|
SHAVE SKIN LESION 1.1-2.0 CM
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
9601130202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$91.24 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Aetna of VT Commercial |
$195.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$184.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$91.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$184.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$124.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$175.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$166.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$163.77
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$164.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$164.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$164.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$92.70
|
| Rate for Payer: Multiplan Commercial |
$191.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$92.70
|
| Rate for Payer: United Healthcare Commercial |
$195.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.70
|
| Rate for Payer: United Healthcare VA CCN |
$92.70
|
|
|
SHAVE SKIN LESION 1.1-2.0 CM
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
9601130202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$55.89 |
| Max. Negotiated Rate |
$209.32 |
| Rate for Payer: Aetna of VT Commercial |
$193.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$184.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$57.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$184.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$78.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$178.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$178.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$178.44
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$62.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$209.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$209.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$129.12
|
| Rate for Payer: Multiplan Commercial |
$191.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$55.89
|
| Rate for Payer: United Healthcare Commercial |
$85.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.89
|
| Rate for Payer: United Healthcare VA CCN |
$55.89
|
|
|
SHAVE SKIN LESION 1.1-2.0 CM
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
5101130201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.87 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Aetna of VT Commercial |
$84.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$75.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$74.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$71.20
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$71.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$71.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$71.20
|
| Rate for Payer: Multiplan Commercial |
$82.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.65
|
| Rate for Payer: United Healthcare Commercial |
$84.55
|
|
|
SHAVE SKIN LESION 1.1-2.0 CM
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
5101130201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.89 |
| Max. Negotiated Rate |
$209.32 |
| Rate for Payer: Aetna of VT Commercial |
$83.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$79.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$57.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$79.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$78.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$178.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$178.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$178.44
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$62.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$209.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$209.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$129.12
|
| Rate for Payer: Multiplan Commercial |
$82.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$55.89
|
| Rate for Payer: United Healthcare Commercial |
$85.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.89
|
| Rate for Payer: United Healthcare VA CCN |
$55.89
|
|
|
SHAVE SKIN LESION 1.1-2.0 CM
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
5101130201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.42 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Aetna of VT Commercial |
$84.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$79.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$79.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$75.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.75
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$71.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$71.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$71.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$40.05
|
| Rate for Payer: Multiplan Commercial |
$82.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.05
|
| Rate for Payer: United Healthcare Commercial |
$84.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.05
|
| Rate for Payer: United Healthcare VA CCN |
$40.05
|
|
|
SHO ARTHRS DX +- SYNOVIAL BX
|
Facility
|
OP
|
$1,534.00
|
|
|
Service Code
|
CPT 29805
|
| Hospital Charge Code |
9822980501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$679.41 |
| Max. Negotiated Rate |
$1,457.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,457.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,374.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$679.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,374.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$923.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,303.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,242.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$690.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,219.53
|
| Rate for Payer: Cash Price |
$767.00
|
| Rate for Payer: Cigna Commercial |
$1,227.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,227.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,227.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$690.30
|
| Rate for Payer: Multiplan Commercial |
$1,426.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,303.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$690.30
|
| Rate for Payer: United Healthcare Commercial |
$1,457.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$690.30
|
| Rate for Payer: United Healthcare VA CCN |
$690.30
|
|
|
SHO ARTHRS DX +- SYNOVIAL BX
|
Professional
|
Both
|
$1,534.00
|
|
|
Service Code
|
CPT 29805
|
| Hospital Charge Code |
9822980501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$448.65 |
| Max. Negotiated Rate |
$1,441.96 |
| Rate for Payer: Aetna of VT Commercial |
$1,441.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,374.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$462.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,374.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$628.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$769.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$769.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$515.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$769.81
|
| Rate for Payer: Cash Price |
$767.00
|
| Rate for Payer: Cash Price |
