|
RELEASE OF FOOT CONTRACTURE
|
Professional
|
Both
|
$1,660.00
|
|
|
Service Code
|
CPT 28270
|
| Hospital Charge Code |
5102827001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$322.34 |
| Max. Negotiated Rate |
$1,560.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,560.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,487.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$332.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,487.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$451.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$750.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$750.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$370.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$750.28
|
| Rate for Payer: Cash Price |
$830.00
|
| Rate for Payer: Cash Price |
$830.00
|
| Rate for Payer: Cigna Commercial |
$609.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$749.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$749.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$461.74
|
| Rate for Payer: Multiplan Commercial |
$1,543.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$457.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$322.34
|
| Rate for Payer: United Healthcare Commercial |
$495.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$322.34
|
| Rate for Payer: United Healthcare VA CCN |
$322.34
|
|
|
RELEASE OF FOOT CONTRACTURE
|
Professional
|
Both
|
$3,010.00
|
|
|
Service Code
|
CPT 28270
|
| Hospital Charge Code |
9602827001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$322.34 |
| Max. Negotiated Rate |
$2,829.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,829.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,696.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$332.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,696.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$451.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$750.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$750.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$370.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$750.28
|
| Rate for Payer: Cash Price |
$1,505.00
|
| Rate for Payer: Cash Price |
$1,505.00
|
| Rate for Payer: Cigna Commercial |
$609.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$749.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$749.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$461.74
|
| Rate for Payer: Multiplan Commercial |
$2,799.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$457.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$322.34
|
| Rate for Payer: United Healthcare Commercial |
$495.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$322.34
|
| Rate for Payer: United Healthcare VA CCN |
$322.34
|
|
|
RELEASE OF FOOT CONTRACTURE
|
Facility
|
IP
|
$1,351.00
|
|
|
Service Code
|
CPT 28270
|
| Hospital Charge Code |
9602827002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$999.88 |
| Max. Negotiated Rate |
$1,283.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,283.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$999.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$999.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,148.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,134.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,080.80
|
| Rate for Payer: Cash Price |
$675.50
|
| Rate for Payer: Cigna Commercial |
$1,080.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,080.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,080.80
|
| Rate for Payer: Multiplan Commercial |
$1,256.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,148.35
|
| Rate for Payer: United Healthcare Commercial |
$1,283.45
|
|
|
RELEASE OF FOOT CONTRACTURE
|
Facility
|
OP
|
$1,351.00
|
|
|
Service Code
|
CPT 28270
|
| Hospital Charge Code |
9602827002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$598.36 |
| Max. Negotiated Rate |
$1,283.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,283.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,210.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$598.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,210.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$813.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,148.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,094.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$607.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,074.05
|
| Rate for Payer: Cash Price |
$675.50
|
| Rate for Payer: Cigna Commercial |
$1,080.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,080.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,080.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$607.95
|
| Rate for Payer: Multiplan Commercial |
$1,256.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,148.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$607.95
|
| Rate for Payer: United Healthcare Commercial |
$1,283.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$607.95
|
| Rate for Payer: United Healthcare VA CCN |
$607.95
|
|
|
RELEASE OF FOOT CONTRACTURE
|
Professional
|
Both
|
$1,351.00
|
|
|
Service Code
|
CPT 28270
|
| Hospital Charge Code |
9602827002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$322.34 |
| Max. Negotiated Rate |
$1,269.94 |
| Rate for Payer: Aetna of VT Commercial |
$1,269.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,210.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$332.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,210.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$451.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$750.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$750.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$370.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$750.28
|
| Rate for Payer: Cash Price |
$675.50
|
| Rate for Payer: Cash Price |
$675.50
|
| Rate for Payer: Cigna Commercial |
$609.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$749.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$749.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$461.74
|
| Rate for Payer: Multiplan Commercial |
$1,256.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$457.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$322.34
|
| Rate for Payer: United Healthcare Commercial |
$495.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$322.34
|
| Rate for Payer: United Healthcare VA CCN |
$322.34
|
|
|
RELEASE OF FOOT CONTRACTURE
|
Facility
|
OP
|
$3,010.00
|
|
|
Service Code
|
CPT 28270
|
| Hospital Charge Code |
9602827001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,333.13 |
| Max. Negotiated Rate |
$2,859.50 |
| Rate for Payer: Aetna of VT Commercial |
$2,859.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,696.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,333.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,696.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,812.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,558.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,438.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,354.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,392.95
|
| Rate for Payer: Cash Price |
$1,505.00
|
| Rate for Payer: Cigna Commercial |
$2,408.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,408.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,408.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,354.50
|
| Rate for Payer: Multiplan Commercial |
$2,799.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,558.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,354.50
|
| Rate for Payer: United Healthcare Commercial |
$2,859.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,354.50
|
| Rate for Payer: United Healthcare VA CCN |
$1,354.50
|
|
|
RELEASE OF FOOT CONTRACTURE
|
Facility
|
IP
|
$1,351.00
|
|
|
Service Code
|
CPT 28270
|
| Hospital Charge Code |
9822827001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$999.88 |
| Max. Negotiated Rate |
