|
STEREO BX DEVICE STD
|
Facility
|
OP
|
$1,113.24
|
|
| Hospital Charge Code |
2720023311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$493.05 |
| Max. Negotiated Rate |
$1,057.58 |
| Rate for Payer: Aetna of VT Commercial |
$1,057.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$997.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$493.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$997.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$670.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$946.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$901.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$500.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$885.03
|
| Rate for Payer: Cash Price |
$556.62
|
| Rate for Payer: Cigna Commercial |
$890.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$890.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$890.59
|
| Rate for Payer: Martins Point Health Care Commercial |
$500.96
|
| Rate for Payer: Multiplan Commercial |
$1,035.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$946.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$500.96
|
| Rate for Payer: United Healthcare Commercial |
$1,057.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$500.96
|
| Rate for Payer: United Healthcare VA CCN |
$500.96
|
|
|
STEREO TISSUE FILTER
|
Facility
|
IP
|
$24.74
|
|
| Hospital Charge Code |
2720023281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.31 |
| Max. Negotiated Rate |
$23.50 |
| Rate for Payer: Aetna of VT Commercial |
$23.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$18.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$18.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.79
|
| Rate for Payer: Cash Price |
$12.37
|
| Rate for Payer: Cigna Commercial |
$19.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.79
|
| Rate for Payer: Multiplan Commercial |
$23.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.03
|
| Rate for Payer: United Healthcare Commercial |
$23.50
|
|
|
STEREO TISSUE FILTER
|
Facility
|
OP
|
$24.74
|
|
| Hospital Charge Code |
2720023281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.96 |
| Max. Negotiated Rate |
$23.50 |
| Rate for Payer: Aetna of VT Commercial |
$23.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$22.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$22.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$14.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.67
|
| Rate for Payer: Cash Price |
$12.37
|
| Rate for Payer: Cigna Commercial |
$19.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.13
|
| Rate for Payer: Multiplan Commercial |
$23.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.13
|
| Rate for Payer: United Healthcare Commercial |
$23.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.13
|
| Rate for Payer: United Healthcare VA CCN |
$11.13
|
|
|
STERILE WATER 250ML
|
Facility
|
IP
|
$3.15
|
|
| Hospital Charge Code |
2720062421
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna of VT Commercial |
$2.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.52
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: Cigna Commercial |
$2.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$2.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.68
|
| Rate for Payer: United Healthcare Commercial |
$2.99
|
|
|
STERILE WATER 250ML
|
Facility
|
OP
|
$3.15
|
|
| Hospital Charge Code |
2720062421
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna of VT Commercial |
$2.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.50
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: Cigna Commercial |
$2.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.52
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$2.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.42
|
| Rate for Payer: United Healthcare Commercial |
$2.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.42
|
| Rate for Payer: United Healthcare VA CCN |
$1.42
|
|
|
ST HEPB VACC 3 DOSE PED/ADOL
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
CPT 90744 SL
|
| Hospital Charge Code |
6369074401
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$87.09 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$87.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$87.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$80.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$80.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$80.85
|
| 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 |
$31.67
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.67
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
STRAPPING ANKLE &/FOOT
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
9812954001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$52.71 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$16.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$22.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.71
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$30.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.92
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.33
|
| Rate for Payer: United Healthcare Commercial |
$25.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.33
|
| Rate for Payer: United Healthcare VA CCN |
$16.33
|
|
|
STRAPPING ANKLE &/FOOT
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
9812954001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
STRAPPING ANKLE &/FOOT
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
9812954002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$73.32 |
| Rate for Payer: Aetna of VT Commercial |
$73.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$16.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$22.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.71
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$30.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.92
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.33
|
| Rate for Payer: United Healthcare Commercial |
$25.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.33
|
| Rate for Payer: United Healthcare VA CCN |
$16.33
|
|
|
STRAPPING ANKLE &/FOOT
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
5102954001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.82 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Aetna of VT Commercial |
$40.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$36.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.40
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cigna Commercial |
$34.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$34.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$34.40
|
| Rate for Payer: Multiplan Commercial |
$39.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.55
|
| Rate for Payer: United Healthcare Commercial |
$40.85
|
|
|
STRAPPING ANKLE &/FOOT
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
9812954002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$34.55 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.01
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.10
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare VA CCN |
$35.10
|
|
|
STRAPPING ANKLE &/FOOT
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
9602954002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$73.32 |
| Rate for Payer: Aetna of VT Commercial |
