|
SHO ARTHRS SRG PRTL SYNVCT
|
Facility
|
OP
|
$2,336.00
|
|
|
Service Code
|
CPT 29820
|
| Hospital Charge Code |
9822982001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,034.61 |
| 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 |
$2,092.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,034.61
|
| 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 |
$1,406.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,985.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,892.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,051.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,857.12
|
| 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: Martins Point Health Care Commercial |
$1,051.20
|
| Rate for Payer: Multiplan Commercial |
$2,172.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,985.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,051.20
|
| Rate for Payer: United Healthcare Commercial |
$2,219.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,051.20
|
| Rate for Payer: United Healthcare VA CCN |
$1,051.20
|
|
|
SHO ARTHRS SRG RMVL LOOSE/FB
|
Facility
|
IP
|
$2,474.00
|
|
|
Service Code
|
CPT 29819
|
| Hospital Charge Code |
9822981901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,831.01 |
| Max. Negotiated Rate |
$2,350.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,350.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,831.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,831.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,102.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,078.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,979.20
|
| Rate for Payer: Cash Price |
$1,237.00
|
| Rate for Payer: Cigna Commercial |
$1,979.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,979.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,979.20
|
| Rate for Payer: Multiplan Commercial |
$2,300.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,102.90
|
| Rate for Payer: United Healthcare Commercial |
$2,350.30
|
|
|
SHO ARTHRS SRG RMVL LOOSE/FB
|
Facility
|
OP
|
$2,474.00
|
|
|
Service Code
|
CPT 29819
|
| Hospital Charge Code |
9822981901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,095.73 |
| Max. Negotiated Rate |
$2,350.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,350.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,216.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,095.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,216.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,489.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,102.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,003.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,113.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,966.83
|
| Rate for Payer: Cash Price |
$1,237.00
|
| Rate for Payer: Cigna Commercial |
$1,979.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,979.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,979.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,113.30
|
| Rate for Payer: Multiplan Commercial |
$2,300.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,102.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,113.30
|
| Rate for Payer: United Healthcare Commercial |
$2,350.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,113.30
|
| Rate for Payer: United Healthcare VA CCN |
$1,113.30
|
|
|
SHO ARTHRS SRG RMVL LOOSE/FB
|
Professional
|
Both
|
$2,474.00
|
|
|
Service Code
|
CPT 29819
|
| Hospital Charge Code |
9822981901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$556.26 |
| Max. Negotiated Rate |
$2,325.56 |
| Rate for Payer: Aetna of VT Commercial |
$2,325.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,216.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$572.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,216.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$778.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,071.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,071.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$639.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,071.16
|
| Rate for Payer: Cash Price |
$1,237.00
|
| Rate for Payer: Cash Price |
$1,237.00
|
| Rate for Payer: Cigna Commercial |
$1,055.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$925.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$925.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$556.27
|
| Rate for Payer: Multiplan Commercial |
$2,300.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$789.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$556.26
|
| Rate for Payer: United Healthcare Commercial |
$855.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$556.26
|
| Rate for Payer: United Healthcare VA CCN |
$556.26
|
|
|
SHO ARTHRS SRG RPR SLAP LES
|
Facility
|
IP
|
$3,668.00
|
|
|
Service Code
|
CPT 29807
|
| Hospital Charge Code |
9822980701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,714.69 |
| Max. Negotiated Rate |
$3,484.60 |
| Rate for Payer: Aetna of VT Commercial |
$3,484.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,714.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,714.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,117.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,081.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,934.40
|
| Rate for Payer: Cash Price |
$1,834.00
|
| Rate for Payer: Cigna Commercial |
$2,934.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,934.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,934.40
|
| Rate for Payer: Multiplan Commercial |
$3,411.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,117.80
|
| Rate for Payer: United Healthcare Commercial |
$3,484.60
|
|
|
SHO ARTHRS SRG RPR SLAP LES
|
Facility
|
OP
|
$3,668.00
|
|
|
Service Code
|
CPT 29807
|
| Hospital Charge Code |
9822980701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,624.56 |
| Max. Negotiated Rate |
$3,484.60 |
| Rate for Payer: Aetna of VT Commercial |
