|
UNLISTED PROCEDURE ANUS
|
Facility
|
OP
|
$2,963.37
|
|
|
Service Code
|
CPT 46999
|
| Hospital Charge Code |
4504699901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,312.48 |
| Max. Negotiated Rate |
$2,815.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,815.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,654.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,312.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,654.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,783.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,518.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,400.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,333.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,355.88
|
| Rate for Payer: Cash Price |
$1,481.68
|
| Rate for Payer: Cigna Commercial |
$2,370.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,370.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,370.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,333.52
|
| Rate for Payer: Multiplan Commercial |
$2,755.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,518.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,333.52
|
| Rate for Payer: United Healthcare Commercial |
$2,815.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,333.52
|
| Rate for Payer: United Healthcare VA CCN |
$1,333.52
|
|
|
UNLISTED PROCEDURE ANUS
|
Facility
|
OP
|
$2,739.00
|
|
|
Service Code
|
CPT 46999
|
| Hospital Charge Code |
9824699901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,213.10 |
| Max. Negotiated Rate |
$2,602.05 |
| Rate for Payer: Aetna of VT Commercial |
$2,602.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,453.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,213.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,453.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,648.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,328.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,218.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,232.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,177.51
|
| Rate for Payer: Cash Price |
$1,369.50
|
| Rate for Payer: Cigna Commercial |
$2,191.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,191.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,191.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,232.55
|
| Rate for Payer: Multiplan Commercial |
$2,547.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,328.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,232.55
|
| Rate for Payer: United Healthcare Commercial |
$2,602.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,232.55
|
| Rate for Payer: United Healthcare VA CCN |
$1,232.55
|
|
|
UNLISTED PROCEDURE ANUS
|
Facility
|
IP
|
$2,739.00
|
|
|
Service Code
|
CPT 46999
|
| Hospital Charge Code |
9814699902
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$2,027.13 |
| Max. Negotiated Rate |
$2,602.05 |
| Rate for Payer: Aetna of VT Commercial |
$2,602.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,027.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,027.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,328.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,300.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,191.20
|
| Rate for Payer: Cash Price |
$1,369.50
|
| Rate for Payer: Cigna Commercial |
$2,191.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,191.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,191.20
|
| Rate for Payer: Multiplan Commercial |
$2,547.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,328.15
|
| Rate for Payer: United Healthcare Commercial |
$2,602.05
|
|
|
UNLISTED PROCEDURE ANUS
|
Facility
|
OP
|
$2,739.00
|
|
|
Service Code
|
CPT 46999
|
| Hospital Charge Code |
9814699901
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,213.10 |
| Max. Negotiated Rate |
$2,602.05 |
| Rate for Payer: Aetna of VT Commercial |
$2,602.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,453.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,213.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,453.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,648.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,328.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,218.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,232.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,177.51
|
| Rate for Payer: Cash Price |
$1,369.50
|
| Rate for Payer: Cigna Commercial |
$2,191.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,191.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,191.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,232.55
|
| Rate for Payer: Multiplan Commercial |
$2,547.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,328.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,232.55
|
| Rate for Payer: United Healthcare Commercial |
$2,602.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,232.55
|
| Rate for Payer: United Healthcare VA CCN |
$1,232.55
|
|
|
UNLISTED PROCEDURE ANUS
|
Facility
|
IP
|
$2,739.00
|
|
|
Service Code
|
CPT 46999
|
| Hospital Charge Code |
9814699901
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$2,027.13 |
| Max. Negotiated Rate |
$2,602.05 |
| Rate for Payer: Aetna of VT Commercial |
$2,602.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,027.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,027.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,328.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,300.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,191.20
|
| Rate for Payer: Cash Price |
$1,369.50
|
| Rate for Payer: Cigna Commercial |
$2,191.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,191.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,191.20
|
| Rate for Payer: Multiplan Commercial |
$2,547.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,328.15
|
| Rate for Payer: United Healthcare Commercial |
$2,602.05
|
|
|
UNLISTED PROCEDURE ANUS
|
Professional
|
Both
|
$2,739.00
|
|
|
Service Code
|
CPT 46999
|
| Hospital Charge Code |