$73.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$16.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$22.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.71
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$30.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.92
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.33
|
| Rate for Payer: United Healthcare Commercial |
$25.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.33
|
| Rate for Payer: United Healthcare VA CCN |
$16.33
|
|
|
STRAPPING ANKLE &/FOOT
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
9602954001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$112.80 |
| Rate for Payer: Aetna of VT Commercial |
$112.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$107.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$16.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$107.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$22.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.71
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$30.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.92
|
| Rate for Payer: Multiplan Commercial |
$111.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.33
|
| Rate for Payer: United Healthcare Commercial |
$25.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.33
|
| Rate for Payer: United Healthcare VA CCN |
$16.33
|
|
|
STRAPPING ANKLE &/FOOT
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
9602954001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$53.15 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna of VT Commercial |
$114.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$107.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$53.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$107.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$97.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$95.40
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$96.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$111.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$54.00
|
| Rate for Payer: United Healthcare Commercial |
$114.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.00
|
| Rate for Payer: United Healthcare VA CCN |
$54.00
|
|
|
STRAPPING ANKLE &/FOOT
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
9602954002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$34.55 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.01
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.10
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare VA CCN |
$35.10
|
|
|
STRAPPING ANKLE &/FOOT
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
5102954001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Aetna of VT Commercial |
$40.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$19.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.19
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cigna Commercial |
$34.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$34.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$34.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.35
|
| Rate for Payer: Multiplan Commercial |
$39.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare Commercial |
$40.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare VA CCN |
$19.35
|
|
|
STRAPPING ANKLE &/FOOT
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
9602954001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$88.81 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna of VT Commercial |
$114.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$96.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$111.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.00
|
| Rate for Payer: United Healthcare Commercial |
$114.00
|
|
|
STRAPPING ANKLE &/FOOT
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
9602954002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$57.73 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$57.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$57.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.40
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
|
|
STRAPPING ANKLE &/FOOT
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
9812954001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
STRAPPING ANKLE &/FOOT
|
Facility
|
IP
|
$42.39
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
4502954001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.37 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna of VT Commercial |
$40.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.91
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Cigna Commercial |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.91
|
| Rate for Payer: Multiplan Commercial |
$39.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.03
|
| Rate for Payer: United Healthcare Commercial |
$40.27
|
|
|
STRAPPING ANKLE &/FOOT
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
9822954001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$73.32 |
| Rate for Payer: Aetna of VT Commercial |
$73.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$16.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$22.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.71
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$30.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.92
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.33
|
| Rate for Payer: United Healthcare Commercial |
$25.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.33
|
| Rate for Payer: United Healthcare VA CCN |
$16.33
|
|
|
STRAPPING ANKLE &/FOOT
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
9822954001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$34.55 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.01
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.10
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare VA CCN |
$35.10
|
|
|
STRAPPING ANKLE &/FOOT
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
9822954001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$57.73 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$57.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$57.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.40
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
|
|
STRAPPING ANKLE &/FOOT
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
9812954002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$57.73 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$57.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$57.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.40
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
|
|
STRAPPING ANKLE &/FOOT
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
5102954001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$52.71 |
| Rate for Payer: Aetna of VT Commercial |
$40.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$16.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$22.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.71
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cigna Commercial |
$30.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.92
|
| Rate for Payer: Multiplan Commercial |
$39.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.33
|
| Rate for Payer: United Healthcare Commercial |
$25.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.33
|
| Rate for Payer: United Healthcare VA CCN |
$16.33
|
|