$3,484.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,286.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,624.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,286.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,208.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,117.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,971.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,650.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,916.06
|
| Rate for Payer: Cash Price |
$1,834.00
|
| Rate for Payer: Cigna Commercial |
$2,934.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,934.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,934.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,650.60
|
| Rate for Payer: Multiplan Commercial |
$3,411.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,117.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,650.60
|
| Rate for Payer: United Healthcare Commercial |
$3,484.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,650.60
|
| Rate for Payer: United Healthcare VA CCN |
$1,650.60
|
|
|
SHO ARTHRS SRG RPR SLAP LES
|
Professional
|
Both
|
$3,668.00
|
|
|
Service Code
|
CPT 29807
|
| Hospital Charge Code |
9822980701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$969.73 |
| Max. Negotiated Rate |
$3,447.92 |
| Rate for Payer: Aetna of VT Commercial |
$3,447.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,286.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$998.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,286.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,357.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,518.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,518.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,115.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,518.31
|
| Rate for Payer: Cash Price |
$1,834.00
|
| Rate for Payer: Cash Price |
$1,834.00
|
| Rate for Payer: Cigna Commercial |
$1,839.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,618.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,618.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$969.73
|
| Rate for Payer: Multiplan Commercial |
$3,411.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,377.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$969.74
|
| Rate for Payer: United Healthcare Commercial |
$1,491.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$969.74
|
| Rate for Payer: United Healthcare VA CCN |
$969.74
|
|
|
SHO ARTHRS SRG RT8TR CUF RPR
|
Professional
|
Both
|
$2,722.00
|
|
|
Service Code
|
CPT 29827
|
| Hospital Charge Code |
9822982701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$999.91 |
| Max. Negotiated Rate |
$2,558.68 |
| Rate for Payer: Aetna of VT Commercial |
$2,558.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,438.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,029.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,438.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,399.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,592.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,592.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,149.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,592.35
|
| Rate for Payer: Cash Price |
$1,361.00
|
| Rate for Payer: Cash Price |
$1,361.00
|
| Rate for Payer: Cigna Commercial |
$1,896.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,669.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,669.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$999.91
|
| Rate for Payer: Multiplan Commercial |
$2,531.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,419.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$999.91
|
| Rate for Payer: United Healthcare Commercial |
$1,538.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$999.91
|
| Rate for Payer: United Healthcare VA CCN |
$999.91
|
|
|
SHO ARTHRS SRG RT8TR CUF RPR
|
Facility
|
IP
|
$2,722.00
|
|
|
Service Code
|
CPT 29827
|
| Hospital Charge Code |
9822982701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,014.55 |
| Max. Negotiated Rate |
$2,585.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,585.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,014.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,014.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,313.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,286.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,177.60
|
| Rate for Payer: Cash Price |
$1,361.00
|
| Rate for Payer: Cigna Commercial |
$2,177.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,177.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,177.60
|
| Rate for Payer: Multiplan Commercial |
$2,531.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,313.70
|
| Rate for Payer: United Healthcare Commercial |
$2,585.90
|
|
|
SHO ARTHRS SRG RT8TR CUF RPR
|
Facility
|
OP
|
$2,722.00
|
|
|
Service Code
|
CPT 29827
|
| Hospital Charge Code |
9822982701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,205.57 |
| Max. Negotiated Rate |
$2,585.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,585.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,438.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,205.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,438.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,638.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,313.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,204.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,224.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,163.99
|
| Rate for Payer: Cash Price |
$1,361.00
|
| Rate for Payer: Cigna Commercial |
$2,177.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,177.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,177.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,224.90
|
| Rate for Payer: Multiplan Commercial |
$2,531.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,313.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,224.90
|
| Rate for Payer: United Healthcare Commercial |
$2,585.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,224.90
|
| Rate for Payer: United Healthcare VA CCN |
$1,224.90
|
|
|
SHO ARTHRS SRG XTNSV DBRDMT
|
Facility
|
IP
|
