|
TOTAL HIP ARTHROPLASTY
|
Facility
|
OP
|
$6,723.00
|
|
|
Service Code
|
CPT 27132
|
| Hospital Charge Code |
9822713201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,977.62 |
| Max. Negotiated Rate |
$6,386.85 |
| Rate for Payer: Aetna of VT Commercial |
$6,386.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,023.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,977.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,023.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,047.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,714.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,445.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,025.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,344.78
|
| Rate for Payer: Cash Price |
$3,361.50
|
| Rate for Payer: Cigna Commercial |
$5,378.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,378.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,378.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,025.35
|
| Rate for Payer: Multiplan Commercial |
$6,252.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,714.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,025.35
|
| Rate for Payer: United Healthcare Commercial |
$6,386.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,025.35
|
| Rate for Payer: United Healthcare VA CCN |
$3,025.35
|
|
|
TOTAL HIP ARTHROPLASTY
|
Facility
|
IP
|
$6,723.00
|
|
|
Service Code
|
CPT 27132
|
| Hospital Charge Code |
9822713201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$4,975.69 |
| Max. Negotiated Rate |
$6,386.85 |
| Rate for Payer: Aetna of VT Commercial |
$6,386.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,975.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,975.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,714.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,647.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,378.40
|
| Rate for Payer: Cash Price |
$3,361.50
|
| Rate for Payer: Cigna Commercial |
$5,378.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,378.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,378.40
|
| Rate for Payer: Multiplan Commercial |
$6,252.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,714.55
|
| Rate for Payer: United Healthcare Commercial |
$6,386.85
|
|
|
TOTAL HYSTERECTOMY
|
Facility
|
IP
|
$2,543.00
|
|
|
Service Code
|
CPT 58150
|
| Hospital Charge Code |
9825815001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,882.07 |
| Max. Negotiated Rate |
$2,415.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,415.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,882.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,882.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,161.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,136.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,034.40
|
| Rate for Payer: Cash Price |
$1,271.50
|
| Rate for Payer: Cigna Commercial |
$2,034.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,034.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,034.40
|
| Rate for Payer: Multiplan Commercial |
$2,364.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,161.55
|
| Rate for Payer: United Healthcare Commercial |
$2,415.85
|
|
|
TOTAL HYSTERECTOMY
|
Professional
|
Both
|
$2,543.00
|
|
|
Service Code
|
CPT 58150
|
| Hospital Charge Code |
9825815001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$945.45 |
| Max. Negotiated Rate |
$2,390.42 |
| Rate for Payer: Aetna of VT Commercial |
$2,390.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,278.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$973.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,278.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,323.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,571.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,571.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,087.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,571.29
|
| Rate for Payer: Cash Price |
$1,271.50
|
| Rate for Payer: Cash Price |
$1,271.50
|
| Rate for Payer: Cigna Commercial |
$1,663.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,578.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,578.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$945.45
|
| Rate for Payer: Multiplan Commercial |
$2,364.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,342.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$945.45
|
| Rate for Payer: United Healthcare Commercial |
$1,454.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$945.45
|
| Rate for Payer: United Healthcare VA CCN |
$945.45
|
|
|
TOTAL HYSTERECTOMY
|
Facility
|
OP
|
$2,543.00
|
|
|
Service Code
|
CPT 58150
|
| Hospital Charge Code |
9825815001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,126.29 |
| Max. Negotiated Rate |
$2,415.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,415.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,278.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,126.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,278.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,530.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,161.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,059.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,144.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,021.68
|
| Rate for Payer: Cash Price |
$1,271.50
|
| Rate for Payer: Cigna Commercial |
$2,034.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,034.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,034.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,144.35
|
| Rate for Payer: Multiplan Commercial |
$2,364.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,161.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,144.35
|
| Rate for Payer: United Healthcare Commercial |
$2,415.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,144.35
|
| Rate for Payer: United Healthcare VA CCN |
$1,144.35
|
|
|
TOTAL KNEE ARTHROPLASTY
|
Facility
|
IP
|
$3,615.00
|
|
|
Service Code
|
CPT 27447
|
| Hospital Charge Code |
9822744701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,675.46 |
| Max. Negotiated Rate |
$3,434.25 |
| Rate for Payer: Aetna of VT Commercial |
$3,434.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,675.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,675.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,072.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,036.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,892.00
|
| Rate for Payer: Cash Price |
$1,807.50
|
| Rate for Payer: Cigna Commercial |
$2,892.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,892.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,892.00
|
| Rate for Payer: Multiplan Commercial |
$3,361.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,072.75
|
| Rate for Payer: United Healthcare Commercial |
$3,434.25
|
|
|
TOTAL KNEE ARTHROPLASTY
|
Facility
|
OP
|
$3,615.00
|
|
|
Service Code
|
CPT 27447
|
| Hospital Charge Code |
9822744701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,601.08 |
| Max. Negotiated Rate |
$3,434.25 |
| Rate for Payer: Aetna of VT Commercial |
$3,434.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,238.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,601.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,238.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,176.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,072.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,928.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,626.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,873.93
|
| Rate for Payer: Cash Price |
$1,807.50
|
| Rate for Payer: Cigna Commercial |
$2,892.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,892.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,892.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,626.75
