan Commercial |
$169.26
|
| Rate for Payer: United Healthcare Commercial |
$154.70
|
| Rate for Payer: United Healthcare VA CCN |
$72.80
|
|
|
SBSQ OBSERVATION CARE/DAY 15 M
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 99224
|
| Hospital Charge Code |
9829922401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$80.61 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna of VT Commercial |
$172.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$80.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$109.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$154.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.69
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cigna Commercial |
$145.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$145.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$145.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$81.90
|
| Rate for Payer: Multiplan Commercial |
$169.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$154.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$81.90
|
| Rate for Payer: United Healthcare Commercial |
$172.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.90
|
| Rate for Payer: United Healthcare VA CCN |
$81.90
|
|
|
SBSQ OBSERVATION CARE/DAY 15 M
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 99224
|
| Hospital Charge Code |
9829922401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$134.70 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna of VT Commercial |
$172.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$134.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$134.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$154.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$152.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$145.60
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cigna Commercial |
$145.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$145.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$145.60
|
| Rate for Payer: Multiplan Commercial |
$169.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$154.70
|
| Rate for Payer: United Healthcare Commercial |
$172.90
|
|
|
SBSQ OBSERVATION CARE/DAY 25 M
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
CPT 99225
|
| Hospital Charge Code |
9829922501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$351.55 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Aetna of VT Commercial |
$451.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$351.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$351.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$399.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$380.00
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$380.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$380.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$380.00
|
| Rate for Payer: Multiplan Commercial |
$441.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$403.75
|
| Rate for Payer: United Healthcare Commercial |
$451.25
|
|
|
SBSQ OBSERVATION CARE/DAY 25 M
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
CPT 99225
|
| Hospital Charge Code |
9829922501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$210.38 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Aetna of VT Commercial |
$451.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$425.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$425.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$285.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$384.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$213.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$377.62
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$380.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$380.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$380.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$213.75
|
| Rate for Payer: Multiplan Commercial |
$441.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$403.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$213.75
|
| Rate for Payer: United Healthcare Commercial |
$451.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$213.75
|
| Rate for Payer: United Healthcare VA CCN |
$213.75
|
|
|
SBSQ OBSERVATION CARE/DAY 25 M
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
CPT 99225
|
| Hospital Charge Code |
9829922501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Aetna of VT Commercial |
$446.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$425.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$425.55
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Multiplan Commercial |
$441.75
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
| Rate for Payer: United Healthcare VA CCN |
$190.00
|
|
|
SCALPEL DISP 11
|
Facility
|
OP
|
$3.35
|
|
| Hospital Charge Code |
2720013771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Aetna of VT Commercial |
$3.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.66
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Cigna Commercial |
$2.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$3.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.51
|
| Rate for Payer: United Healthcare Commercial |
$3.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.51
|
| Rate for Payer: United Healthcare VA CCN |
$1.51
|
|
|
SCALPEL DISP 11
|
Facility
|
IP
|
$3.35
|
|
| Hospital Charge Code |
2720013771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Aetna of VT Commercial |
$3.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.68
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Cigna Commercial |
$2.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.68
|
| Rate for Payer: Multiplan Commercial |
$3.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.85
|
| Rate for Payer: United Healthcare Commercial |
$3.18
|
|
|
SCHOOL BASED THERAPY 1/4 HR
|
Facility
|
IP
|
$31.02
|
|
| Hospital Charge Code |
440000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$29.47 |
| Rate for Payer: Aetna of VT Commercial |
$29.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.82
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cigna Commercial |
$24.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$24.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$24.82
|
| Rate for Payer: Multiplan Commercial |
$28.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.37
|
| Rate for Payer: United Healthcare Commercial |
$29.47
|
|
|
SCHOOL BASED THERAPY 1/4 HR
|
Facility
|
OP
|
$31.02
|
|
| Hospital Charge Code |
440000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$29.47 |
| Rate for Payer: Aetna of VT Commercial |
$29.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$27.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$27.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$25.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.66
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cigna Commercial |
$24.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$24.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$24.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.96
|
| Rate for Payer: Multiplan Commercial |
$28.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.96
|
| Rate for Payer: United Healthcare Commercial |
$29.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.96
|
| Rate for Payer: United Healthcare VA CCN |
$13.96
|
|
|
SCORPION-MULTIFIRE NEEDLE
|
Facility
|
OP
|
$237.00
|
|
| Hospital Charge Code |
2720074691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.97 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Aetna of VT Commercial |
$225.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$212.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$104.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$212.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$142.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$201.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$191.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$106.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$188.41
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cigna Commercial |
$189.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$189.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$189.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$106.65
|
| Rate for Payer: Multiplan Commercial |
$220.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$201.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$106.65
|
| Rate for Payer: United Healthcare Commercial |
$225.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$106.65
|
| Rate for Payer: United Healthcare VA CCN |
$106.65
|
|
|
SCORPION-MULTIFIRE NEEDLE
|
Facility
|
IP
|
$237.00
|
|
| Hospital Charge Code |
2720074691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.40 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Aetna of VT Commercial |
$225.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$175.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$175.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$201.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$199.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$189.60
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cigna Commercial |
$189.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$189.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$189.60
|
| Rate for Payer: Multiplan Commercial |
$220.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$201.45
|
| Rate for Payer: United Healthcare Commercial |
$225.15
|
|
|
SCR BONE 2.3MM X 10MM
|
Facility
|
OP
|
$418.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$185.30 |
| Max. Negotiated Rate |
$397.45 |
| Rate for Payer: Aetna of VT Commercial |
$397.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$374.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$185.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$374.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$251.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$355.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$338.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$188.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$332.60