9814699901
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,095.60 |
| Max. Negotiated Rate |
$2,574.66 |
| Rate for Payer: Aetna of VT Commercial |
$2,574.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,453.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,453.87
|
| Rate for Payer: Cash Price |
$1,369.50
|
| Rate for Payer: Multiplan Commercial |
$2,547.27
|
| Rate for Payer: United Healthcare Commercial |
$2,328.15
|
| Rate for Payer: United Healthcare VA CCN |
$1,095.60
|
|
|
UNLISTED PROCEDURE ANUS
|
Professional
|
Both
|
$2,739.00
|
|
|
Service Code
|
CPT 46999
|
| Hospital Charge Code |
9814699902
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,095.60 |
| Max. Negotiated Rate |
$2,574.66 |
| Rate for Payer: Aetna of VT Commercial |
$2,574.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,453.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,453.87
|
| Rate for Payer: Cash Price |
$1,369.50
|
| Rate for Payer: Multiplan Commercial |
$2,547.27
|
| Rate for Payer: United Healthcare Commercial |
$2,328.15
|
| Rate for Payer: United Healthcare VA CCN |
$1,095.60
|
|
|
UNLISTED PROCEDURE ANUS
|
Facility
|
IP
|
$2,739.00
|
|
|
Service Code
|
CPT 46999
|
| Hospital Charge Code |
9824699901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,027.13 |
| Max. Negotiated Rate |
$2,602.05 |
| Rate for Payer: Aetna of VT Commercial |
$2,602.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,027.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,027.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,328.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,300.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,191.20
|
| Rate for Payer: Cash Price |
$1,369.50
|
| Rate for Payer: Cigna Commercial |
$2,191.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,191.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,191.20
|
| Rate for Payer: Multiplan Commercial |
$2,547.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,328.15
|
| Rate for Payer: United Healthcare Commercial |
$2,602.05
|
|
|
UNLISTED PROCEDURE ANUS
|
Professional
|
Both
|
$2,739.00
|
|
|
Service Code
|
CPT 46999
|
| Hospital Charge Code |
9824699901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,095.60 |
| Max. Negotiated Rate |
$2,574.66 |
| Rate for Payer: Aetna of VT Commercial |
$2,574.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,453.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,453.87
|
| Rate for Payer: Cash Price |
$1,369.50
|
| Rate for Payer: Multiplan Commercial |
$2,547.27
|
| Rate for Payer: United Healthcare Commercial |
$2,328.15
|
| Rate for Payer: United Healthcare VA CCN |
$1,095.60
|
|
|
UNLISTED PROCEDURE ANUS
|
Facility
|
IP
|
$2,963.37
|
|
|
Service Code
|
CPT 46999
|
| Hospital Charge Code |
4504699901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,193.19 |
| Max. Negotiated Rate |
$2,815.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,815.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,193.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,193.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,518.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,489.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,370.70
|
| Rate for Payer: Cash Price |
$1,481.68
|
| Rate for Payer: Cigna Commercial |
$2,370.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,370.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,370.70
|
| Rate for Payer: Multiplan Commercial |
$2,755.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,518.86
|
| Rate for Payer: United Healthcare Commercial |
$2,815.20
|
|
|
UNLISTED PROCEDURE ANUS
|
Facility
|
OP
|
$2,739.00
|
|
|
Service Code
|
CPT 46999
|
| Hospital Charge Code |
9814699902
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,213.10 |
| Max. Negotiated Rate |
$2,602.05 |
| Rate for Payer: Aetna of VT Commercial |
$2,602.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,453.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,213.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,453.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,648.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,328.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,218.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,232.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,177.51
|
| Rate for Payer: Cash Price |
$1,369.50
|
| Rate for Payer: Cigna Commercial |
$2,191.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,191.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,191.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,232.55
|
| Rate for Payer: Multiplan Commercial |
$2,547.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,328.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,232.55
|
| Rate for Payer: United Healthcare Commercial |
$2,602.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,232.55
|
| Rate for Payer: United Healthcare VA CCN |
$1,232.55
|
|
|
UNLISTED PROCEDURE ARTHROSCOPY
|
Facility
|
OP
|
$1,988.00
|
|
|
Service Code
|
CPT 29999
|
| Hospital Charge Code |
9822999901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$880.49 |
| Max. Negotiated Rate |
$1,888.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,888.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,781.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$880.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,781.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,196.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,689.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,610.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$894.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,580.46
|
| Rate for Payer: Cash Price |
$994.00
|
| Rate for Payer: Cigna Commercial |
$1,590.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,590.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,590.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$894.60
|
| Rate for Payer: Multiplan Commercial |