|
| Rate for Payer: Multiplan Commercial |
$3,361.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,072.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,626.75
|
| Rate for Payer: United Healthcare Commercial |
$3,434.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,626.75
|
| Rate for Payer: United Healthcare VA CCN |
$1,626.75
|
|
|
TOTAL KNEE ARTHROPLASTY
|
Professional
|
Both
|
$3,615.00
|
|
|
Service Code
|
CPT 27447
|
| Hospital Charge Code |
9822744701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,192.11 |
| Max. Negotiated Rate |
$3,398.10 |
| Rate for Payer: Aetna of VT Commercial |
$3,398.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,238.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,227.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,238.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,668.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,986.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,986.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,370.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,986.89
|
| Rate for Payer: Cash Price |
$1,807.50
|
| Rate for Payer: Cash Price |
$1,807.50
|
| Rate for Payer: Cigna Commercial |
$2,258.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,999.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,999.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,192.11
|
| Rate for Payer: Multiplan Commercial |
$3,361.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,692.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,192.12
|
| Rate for Payer: United Healthcare Commercial |
$1,833.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,192.12
|
| Rate for Payer: United Healthcare VA CCN |
$1,192.12
|
|
|
TOTAL TAU
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
CPT 84394
|
| Hospital Charge Code |
3008439401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$720.00 |
| Max. Negotiated Rate |
$1,692.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,692.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,612.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,612.62
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
| Rate for Payer: United Healthcare Commercial |
$1,530.00
|
| Rate for Payer: United Healthcare VA CCN |
$720.00
|
|
|
TOTAL TAU
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
CPT 84394
|
| Hospital Charge Code |
3008439401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,332.18 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,710.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,332.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,332.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,512.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,440.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,440.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,440.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,440.00
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,530.00
|
| Rate for Payer: United Healthcare Commercial |
$1,710.00
|
|
|
TOTAL TAU
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
CPT 84394
|
| Hospital Charge Code |
3008439401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$797.22 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,710.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,612.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$797.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,612.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,083.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,458.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$810.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,431.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,440.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,440.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,440.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$810.00
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,530.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$810.00
|
| Rate for Payer: United Healthcare Commercial |
$1,710.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$810.00
|
| Rate for Payer: United Healthcare VA CCN |
$810.00
|
|
|
T PLATE 8 HOLE
|
Facility
|
OP
|
$1,235.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780074161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.98 |
| Max. Negotiated Rate |
$1,173.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,173.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,106.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$546.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,106.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$743.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,049.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,000.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$555.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$981.83
|
| Rate for Payer: Cash Price |
$617.50
|
| Rate for Payer: Cigna Commercial |
$988.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$988.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$988.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$555.75
|
| Rate for Payer: Multiplan Commercial |
$1,148.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,049.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$555.75
|
| Rate for Payer: United Healthcare Commercial |
$1,173.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$555.75
|
| Rate for Payer: United Healthcare VA CCN |
$555.75
|
|
|
T PLATE 8 HOLE
|
Facility
|
IP
|
$1,235.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780074161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.02 |
| Max. Negotiated Rate |
$1,173.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,173.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$914.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$914.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,049.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,037.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$988.00
|
| Rate for Payer: Cash Price |
$617.50
|
| Rate for Payer: Cigna Commercial |
$988.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$988.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$988.00
|
| Rate for Payer: Multiplan Commercial |
$1,148.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,049.75
|
| Rate for Payer: United Healthcare Commercial |
$1,173.25
|
|
|
T-POD STABLIZATION DEVICE
|
Facility
|
OP
|
$131.52
|
|
| Hospital Charge Code |
2720073151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.25 |
| Max. Negotiated Rate |
$124.94 |
| Rate for Payer: Aetna of VT Commercial |
$124.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$117.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$117.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$111.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.56
|
| Rate for Payer: Cash Price |
$65.76
|
| Rate for Payer: Cigna Commercial |
$105.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$59.18
|
| Rate for Payer: Multiplan Commercial |
$122.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$111.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.18
|
| Rate for Payer: United Healthcare Commercial |
$124.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.18
|
| Rate for Payer: United Healthcare VA CCN |
$59.18
|
|
|
T-POD STABLIZATION DEVICE
|
Facility
|
IP
|
$131.52
|
|
| Hospital Charge Code |
2720073151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$124.94 |
| Rate for Payer: Aetna of VT Commercial |
$124.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$111.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$105.22
|