|
| Rate for Payer: Cash Price |
$209.18
|
| Rate for Payer: Cigna Commercial |
$334.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$334.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$334.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$188.27
|
| Rate for Payer: Multiplan Commercial |
$389.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$355.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$188.27
|
| Rate for Payer: United Healthcare Commercial |
$397.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.27
|
| Rate for Payer: United Healthcare VA CCN |
$188.27
|
|
|
SCR BONE 2.3MM X 10MM
|
Facility
|
IP
|
$418.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$309.64 |
| Max. Negotiated Rate |
$397.45 |
| Rate for Payer: Aetna of VT Commercial |
$397.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$309.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$309.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$355.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$351.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$334.70
|
| Rate for Payer: Cash Price |
$209.18
|
| Rate for Payer: Cigna Commercial |
$334.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$334.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$334.70
|
| Rate for Payer: Multiplan Commercial |
$389.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$355.61
|
| Rate for Payer: United Healthcare Commercial |
$397.45
|
|
|
SCR BONE 2.3X10MM CROSS PIN ST
|
Facility
|
IP
|
$137.56
|
|
| Hospital Charge Code |
2720037331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.81 |
| Max. Negotiated Rate |
$130.68 |
| Rate for Payer: Aetna of VT Commercial |
$130.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$101.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$101.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$116.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$115.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.05
|
| Rate for Payer: Cash Price |
$68.78
|
| Rate for Payer: Cigna Commercial |
$110.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$110.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$110.05
|
| Rate for Payer: Multiplan Commercial |
$127.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$116.93
|
| Rate for Payer: United Healthcare Commercial |
$130.68
|
|
|
SCR BONE 2.3X10MM CROSS PIN ST
|
Facility
|
OP
|
$137.56
|
|
| Hospital Charge Code |
2720037331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.93 |
| Max. Negotiated Rate |
$130.68 |
| Rate for Payer: Aetna of VT Commercial |
$130.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$123.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$60.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$123.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$82.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$116.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$111.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$109.36
|
| Rate for Payer: Cash Price |
$68.78
|
| Rate for Payer: Cigna Commercial |
$110.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$110.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$110.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$61.90
|
| Rate for Payer: Multiplan Commercial |
$127.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$116.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$61.90
|
| Rate for Payer: United Healthcare Commercial |
$130.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.90
|
| Rate for Payer: United Healthcare VA CCN |
$61.90
|
|
|
SCREW 2.7 LP 14MM
|
Facility
|
IP
|
$278.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.04 |
| Max. Negotiated Rate |
$264.48 |
| Rate for Payer: Aetna of VT Commercial |
$264.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$206.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$206.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$233.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$222.72
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$222.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$222.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$222.72
|
| Rate for Payer: Multiplan Commercial |
$258.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.64
|
| Rate for Payer: United Healthcare Commercial |
$264.48
|
|
|
SCREW 2.7 LP 14MM
|
Facility
|
OP
|
$278.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.30 |
| Max. Negotiated Rate |
$264.48 |
| Rate for Payer: Aetna of VT Commercial |
$264.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$249.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$123.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$249.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$167.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$225.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$125.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$221.33
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$222.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$222.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$222.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$125.28
|
| Rate for Payer: Multiplan Commercial |
$258.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$125.28
|
| Rate for Payer: United Healthcare Commercial |
$264.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.28
|
| Rate for Payer: United Healthcare VA CCN |
$125.28
|
|
|
SCR HEADLESS CANN ST 7.0X84MM
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780074261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$791.91 |
| Max. Negotiated Rate |
$1,016.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,016.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$791.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$791.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$909.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$898.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$856.00
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$856.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$856.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$856.00
|
| Rate for Payer: Multiplan Commercial |
$995.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$909.50
|
| Rate for Payer: United Healthcare Commercial |
$1,016.50
|
|
|
SCR HEADLESS CANN ST 7.0X84MM
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780074261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$473.90 |
| Max. Negotiated Rate |
$1,016.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,016.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$958.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$473.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$958.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$644.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$909.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$866.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$481.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$850.65
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$856.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$856.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$856.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$481.50
|
| Rate for Payer: Multiplan Commercial |
$995.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$909.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$481.50
|
| Rate for Payer: United Healthcare Commercial |
$1,016.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$481.50
|
| Rate for Payer: United Healthcare VA CCN |
$481.50
|
|
|
SCR HEADLESS CANN ST 7.0X86MM
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780074251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$791.91 |
| Max. Negotiated Rate |
$1,016.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,016.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$791.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$791.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$909.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$898.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$856.00
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$856.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$856.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$856.00
|
| Rate for Payer: Multiplan Commercial |
$995.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$909.50
|
| Rate for Payer: United Healthcare Commercial |
$1,016.50
|
|
|
SCR HEADLESS CANN ST 7.0X86MM
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780074251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$473.90 |
| Max. Negotiated Rate |
$1,016.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,016.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$958.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$473.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$958.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$644.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$909.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$866.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$481.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$850.65
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$856.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$856.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$856.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$481.50
|
| Rate for Payer: Multiplan Commercial |
$995.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$909.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$481.50
|
| Rate for Payer: United Healthcare Commercial |
$1,016.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$481.50
|
| Rate for Payer: United Healthcare VA CCN |
$481.50
|
|