$767.00
|
| Rate for Payer: Cigna Commercial |
$843.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$745.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$745.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$448.65
|
| Rate for Payer: Multiplan Commercial |
$1,426.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$637.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$448.66
|
| Rate for Payer: United Healthcare Commercial |
$690.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$448.66
|
| Rate for Payer: United Healthcare VA CCN |
$448.66
|
|
|
SHO ARTHRS DX +- SYNOVIAL BX
|
Facility
|
IP
|
$1,534.00
|
|
|
Service Code
|
CPT 29805
|
| Hospital Charge Code |
9822980501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,135.31 |
| Max. Negotiated Rate |
$1,457.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,457.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,135.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,135.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,303.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,288.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,227.20
|
| Rate for Payer: Cash Price |
$767.00
|
| Rate for Payer: Cigna Commercial |
$1,227.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,227.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,227.20
|
| Rate for Payer: Multiplan Commercial |
$1,426.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,303.90
|
| Rate for Payer: United Healthcare Commercial |
$1,457.30
|
|
|
SHO ARTHRS SRG BICP TENODSIS
|
Professional
|
Both
|
$2,197.00
|
|
|
Service Code
|
CPT 29828
|
| Hospital Charge Code |
9822982801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$859.80 |
| Max. Negotiated Rate |
$2,065.18 |
| Rate for Payer: Aetna of VT Commercial |
$2,065.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,968.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$885.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,968.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,203.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,146.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,146.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$988.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,146.97
|
| Rate for Payer: Cash Price |
$1,098.50
|
| Rate for Payer: Cash Price |
$1,098.50
|
| Rate for Payer: Cigna Commercial |
$1,630.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,434.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,434.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$859.80
|
| Rate for Payer: Multiplan Commercial |
$2,043.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,220.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$859.80
|
| Rate for Payer: United Healthcare Commercial |
$1,322.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$859.80
|
| Rate for Payer: United Healthcare VA CCN |
$859.80
|
|
|
SHO ARTHRS SRG BICP TENODSIS
|
Facility
|
IP
|
$2,197.00
|
|
|
Service Code
|
CPT 29828
|
| Hospital Charge Code |
9822982801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,626.00 |
| Max. Negotiated Rate |
$2,087.15 |
| Rate for Payer: Aetna of VT Commercial |
$2,087.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,867.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,845.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,757.60
|
| Rate for Payer: Cash Price |
$1,098.50
|
| Rate for Payer: Cigna Commercial |
$1,757.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,757.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,757.60
|
| Rate for Payer: Multiplan Commercial |
$2,043.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,867.45
|
| Rate for Payer: United Healthcare Commercial |
$2,087.15
|
|
|
SHO ARTHRS SRG BICP TENODSIS
|
Facility
|
OP
|
$2,197.00
|
|
|
Service Code
|
CPT 29828
|
| Hospital Charge Code |
9822982801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$973.05 |
| Max. Negotiated Rate |
$2,087.15 |
| Rate for Payer: Aetna of VT Commercial |
$2,087.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,968.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$973.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,968.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,322.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,867.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,779.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$988.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,746.62
|
| Rate for Payer: Cash Price |
$1,098.50
|
| Rate for Payer: Cigna Commercial |
$1,757.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,757.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,757.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$988.65
|
| Rate for Payer: Multiplan Commercial |
$2,043.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,867.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$988.65
|
| Rate for Payer: United Healthcare Commercial |
$2,087.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$988.65
|
| Rate for Payer: United Healthcare VA CCN |
$988.65
|
|
|
SHO ARTHRS SRG CAPSULORRAPHY
|
Facility
|
OP
|
$3,754.00
|
|
|
Service Code
|
CPT 29806
|
| Hospital Charge Code |
9822980601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,662.65 |
| Max. Negotiated Rate |
$3,566.30 |
| Rate for Payer: Aetna of VT Commercial |
$3,566.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,363.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,662.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,363.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,259.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,190.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,040.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,689.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,984.43
|
| Rate for Payer: Cash Price |
$1,877.00
|
| Rate for Payer: Cigna Commercial |
$3,003.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,003.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,003.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,689.30
|
| Rate for Payer: Multiplan Commercial |
$3,491.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,190.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,689.30
|
| Rate for Payer: United Healthcare Commercial |
$3,566.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,689.30
|
| Rate for Payer: United Healthcare VA CCN |
$1,689.30
|
|
|
SHO ARTHRS SRG CAPSULORRAPHY
|
Professional
|
Both
|
$3,754.00
|
|
|
Service Code
|
CPT 29806
|
| Hospital Charge Code |
9822980601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$992.39 |
| Max. Negotiated Rate |
$3,528.76 |
| Rate for Payer: Aetna of VT Commercial |
$3,528.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,363.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,022.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,363.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,389.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,558.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,558.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,141.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,558.41
|
| Rate for Payer: Cash Price |
$1,877.00
|
| Rate for Payer: Cash Price |
$1,877.00
|
| Rate for Payer: Cigna Commercial |
