|
TIBIAL ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,813.00
|
|
|
Service Code
|
CPT 29855
|
| Hospital Charge Code |
9822985501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,245.88 |
| Max. Negotiated Rate |
$2,672.35 |
| Rate for Payer: Aetna of VT Commercial |
$2,672.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,520.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,245.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,520.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,693.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,391.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,278.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,265.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,236.34
|
| Rate for Payer: Cash Price |
$1,406.50
|
| Rate for Payer: Cigna Commercial |
$2,250.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,250.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,250.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,265.85
|
| Rate for Payer: Multiplan Commercial |
$2,616.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,391.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,265.85
|
| Rate for Payer: United Healthcare Commercial |
$2,672.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,265.85
|
| Rate for Payer: United Healthcare VA CCN |
$1,265.85
|
|
|
TIBIAL ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$2,813.00
|
|
|
Service Code
|
CPT 29855
|
| Hospital Charge Code |
9822985501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$737.06 |
| Max. Negotiated Rate |
$2,644.22 |
| Rate for Payer: Aetna of VT Commercial |
$2,644.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,520.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$759.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,520.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,031.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,181.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,181.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$847.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,181.13
|
| Rate for Payer: Cash Price |
$1,406.50
|
| Rate for Payer: Cash Price |
$1,406.50
|
| Rate for Payer: Cigna Commercial |
$1,393.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,228.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,228.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$737.06
|
| Rate for Payer: Multiplan Commercial |
$2,616.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,046.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$737.06
|
| Rate for Payer: United Healthcare Commercial |
$1,133.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$737.06
|
| Rate for Payer: United Healthcare VA CCN |
$737.06
|
|
|
TIBIAL ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$2,961.00
|
|
|
Service Code
|
CPT 29856
|
| Hospital Charge Code |
9822985601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,191.44 |
| Max. Negotiated Rate |
$2,812.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,812.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,191.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,191.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,516.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,487.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,368.80
|
| Rate for Payer: Cash Price |
$1,480.50
|
| Rate for Payer: Cigna Commercial |
$2,368.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,368.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,368.80
|
| Rate for Payer: Multiplan Commercial |
$2,753.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,516.85
|
| Rate for Payer: United Healthcare Commercial |
$2,812.95
|
|
|
TIBIAL ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$2,961.00
|
|
|
Service Code
|
CPT 29856
|
| Hospital Charge Code |
9822985601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$931.29 |
| Max. Negotiated Rate |
$2,783.34 |
| Rate for Payer: Aetna of VT Commercial |
$2,783.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,652.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$959.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,652.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,303.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,851.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,851.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,070.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,851.61
|
| Rate for Payer: Cash Price |
$1,480.50
|
| Rate for Payer: Cash Price |
$1,480.50
|
| Rate for Payer: Cigna Commercial |
$1,762.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,557.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,557.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$931.29
|
| Rate for Payer: Multiplan Commercial |
$2,753.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,322.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$931.29
|
| Rate for Payer: United Healthcare Commercial |
$1,432.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$931.29
|
| Rate for Payer: United Healthcare VA CCN |
$931.29
|
|
|
TIBIAL TRAY CEMENTED LEFT S6
|
Facility
|
OP
|
$0.03
|
|
| Hospital Charge Code |
2780067071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
TIBIAL TRAY CEMENTED LEFT S6
|
Facility
|
IP
|
$0.03
|
|
| Hospital Charge Code |
2780067071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
|
|
TIBIAL TRAY CEMENTED RIGHT S4
|
Facility
|
IP
|
$0.03
|
|
| Hospital Charge Code |
2780067011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
|
|
TIBIAL TRAY CEMENTED RIGHT S4
|
Facility
|
OP
|
$0.03
|
|
| Hospital Charge Code |
2780067011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
TIBIAL TRAY FIX CEMENTED S5 LM
|
Facility
|
IP
|
$1,445.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780074121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,069.81 |
| Max. Negotiated Rate |
$1,373.22 |
| Rate for Payer: Aetna of VT Commercial |
$1,373.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,069.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,069.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,228.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,214.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,156.40
|
| Rate for Payer: Cash Price |
$722.75
|
| Rate for Payer: Cigna Commercial |
$1,156.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,156.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,156.40
|
| Rate for Payer: Multiplan Commercial |
$1,344.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,228.67
|
| Rate for Payer: United Healthcare Commercial |
$1,373.22
|
|
|
TIBIAL TRAY FIX CEMENTED S5 LM
|
Facility
|
OP
|
$1,445.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780074121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.21 |
| Max. Negotiated Rate |
$1,373.22 |
| Rate for Payer: Aetna of VT Commercial |
$1,373.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,295.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$640.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,295.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$870.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,228.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,170.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$650.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,149.17
|
| Rate for Payer: Cash Price |
$722.75
|
| Rate for Payer: Cigna Commercial |
$1,156.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,156.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,156.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$650.48
|
| Rate for Payer: Multiplan Commercial |
$1,344.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,228.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$650.48
|
| Rate for Payer: United Healthcare Commercial |
$1,373.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$650.48
|
| Rate for Payer: United Healthcare VA CCN |
$650.48
|
|
|
TIBIAL TRAY FOX CEMENTED S4 R,
|
Facility
|
OP
|
$1,820.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780073951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$806.08 |
| Max. Negotiated Rate |