$1,569.00
|
|
|
Service Code
|
CPT 29823
|
| Hospital Charge Code |
9822982301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,161.22 |
| Max. Negotiated Rate |
$1,490.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,490.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,161.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,161.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,333.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,317.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,255.20
|
| Rate for Payer: Cash Price |
$784.50
|
| Rate for Payer: Cigna Commercial |
$1,255.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,255.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,255.20
|
| Rate for Payer: Multiplan Commercial |
$1,459.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,333.65
|
| Rate for Payer: United Healthcare Commercial |
$1,490.55
|
|
|
SHO ARTHRS SRG XTNSV DBRDMT
|
Professional
|
Both
|
$1,569.00
|
|
|
Service Code
|
CPT 29823
|
| Hospital Charge Code |
9822982301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$561.61 |
| Max. Negotiated Rate |
$1,474.86 |
| Rate for Payer: Aetna of VT Commercial |
$1,474.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,405.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$578.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,405.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$786.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,270.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,270.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$645.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,270.40
|
| Rate for Payer: Cash Price |
$784.50
|
| Rate for Payer: Cash Price |
$784.50
|
| Rate for Payer: Cigna Commercial |
$1,064.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$934.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$934.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$561.62
|
| Rate for Payer: Multiplan Commercial |
$1,459.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$797.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$561.61
|
| Rate for Payer: United Healthcare Commercial |
$863.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$561.61
|
| Rate for Payer: United Healthcare VA CCN |
$561.61
|
|
|
SHO ARTHRS SRG XTNSV DBRDMT
|
Facility
|
OP
|
$1,569.00
|
|
|
Service Code
|
CPT 29823
|
| Hospital Charge Code |
9822982301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$694.91 |
| Max. Negotiated Rate |
$1,490.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,490.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,405.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$694.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,405.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$944.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,333.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,270.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$706.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,247.36
|
| Rate for Payer: Cash Price |
$784.50
|
| Rate for Payer: Cigna Commercial |
$1,255.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,255.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,255.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$706.05
|
| Rate for Payer: Multiplan Commercial |
$1,459.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,333.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$706.05
|
| Rate for Payer: United Healthcare Commercial |
$1,490.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$706.05
|
| Rate for Payer: United Healthcare VA CCN |
$706.05
|
|
|
SHOE DARCO M LG
|
Professional
|
Both
|
$54.99
|
|
| Hospital Charge Code |
2740032791
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$51.69 |
| Rate for Payer: Aetna of VT Commercial |
$51.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$49.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$49.27
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$51.14
|
| Rate for Payer: United Healthcare Commercial |
$46.74
|
| Rate for Payer: United Healthcare VA CCN |
$22.00
|
|
|
SHOE DARCO M LG
|
Facility
|
OP
|
$54.99
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740032791
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$52.24 |
| Rate for Payer: Aetna of VT Commercial |
$52.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$49.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$24.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$49.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$33.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$46.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.72
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$43.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$51.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$24.75
|
| Rate for Payer: United Healthcare Commercial |
$52.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.75
|
| Rate for Payer: United Healthcare VA CCN |
$24.75
|
|
|
SHOE DARCO M LG
|
Facility
|
IP
|
$54.99
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740032791
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$52.24 |
| Rate for Payer: Aetna of VT Commercial |
$52.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$40.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$40.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$46.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$46.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.99
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$43.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.99
|
| Rate for Payer: Multiplan Commercial |
$51.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.74
|
| Rate for Payer: United Healthcare Commercial |
$52.24
|
|
|
SHOE DARCO M M
|
Professional
|
Both
|
$54.99
|
|
| Hospital Charge Code |
2740032781
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$51.69 |
| Rate for Payer: Aetna of VT Commercial |
$51.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$49.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$49.27