$1,283.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,283.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$999.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$999.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,148.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,134.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,080.80
|
| Rate for Payer: Cash Price |
$675.50
|
| Rate for Payer: Cigna Commercial |
$1,080.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,080.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,080.80
|
| Rate for Payer: Multiplan Commercial |
$1,256.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,148.35
|
| Rate for Payer: United Healthcare Commercial |
$1,283.45
|
|
|
RELEASE OF FOOT CONTRACTURE
|
Professional
|
Both
|
$1,351.00
|
|
|
Service Code
|
CPT 28270
|
| Hospital Charge Code |
9822827001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$322.34 |
| Max. Negotiated Rate |
$1,269.94 |
| Rate for Payer: Aetna of VT Commercial |
$1,269.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,210.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$332.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,210.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$451.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$750.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$750.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$370.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$750.28
|
| Rate for Payer: Cash Price |
$675.50
|
| Rate for Payer: Cash Price |
$675.50
|
| Rate for Payer: Cigna Commercial |
$609.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$749.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$749.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$461.74
|
| Rate for Payer: Multiplan Commercial |
$1,256.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$457.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$322.34
|
| Rate for Payer: United Healthcare Commercial |
$495.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$322.34
|
| Rate for Payer: United Healthcare VA CCN |
$322.34
|
|
|
RELEASE OF FOOT CONTRACTURE
|
Facility
|
IP
|
$1,660.00
|
|
|
Service Code
|
CPT 28270
|
| Hospital Charge Code |
5102827001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,228.57 |
| Max. Negotiated Rate |
$1,577.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,577.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,228.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,228.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,411.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,394.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,328.00
|
| Rate for Payer: Cash Price |
$830.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,328.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,328.00
|
| Rate for Payer: Multiplan Commercial |
$1,543.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,411.00
|
| Rate for Payer: United Healthcare Commercial |
$1,577.00
|
|
|
RELEASE OF FOOT CONTRACTURE
|
Facility
|
OP
|
$1,660.00
|
|
|
Service Code
|
CPT 28270
|
| Hospital Charge Code |
5102827001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$735.21 |
| Max. Negotiated Rate |
$1,577.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,577.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,487.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$735.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,487.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$999.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,411.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,344.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$747.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,319.70
|
| Rate for Payer: Cash Price |
$830.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,328.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,328.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$747.00
|
| Rate for Payer: Multiplan Commercial |
$1,543.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,411.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$747.00
|
| Rate for Payer: United Healthcare Commercial |
$1,577.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$747.00
|
| Rate for Payer: United Healthcare VA CCN |
$747.00
|
|
|
RELEASE OF SHOULDER LIGAMENT
|
Facility
|
OP
|
$2,026.00
|
|
|
Service Code
|
CPT 23415
|
| Hospital Charge Code |
9822341501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$897.32 |
| Max. Negotiated Rate |
$1,924.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,924.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,815.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$897.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,815.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,219.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,722.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,641.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$911.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,610.67
|
| Rate for Payer: Cash Price |
$1,013.00
|
| Rate for Payer: Cigna Commercial |
$1,620.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,620.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,620.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$911.70
|
| Rate for Payer: Multiplan Commercial |
$1,884.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,722.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$911.70
|
| Rate for Payer: United Healthcare Commercial |
$1,924.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$911.70
|
| Rate for Payer: United Healthcare VA CCN |
$911.70
|
|
|
RELEASE OF SHOULDER LIGAMENT
|
Facility
|
IP
|
$2,026.00
|
|
|
Service Code
|
CPT 23415
|
| Hospital Charge Code |
9822341501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,499.44 |
| Max. Negotiated Rate |
$1,924.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,924.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,722.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,701.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,620.80
|
| Rate for Payer: Cash Price |
$1,013.00
|
| Rate for Payer: Cigna Commercial |
$1,620.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,620.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,620.80
|
| Rate for Payer: Multiplan Commercial |
$1,884.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,722.10
|
| Rate for Payer: United Healthcare Commercial |
$1,924.70
|
|
|
RELEASE OF SHOULDER LIGAMENT
|
Professional
|
Both
|
$2,026.00
|
|
|
Service Code
|
CPT 23415
|
| Hospital Charge Code |
9822341501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$664.60 |
| Max. Negotiated Rate |
$1,904.44 |
| Rate for Payer: Aetna of VT Commercial |
$1,904.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,815.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$684.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,815.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$930.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,339.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,339.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$764.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,339.44
|
| Rate for Payer: Cash Price |
$1,013.00
|
| Rate for Payer: Cash Price |
$1,013.00
|
| Rate for Payer: Cigna Commercial |
$1,254.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,107.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,107.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$664.60
|
| Rate for Payer: Multiplan Commercial |
$1,884.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$943.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$664.60
|
| Rate for Payer: United Healthcare Commercial |
$1,022.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$664.60
|
| Rate for Payer: United Healthcare VA CCN |
$664.60
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
OP
|
$9,136.00
|
|
|
Service Code
|
CPT 26123
|
| Hospital Charge Code |
5102612301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,046.33 |
| Max. Negotiated Rate |
$8,679.20 |
| Rate for Payer: Aetna of VT Commercial |