$1,848.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,689.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$894.60
|
| Rate for Payer: United Healthcare Commercial |
$1,888.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$894.60
|
| Rate for Payer: United Healthcare VA CCN |
$894.60
|
|
|
UNLISTED PROCEDURE ARTHROSCOPY
|
Professional
|
Both
|
$1,988.00
|
|
|
Service Code
|
CPT 29999
|
| Hospital Charge Code |
9822999901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$795.20 |
| Max. Negotiated Rate |
$1,868.72 |
| Rate for Payer: Aetna of VT Commercial |
$1,868.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,781.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,781.05
|
| Rate for Payer: Cash Price |
$994.00
|
| Rate for Payer: Multiplan Commercial |
$1,848.84
|
| Rate for Payer: United Healthcare Commercial |
$1,689.80
|
| Rate for Payer: United Healthcare VA CCN |
$795.20
|
|
|
UNLISTED PROCEDURE ARTHROSCOPY
|
Facility
|
IP
|
$1,988.00
|
|
|
Service Code
|
CPT 29999
|
| Hospital Charge Code |
9822999901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,471.32 |
| Max. Negotiated Rate |
$1,888.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,888.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,471.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,471.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,689.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,669.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,590.40
|
| Rate for Payer: Cash Price |
$994.00
|
| Rate for Payer: Cigna Commercial |
$1,590.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,590.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,590.40
|
| Rate for Payer: Multiplan Commercial |
$1,848.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,689.80
|
| Rate for Payer: United Healthcare Commercial |
$1,888.60
|
|
|
UNLISTED PROCEDURE SHOULDER
|
Facility
|
IP
|
$1,951.00
|
|
|
Service Code
|
CPT 23929
|
| Hospital Charge Code |
9822392901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,443.94 |
| Max. Negotiated Rate |
$1,853.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,853.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,443.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,443.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,658.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,638.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,560.80
|
| Rate for Payer: Cash Price |
$975.50
|
| Rate for Payer: Cigna Commercial |
$1,560.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,560.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,560.80
|
| Rate for Payer: Multiplan Commercial |
$1,814.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,658.35
|
| Rate for Payer: United Healthcare Commercial |
$1,853.45
|
|
|
UNLISTED PROCEDURE SHOULDER
|
Professional
|
Both
|
$1,951.00
|
|
|
Service Code
|
CPT 23929
|
| Hospital Charge Code |
9822392901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$780.40 |
| Max. Negotiated Rate |
$1,833.94 |
| Rate for Payer: Aetna of VT Commercial |
$1,833.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,747.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,747.90
|
| Rate for Payer: Cash Price |
$975.50
|
| Rate for Payer: Multiplan Commercial |
$1,814.43
|
| Rate for Payer: United Healthcare Commercial |
$1,658.35
|
| Rate for Payer: United Healthcare VA CCN |
$780.40
|
|
|
UNLISTED PROCEDURE SHOULDER
|
Facility
|
OP
|
$1,951.00
|
|
|
Service Code
|
CPT 23929
|
| Hospital Charge Code |
9822392901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$864.10 |
| Max. Negotiated Rate |
$1,853.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,853.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,747.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$864.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,747.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,174.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,658.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,580.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$877.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,551.05
|
| Rate for Payer: Cash Price |
$975.50
|
| Rate for Payer: Cigna Commercial |
$1,560.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,560.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,560.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$877.95
|
| Rate for Payer: Multiplan Commercial |
$1,814.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,658.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$877.95
|
| Rate for Payer: United Healthcare Commercial |
$1,853.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$877.95
|
| Rate for Payer: United Healthcare VA CCN |
$877.95
|
|
|
UNLISTED PULMONARY SVC/PX
|
Facility
|
IP
|
$242.99
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
4109479901
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$179.84 |
| Max. Negotiated Rate |
$230.84 |
| Rate for Payer: Aetna of VT Commercial |
$230.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$179.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$179.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$206.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$204.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$194.39
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$194.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$194.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$194.39
|
| Rate for Payer: Multiplan Commercial |
$225.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$206.54
|
| Rate for Payer: United Healthcare Commercial |
$230.84
|
|
|
UNLISTED PULMONARY SVC/PX
|
Facility
|
OP
|
$242.99
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
4109479901
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$107.62 |
| Max. Negotiated Rate |
$230.84 |
| Rate for Payer: Aetna of VT Commercial |