$1,729.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,729.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,630.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$806.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,630.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,095.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,547.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,474.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$819.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,446.90
|
| Rate for Payer: Cash Price |
$910.00
|
| Rate for Payer: Cigna Commercial |
$1,456.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,456.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,456.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$819.00
|
| Rate for Payer: Multiplan Commercial |
$1,692.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,547.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$819.00
|
| Rate for Payer: United Healthcare Commercial |
$1,729.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$819.00
|
| Rate for Payer: United Healthcare VA CCN |
$819.00
|
|
|
TIBIAL TRAY FOX CEMENTED S4 R,
|
Facility
|
IP
|
$1,820.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780073951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,346.98 |
| Max. Negotiated Rate |
$1,729.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,729.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,346.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,346.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,547.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,528.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,456.00
|
| Rate for Payer: Cash Price |
$910.00
|
| Rate for Payer: Cigna Commercial |
$1,456.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,456.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,456.00
|
| Rate for Payer: Multiplan Commercial |
$1,692.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,547.00
|
| Rate for Payer: United Healthcare Commercial |
$1,729.00
|
|
|
TIB INSERT ECROSS-FLEX 2L-11MM
|
Facility
|
IP
|
$1,239.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780056541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.98 |
| Max. Negotiated Rate |
$1,177.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,177.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$916.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$916.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,053.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,040.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$991.20
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cigna Commercial |
$991.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$991.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$991.20
|
| Rate for Payer: Multiplan Commercial |
$1,152.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,053.15
|
| Rate for Payer: United Healthcare Commercial |
$1,177.05
|
|
|
TIB INSERT ECROSS-FLEX 2L-11MM
|
Facility
|
OP
|
$1,239.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780056541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.75 |
| Max. Negotiated Rate |
$1,177.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,177.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,110.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$548.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,110.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$745.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,053.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,003.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$557.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$985.00
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cigna Commercial |
$991.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$991.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$991.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$557.55
|
| Rate for Payer: Multiplan Commercial |
$1,152.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,053.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$557.55
|
| Rate for Payer: United Healthcare Commercial |
$1,177.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$557.55
|
| Rate for Payer: United Healthcare VA CCN |
$557.55
|
|
|
TIB INSERT ECROSS FLEX 2R-11MM
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
HCPCS C1176
|
| Hospital Charge Code |
2780074091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,727.31 |
| Max. Negotiated Rate |
$3,705.00 |
| Rate for Payer: Aetna of VT Commercial |
$3,705.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,494.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,727.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,494.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,347.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,315.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,159.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,755.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,100.50
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cigna Commercial |
$3,120.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,120.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,120.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,755.00
|
| Rate for Payer: Multiplan Commercial |
$3,627.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,315.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,755.00
|
| Rate for Payer: United Healthcare Commercial |
$3,705.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,755.00
|
| Rate for Payer: United Healthcare VA CCN |
$1,755.00
|
|
|
TIB INSERT ECROSS FLEX 2R-11MM
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
HCPCS C1176
|
| Hospital Charge Code |
2780074091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.39 |
| Max. Negotiated Rate |
$3,705.00 |
| Rate for Payer: Aetna of VT Commercial |
$3,705.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,886.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,886.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,315.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,276.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,120.00
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cigna Commercial |
$3,120.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,120.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,120.00
|
| Rate for Payer: Multiplan Commercial |
$3,627.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare Commercial |
$3,705.00
|
|
|
TIB INSERT ECROSS FLEX 5L-10MM
|
Facility
|
IP
|
$1,240.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780056451
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.32 |
| Max. Negotiated Rate |
$1,178.76 |
| Rate for Payer: Aetna of VT Commercial |
$1,178.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$918.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$918.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,054.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,042.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$992.64
|
| Rate for Payer: Cash Price |
$620.40
|
| Rate for Payer: Cigna Commercial |
$992.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$992.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$992.64
|
| Rate for Payer: Multiplan Commercial |
$1,153.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,054.68
|
| Rate for Payer: United Healthcare Commercial |
$1,178.76
|
|
|
TIB INSERT ECROSS FLEX 5L-10MM
|
Facility
|
OP
|
$1,240.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780056451
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.55 |
| Max. Negotiated Rate |
$1,178.76 |
| Rate for Payer: Aetna of VT Commercial |
$1,178.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,111.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$549.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,111.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$746.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,054.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,005.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$558.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$986.44
|
| Rate for Payer: Cash Price |
$620.40
|
| Rate for Payer: Cigna Commercial |
$992.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$992.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$992.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$558.36
|
| Rate for Payer: Multiplan Commercial |