$1,883.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,657.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,657.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$992.39
|
| Rate for Payer: Multiplan Commercial |
$3,491.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,409.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$992.40
|
| Rate for Payer: United Healthcare Commercial |
$1,526.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$992.40
|
| Rate for Payer: United Healthcare VA CCN |
$992.40
|
|
|
SHO ARTHRS SRG CAPSULORRAPHY
|
Facility
|
IP
|
$3,754.00
|
|
|
Service Code
|
CPT 29806
|
| Hospital Charge Code |
9822980601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,778.34 |
| Max. Negotiated Rate |
$3,566.30 |
| Rate for Payer: Aetna of VT Commercial |
$3,566.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,778.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,778.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,190.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,153.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,003.20
|
| Rate for Payer: Cash Price |
$1,877.00
|
| Rate for Payer: Cigna Commercial |
$3,003.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,003.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,003.20
|
| Rate for Payer: Multiplan Commercial |
$3,491.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,190.90
|
| Rate for Payer: United Healthcare Commercial |
$3,566.30
|
|
|
SHO ARTHRS SRG DECOMPRESSION
|
Professional
|
Both
|
$1,665.00
|
|
|
Service Code
|
CPT 29826
|
| Hospital Charge Code |
9822982601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$157.03 |
| Max. Negotiated Rate |
$1,565.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,565.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,491.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$161.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,491.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$219.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$400.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$400.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$180.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$400.28
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$297.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$264.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$264.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$157.03
|
| Rate for Payer: Multiplan Commercial |
$1,548.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$222.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$157.03
|
| Rate for Payer: United Healthcare Commercial |
$241.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.03
|
| Rate for Payer: United Healthcare VA CCN |
$157.03
|
|
|
SHO ARTHRS SRG DECOMPRESSION
|
Facility
|
IP
|
$1,665.00
|
|
|
Service Code
|
CPT 29826
|
| Hospital Charge Code |
9822982601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,232.27 |
| Max. Negotiated Rate |
$1,581.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,581.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,232.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,232.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,415.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,398.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,332.00
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$1,332.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,332.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,332.00
|
| Rate for Payer: Multiplan Commercial |
$1,548.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,415.25
|
| Rate for Payer: United Healthcare Commercial |
$1,581.75
|
|
|
SHO ARTHRS SRG DECOMPRESSION
|
Facility
|
OP
|
$1,665.00
|
|
|
Service Code
|
CPT 29826
|
| Hospital Charge Code |
9822982601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$737.43 |
| Max. Negotiated Rate |
$1,581.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,581.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,491.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$737.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,491.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,002.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,415.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,348.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$749.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,323.67
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$1,332.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,332.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,332.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$749.25
|
| Rate for Payer: Multiplan Commercial |
$1,548.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,415.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$749.25
|
| Rate for Payer: United Healthcare Commercial |
$1,581.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$749.25
|
| Rate for Payer: United Healthcare VA CCN |
$749.25
|
|
|
SHO ARTHRS SRG DSTL CLAVICLC
|
Facility
|
OP
|
$1,656.00
|
|
|
Service Code
|
CPT 29824
|
| Hospital Charge Code |
9822982401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$733.44 |
| Max. Negotiated Rate |
$1,573.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,573.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,483.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$733.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,483.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$996.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,407.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,341.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$745.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,316.52
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cigna Commercial |
$1,324.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,324.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,324.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$745.20
|
| Rate for Payer: Multiplan Commercial |
$1,540.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,407.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$745.20
|
| Rate for Payer: United Healthcare Commercial |
$1,573.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$745.20
|
| Rate for Payer: United Healthcare VA CCN |
$745.20
|
|
|
SHO ARTHRS SRG DSTL CLAVICLC
|
Facility
|
IP
|
$1,656.00
|
|
|
Service Code
|
CPT 29824
|
| Hospital Charge Code |
9822982401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,225.61 |
| Max. Negotiated Rate |
$1,573.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,573.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,225.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,225.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,407.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,391.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,324.80
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cigna Commercial |
$1,324.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,324.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,324.80
|
| Rate for Payer: Multiplan Commercial |
$1,540.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,407.60
|
| Rate for Payer: United Healthcare Commercial |