$230.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$217.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$107.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$217.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$146.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$206.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$109.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$193.18
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$194.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$194.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$194.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$109.35
|
| Rate for Payer: Multiplan Commercial |
$225.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$206.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$109.35
|
| Rate for Payer: United Healthcare Commercial |
$230.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$109.35
|
| Rate for Payer: United Healthcare VA CCN |
$109.35
|
|
|
UNLISTED PX CASTING/STRPG
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 29799
|
| Hospital Charge Code |
9832979901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$72.53 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Aetna of VT Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$82.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.40
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cigna Commercial |
$78.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$78.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$91.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$83.30
|
| Rate for Payer: United Healthcare Commercial |
$93.10
|
|
|
UNLISTED PX CASTING/STRPG
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
CPT 29799
|
| Hospital Charge Code |
9832979901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$92.12 |
| Rate for Payer: Aetna of VT Commercial |
$92.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$87.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$87.80
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$91.14
|
| Rate for Payer: United Healthcare Commercial |
$83.30
|
| Rate for Payer: United Healthcare VA CCN |
$39.20
|
|
|
UNLISTED PX CASTING/STRPG
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 29799
|
| Hospital Charge Code |
9832979901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Aetna of VT Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$87.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$43.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$87.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$59.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$79.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$77.91
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cigna Commercial |
$78.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$78.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$78.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$44.10
|
| Rate for Payer: Multiplan Commercial |
$91.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$83.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$44.10
|
| Rate for Payer: United Healthcare Commercial |
$93.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.10
|
| Rate for Payer: United Healthcare VA CCN |
$44.10
|
|
|
UNLISTED PX FEMUR/KNEE
|
Facility
|
OP
|
$3,557.00
|
|
|
Service Code
|
CPT 27599
|
| Hospital Charge Code |
9822759901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,575.40 |
| Max. Negotiated Rate |
$3,379.15 |
| Rate for Payer: Aetna of VT Commercial |
$3,379.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,186.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,575.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,186.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,141.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,023.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,881.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,600.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,827.82
|
| Rate for Payer: Cash Price |
$1,778.50
|
| Rate for Payer: Cigna Commercial |
$2,845.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,845.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,845.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,600.65
|
| Rate for Payer: Multiplan Commercial |
$3,308.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,023.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,600.65
|
| Rate for Payer: United Healthcare Commercial |
$3,379.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,600.65
|
| Rate for Payer: United Healthcare VA CCN |
$1,600.65
|
|
|
UNLISTED PX FEMUR/KNEE
|
Professional
|
Both
|
$3,557.00
|
|
|
Service Code
|
CPT 27599
|
| Hospital Charge Code |
9822759901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,422.80 |
| Max. Negotiated Rate |
$3,343.58 |
| Rate for Payer: Aetna of VT Commercial |
$3,343.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,186.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,186.72
|
| Rate for Payer: Cash Price |
$1,778.50
|
| Rate for Payer: Multiplan Commercial |
$3,308.01
|
| Rate for Payer: United Healthcare Commercial |
$3,023.45
|
| Rate for Payer: United Healthcare VA CCN |
$1,422.80
|
|
|
UNLISTED PX FEMUR/KNEE
|
Facility
|
IP
|
$3,557.00
|
|
|
Service Code
|
CPT 27599
|
| Hospital Charge Code |
9822759901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,632.54 |
| Max. Negotiated Rate |
$3,379.15 |
| Rate for Payer: Aetna of VT Commercial |
$3,379.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,632.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,632.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,023.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,987.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,845.60
|
| Rate for Payer: Cash Price |
$1,778.50
|
| Rate for Payer: Cigna Commercial |
$2,845.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,845.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,845.60
|
| Rate for Payer: Multiplan Commercial |
$3,308.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,023.45
|
| Rate for Payer: United Healthcare Commercial |
$3,379.15
|
|