| Rate for Payer: Cash Price |
$65.76
|
| Rate for Payer: Cigna Commercial |
$105.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.22
|
| Rate for Payer: Multiplan Commercial |
$122.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$111.79
|
| Rate for Payer: United Healthcare Commercial |
$124.94
|
|
|
TRACE ELEMENTS 1 ML VIAL
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 517930501
|
| Hospital Charge Code |
2500000568
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
TRACE ELEMENTS 1 ML VIAL
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 517930501
|
| Hospital Charge Code |
2500000568
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
TRACE ELEMENTS 1 ML VIAL
|
Facility
|
IP
|
$0.01
|
|
| Hospital Charge Code |
2500000568
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
TRACE ELEMENTS 1 ML VIAL
|
Facility
|
OP
|
$0.01
|
|
| Hospital Charge Code |
2500000568
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
TRANSABDOM AMNIOINFUS W/US
|
Professional
|
Both
|
$1,123.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
9825907001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$274.51 |
| Max. Negotiated Rate |
$1,055.62 |
| Rate for Payer: Aetna of VT Commercial |
$1,055.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,006.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$282.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,006.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$384.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$659.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$659.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$315.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$659.23
|
| Rate for Payer: Cash Price |
$561.50
|
| Rate for Payer: Cash Price |
$561.50
|
| Rate for Payer: Cigna Commercial |
$300.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$615.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$615.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$360.91
|
| Rate for Payer: Multiplan Commercial |
$1,044.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$389.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$274.51
|
| Rate for Payer: United Healthcare Commercial |
$422.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$274.51
|
| Rate for Payer: United Healthcare VA CCN |
$274.51
|
|
|
TRANSABDOM AMNIOINFUS W/US
|
Facility
|
OP
|
$1,123.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
9825907001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$497.38 |
| Max. Negotiated Rate |
$1,066.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,066.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,006.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$497.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,006.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$676.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$954.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$909.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$505.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$892.78
|
| Rate for Payer: Cash Price |
$561.50
|
| Rate for Payer: Cigna Commercial |
$898.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$898.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$898.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$505.35
|
| Rate for Payer: Multiplan Commercial |
$1,044.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$954.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$505.35
|
| Rate for Payer: United Healthcare Commercial |
$1,066.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$505.35
|
| Rate for Payer: United Healthcare VA CCN |
$505.35
|
|
|
TRANSABDOM AMNIOINFUS W/US
|
Facility
|
IP
|
$1,123.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
9825907001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$831.13 |
| Max. Negotiated Rate |
$1,066.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,066.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$831.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$831.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$954.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$943.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$898.40
|
| Rate for Payer: Cash Price |
$561.50
|
| Rate for Payer: Cigna Commercial |
$898.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$898.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$898.40
|
| Rate for Payer: Multiplan Commercial |
$1,044.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$954.55
|
| Rate for Payer: United Healthcare Commercial |
$1,066.85
|
|
|
TRANSFERASE (AST) (SGOT)
|
Facility
|
OP
|
$60.75
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
3008445001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$57.71 |
| Rate for Payer: Aetna of VT Commercial |
$57.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$36.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$51.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$49.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$27.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$48.30
|
| Rate for Payer: Cash Price |
$30.38
|
| Rate for Payer: Cash Price |
$30.38
|
| Rate for Payer: Cigna Commercial |
$48.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$48.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$48.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$27.34
|
| Rate for Payer: Multiplan Commercial |
$56.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$27.34
|
| Rate for Payer: United Healthcare Commercial |
$57.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare VA CCN |
$27.34
|
|
|
TRANSFERASE (AST) (SGOT)
|
Facility
|
IP
|
$60.75
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
3008445001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.96 |
| Max. Negotiated Rate |
$57.71 |
| Rate for Payer: Aetna of VT Commercial |
$57.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$44.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$44.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$51.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$51.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$48.60
|
| Rate for Payer: Cash Price |
$30.38
|
| Rate for Payer: Cigna Commercial |
$48.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$48.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$48.60
|
| Rate for Payer: Multiplan Commercial |
$56.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.64
|
| Rate for Payer: United Healthcare Commercial |
$57.71
|
|
|
TRANSJ CARE MGMT HIGH F2F 7D
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
9609949602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$321.10 |
| Max. Negotiated Rate |
$688.75 |
| Rate for Payer: Aetna of VT Commercial |
$688.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$649.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$321.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$649.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$436.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$616.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$587.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$326.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$576.38
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$580.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$580.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$580.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$326.25
|
| Rate for Payer: Multiplan Commercial |
$674.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$616.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$326.25
|
| Rate for Payer: United Healthcare Commercial |
$688.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$326.25
|
| Rate for Payer: United Healthcare VA CCN |
$326.25
|
|