$1,573.20
|
|
|
SHO ARTHRS SRG DSTL CLAVICLC
|
Professional
|
Both
|
$1,656.00
|
|
|
Service Code
|
CPT 29824
|
| Hospital Charge Code |
9822982401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$641.97 |
| Max. Negotiated Rate |
$1,556.64 |
| Rate for Payer: Aetna of VT Commercial |
$1,556.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,483.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$661.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,483.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$898.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$929.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$929.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$738.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$929.64
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cigna Commercial |
$1,215.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,068.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,068.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$641.97
|
| Rate for Payer: Multiplan Commercial |
$1,540.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$911.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$641.97
|
| Rate for Payer: United Healthcare Commercial |
$987.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$641.97
|
| Rate for Payer: United Healthcare VA CCN |
$641.97
|
|
|
SHO ARTHRS SRG LMTD DBRDMT
|
Facility
|
IP
|
$1,439.00
|
|
|
Service Code
|
CPT 29822
|
| Hospital Charge Code |
9822982201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,065.00 |
| Max. Negotiated Rate |
$1,367.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,367.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,065.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,065.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,223.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,208.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,151.20
|
| Rate for Payer: Cash Price |
$719.50
|
| Rate for Payer: Cigna Commercial |
$1,151.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,151.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,151.20
|
| Rate for Payer: Multiplan Commercial |
$1,338.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,223.15
|
| Rate for Payer: United Healthcare Commercial |
$1,367.05
|
|
|
SHO ARTHRS SRG LMTD DBRDMT
|
Professional
|
Both
|
$1,439.00
|
|
|
Service Code
|
CPT 29822
|
| Hospital Charge Code |
9822982201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$515.35 |
| Max. Negotiated Rate |
$1,352.66 |
| Rate for Payer: Aetna of VT Commercial |
$1,352.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,289.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$530.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,289.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$721.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,049.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,049.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$592.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,049.75
|
| Rate for Payer: Cash Price |
$719.50
|
| Rate for Payer: Cash Price |
$719.50
|
| Rate for Payer: Cigna Commercial |
$974.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$856.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$856.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$515.35
|
| Rate for Payer: Multiplan Commercial |
$1,338.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$731.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$515.36
|
| Rate for Payer: United Healthcare Commercial |
$792.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$515.36
|
| Rate for Payer: United Healthcare VA CCN |
$515.36
|
|
|
SHO ARTHRS SRG LMTD DBRDMT
|
Facility
|
OP
|
$1,439.00
|
|
|
Service Code
|
CPT 29822
|
| Hospital Charge Code |
9822982201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$637.33 |
| Max. Negotiated Rate |
$1,367.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,367.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,289.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$637.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,289.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$866.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,223.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,165.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$647.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,144.01
|
| Rate for Payer: Cash Price |
$719.50
|
| Rate for Payer: Cigna Commercial |
$1,151.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,151.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,151.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$647.55
|
| Rate for Payer: Multiplan Commercial |
$1,338.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,223.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$647.55
|
| Rate for Payer: United Healthcare Commercial |
$1,367.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$647.55
|
| Rate for Payer: United Healthcare VA CCN |
$647.55
|
|
|
SHO ARTHRS SRG PRTL SYNVCT
|
Professional
|
Both
|
$2,336.00
|
|
|
Service Code
|
CPT 29820
|
| Hospital Charge Code |
9822982001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$508.16 |
| Max. Negotiated Rate |
$2,195.84 |
| Rate for Payer: Aetna of VT Commercial |
$2,195.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,092.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$523.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,092.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$711.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$988.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$988.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$584.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$988.30
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cigna Commercial |
$958.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$845.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$845.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$508.16
|
| Rate for Payer: Multiplan Commercial |
$2,172.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$721.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$508.16
|
| Rate for Payer: United Healthcare Commercial |
$781.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$508.16
|
| Rate for Payer: United Healthcare VA CCN |
$508.16
|
|
|
SHO ARTHRS SRG PRTL SYNVCT
|
Facility
|
IP
|
$2,336.00
|
|
|
Service Code
|
CPT 29820
|
| Hospital Charge Code |
9822982001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,728.87 |
| Max. Negotiated Rate |
$2,219.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,219.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,728.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,728.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,985.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,962.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,868.80
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cigna Commercial |
$1,868.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,868.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,868.80
|
| Rate for Payer: Multiplan Commercial |
$2,172.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,985.60
|
| Rate for Payer: United Healthcare Commercial |
$2,219.20
|
|