$1,153.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,054.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$558.36
|
| Rate for Payer: United Healthcare Commercial |
$1,178.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$558.36
|
| Rate for Payer: United Healthcare VA CCN |
$558.36
|
|
|
TIGHTROPE ABS BUTTON RND 14MM
|
Facility
|
IP
|
$386.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780072971
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.21 |
| Max. Negotiated Rate |
$367.38 |
| Rate for Payer: Aetna of VT Commercial |
$367.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$286.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$286.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$328.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$324.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$309.38
|
| Rate for Payer: Cash Price |
$193.36
|
| Rate for Payer: Cigna Commercial |
$309.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$309.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$309.38
|
| Rate for Payer: Multiplan Commercial |
$359.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$328.71
|
| Rate for Payer: United Healthcare Commercial |
$367.38
|
|
|
TIGHTROPE ABS BUTTON RND 14MM
|
Facility
|
OP
|
$386.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780072971
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.28 |
| Max. Negotiated Rate |
$367.38 |
| Rate for Payer: Aetna of VT Commercial |
$367.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$346.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$171.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$346.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$232.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$328.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$313.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$174.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$307.44
|
| Rate for Payer: Cash Price |
$193.36
|
| Rate for Payer: Cigna Commercial |
$309.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$309.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$309.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$174.02
|
| Rate for Payer: Multiplan Commercial |
$359.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$328.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$174.02
|
| Rate for Payer: United Healthcare Commercial |
$367.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$174.02
|
| Rate for Payer: United Healthcare VA CCN |
$174.02
|
|
|
TIGHTROPE ABS BUTTON RND 20MM
|
Facility
|
OP
|
$386.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780072981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.28 |
| Max. Negotiated Rate |
$367.38 |
| Rate for Payer: Aetna of VT Commercial |
$367.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$346.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$171.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$346.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$232.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$328.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$313.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$174.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$307.44
|
| Rate for Payer: Cash Price |
$193.36
|
| Rate for Payer: Cigna Commercial |
$309.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$309.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$309.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$174.02
|
| Rate for Payer: Multiplan Commercial |
$359.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$328.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$174.02
|
| Rate for Payer: United Healthcare Commercial |
$367.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$174.02
|
| Rate for Payer: United Healthcare VA CCN |
$174.02
|
|
|
TIGHTROPE ABS BUTTON RND 20MM
|
Facility
|
IP
|
$386.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780072981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.21 |
| Max. Negotiated Rate |
$367.38 |
| Rate for Payer: Aetna of VT Commercial |
$367.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$286.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$286.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$328.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$324.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$309.38
|
| Rate for Payer: Cash Price |
$193.36
|
| Rate for Payer: Cigna Commercial |
$309.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$309.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$309.38
|
| Rate for Payer: Multiplan Commercial |
$359.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$328.71
|
| Rate for Payer: United Healthcare Commercial |
$367.38
|
|
|
TIGHTROPE II ABS IMPLANT OPEN
|
Facility
|
IP
|
$330.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780007299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.73 |
| Max. Negotiated Rate |
$314.14 |
| Rate for Payer: Aetna of VT Commercial |
$314.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$244.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$244.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$281.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$277.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$264.54
|
| Rate for Payer: Cash Price |
$165.34
|
| Rate for Payer: Cigna Commercial |
$264.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$264.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$264.54
|
| Rate for Payer: Multiplan Commercial |
$307.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$281.07
|
| Rate for Payer: United Healthcare Commercial |
$314.14
|
|
|
TIGHTROPE II ABS IMPLANT OPEN
|
Facility
|
OP
|
$330.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780007299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.45 |
| Max. Negotiated Rate |
$314.14 |
| Rate for Payer: Aetna of VT Commercial |
$314.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$296.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$146.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$296.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$199.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$281.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$267.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$148.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$262.88
|
| Rate for Payer: Cash Price |
$165.34
|
| Rate for Payer: Cigna Commercial |
$264.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$264.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$264.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$148.80
|
| Rate for Payer: Multiplan Commercial |
$307.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$281.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$148.80
|
| Rate for Payer: United Healthcare Commercial |
$314.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.80
|
| Rate for Payer: United Healthcare VA CCN |
$148.80
|
|
|
TIGHTROPE II ABS IMPLANT OPEN
|
Facility
|
OP
|
$330.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780072991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.45 |
| Max. Negotiated Rate |
$314.14 |
| Rate for Payer: Aetna of VT Commercial |
$314.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$296.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$146.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$296.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$199.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$281.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$267.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$148.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$262.88
|
| Rate for Payer: Cash Price |
$165.34
|
| Rate for Payer: Cigna Commercial |
$264.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$264.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$264.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$148.80
|
| Rate for Payer: Multiplan Commercial |
$307.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$281.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$148.80
|
| Rate for Payer: United Healthcare Commercial |
$314.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.80
|
| Rate for Payer: United Healthcare VA CCN |
$148.80
|
|