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$51.14
|
| Rate for Payer: United Healthcare Commercial |
$46.74
|
| Rate for Payer: United Healthcare VA CCN |
$22.00
|
|
|
SHOE DARCO M M
|
Facility
|
OP
|
$54.99
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740032781
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$52.24 |
| Rate for Payer: Aetna of VT Commercial |
$52.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$49.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$24.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$49.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$33.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$46.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.72
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$43.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$51.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$24.75
|
| Rate for Payer: United Healthcare Commercial |
$52.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.75
|
| Rate for Payer: United Healthcare VA CCN |
$24.75
|
|
|
SHOE DARCO M M
|
Facility
|
IP
|
$54.99
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740032781
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$52.24 |
| Rate for Payer: Aetna of VT Commercial |
$52.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$40.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$40.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$46.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$46.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.99
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$43.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.99
|
| Rate for Payer: Multiplan Commercial |
$51.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.74
|
| Rate for Payer: United Healthcare Commercial |
$52.24
|
|
|
SHOE DARCO M SM
|
Professional
|
Both
|
$43.21
|
|
| Hospital Charge Code |
2740021251
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$40.62 |
| Rate for Payer: Aetna of VT Commercial |
$40.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.71
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$40.19
|
| Rate for Payer: United Healthcare Commercial |
$36.73
|
| Rate for Payer: United Healthcare VA CCN |
$17.28
|
|
|
SHOE DARCO M SM
|
Facility
|
IP
|
$43.21
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740021251
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.98 |
| Max. Negotiated Rate |
$41.05 |
| Rate for Payer: Aetna of VT Commercial |
$41.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$36.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.57
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$34.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$34.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$34.57
|
| Rate for Payer: Multiplan Commercial |
$40.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.73
|
| Rate for Payer: United Healthcare Commercial |
$41.05
|
|
|
SHOE DARCO M SM
|
Facility
|
OP
|
$43.21
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740021251
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$41.05 |
| Rate for Payer: Aetna of VT Commercial |
$41.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$26.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.35
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$34.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$34.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$34.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.44
|
| Rate for Payer: Multiplan Commercial |
$40.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.44
|
| Rate for Payer: United Healthcare Commercial |
$41.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.44
|
| Rate for Payer: United Healthcare VA CCN |
$19.44
|
|
|
SHOE DARCO M XLG
|
Facility
|
IP
|
$62.43
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740021271
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$59.31 |
| Rate for Payer: Aetna of VT Commercial |
$59.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$53.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$49.94
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cigna Commercial |
$49.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$49.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$49.94
|
| Rate for Payer: Multiplan Commercial |
$58.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.07
|
| Rate for Payer: United Healthcare Commercial |
$59.31
|
|
|
SHOE DARCO M XLG
|
Professional
|
Both
|
$62.43
|
|
| Hospital Charge Code |
2740021271
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$58.68 |
| Rate for Payer: Aetna of VT Commercial |
$58.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$55.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$55.93
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Multiplan Commercial |
$58.06
|
| Rate for Payer: United Healthcare Commercial |
$53.07
|
| Rate for Payer: United Healthcare VA CCN |
$24.97
|
|
|
SHOE DARCO M XLG
|
Facility
|
OP
|
$62.43
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740021271
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.65 |
| Max. Negotiated Rate |
$59.31 |
| Rate for Payer: Aetna of VT Commercial |
$59.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$55.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$55.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$53.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$50.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$28.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$49.63
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cigna Commercial |
$49.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$49.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$49.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$28.09
|
| Rate for Payer: Multiplan Commercial |
$58.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$28.09
|
| Rate for Payer: United Healthcare Commercial |
$59.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.09
|
| Rate for Payer: United Healthcare VA CCN |
$28.09
|
|