$8,679.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8,184.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4,046.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8,184.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5,499.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7,765.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7,400.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4,111.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,263.12
|
| Rate for Payer: Cash Price |
$4,568.00
|
| Rate for Payer: Cigna Commercial |
$7,308.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,308.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,308.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$4,111.20
|
| Rate for Payer: Multiplan Commercial |
$8,496.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,765.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4,111.20
|
| Rate for Payer: United Healthcare Commercial |
$8,679.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,111.20
|
| Rate for Payer: United Healthcare VA CCN |
$4,111.20
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
IP
|
$2,303.00
|
|
|
Service Code
|
CPT 26123
|
| Hospital Charge Code |
9822612301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,704.45 |
| Max. Negotiated Rate |
$2,187.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,187.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,704.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,704.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,957.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,934.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,842.40
|
| Rate for Payer: Cash Price |
$1,151.50
|
| Rate for Payer: Cigna Commercial |
$1,842.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,842.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,842.40
|
| Rate for Payer: Multiplan Commercial |
$2,141.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,957.55
|
| Rate for Payer: United Healthcare Commercial |
$2,187.85
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
OP
|
$2,303.00
|
|
|
Service Code
|
CPT 26123
|
| Hospital Charge Code |
9602612302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$2,187.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,187.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,063.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,063.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,386.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,957.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,865.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,036.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,830.88
|
| Rate for Payer: Cash Price |
$1,151.50
|
| Rate for Payer: Cigna Commercial |
$1,842.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,842.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,842.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,036.35
|
| Rate for Payer: Multiplan Commercial |
$2,141.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,957.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,036.35
|
| Rate for Payer: United Healthcare Commercial |
$2,187.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,036.35
|
| Rate for Payer: United Healthcare VA CCN |
$1,036.35
|
|
|
RELEASE PALM CONTRACTURE
|
Professional
|
Both
|
$9,136.00
|
|
|
Service Code
|
CPT 26123
|
| Hospital Charge Code |
5102612301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$800.44 |
| Max. Negotiated Rate |
$8,587.84 |
| Rate for Payer: Aetna of VT Commercial |
$8,587.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8,184.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$824.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8,184.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,120.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,275.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,275.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$920.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,275.50
|
| Rate for Payer: Cash Price |
$4,568.00
|
| Rate for Payer: Cash Price |
$4,568.00
|
| Rate for Payer: Cigna Commercial |
$1,512.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,327.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,327.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$800.44
|
| Rate for Payer: Multiplan Commercial |
$8,496.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,136.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$800.45
|
| Rate for Payer: United Healthcare Commercial |
$1,231.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$800.45
|
| Rate for Payer: United Healthcare VA CCN |
$800.45
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
OP
|
$2,288.00
|
|
|
Service Code
|
CPT 26121
|
| Hospital Charge Code |
9822612101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,013.36 |
| Max. Negotiated Rate |
$2,173.60 |
| Rate for Payer: Aetna of VT Commercial |
$2,173.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,049.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,013.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,049.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,377.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,944.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,853.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,029.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,818.96
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cigna Commercial |
$1,830.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,830.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,830.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,029.60
|
| Rate for Payer: Multiplan Commercial |
$2,127.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,944.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,029.60
|
| Rate for Payer: United Healthcare Commercial |
$2,173.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,029.60
|
| Rate for Payer: United Healthcare VA CCN |
$1,029.60
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
OP
|
$2,303.00
|
|
|
Service Code
|
CPT 26123
|
| Hospital Charge Code |
9822612301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$2,187.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,187.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,063.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,063.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,386.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,957.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,865.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,036.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,830.88
|
| Rate for Payer: Cash Price |
$1,151.50
|
| Rate for Payer: Cigna Commercial |
$1,842.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,842.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,842.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,036.35
|
| Rate for Payer: Multiplan Commercial |
$2,141.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,957.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,036.35
|
| Rate for Payer: United Healthcare Commercial |
$2,187.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,036.35
|
| Rate for Payer: United Healthcare VA CCN |
$1,036.35
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
IP
|
$9,136.00
|
|
|
Service Code
|
CPT 26123
|
| Hospital Charge Code |
5102612301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6,761.55 |
| Max. Negotiated Rate |
$8,679.20 |
| Rate for Payer: Aetna of VT Commercial |
$8,679.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,761.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,761.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7,765.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7,674.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,308.80
|
| Rate for Payer: Cash Price |
$4,568.00
|
| Rate for Payer: Cigna Commercial |
$7,308.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,308.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,308.80
|
| Rate for Payer: Multiplan Commercial |
$8,496.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,765.60
|
| Rate for Payer: United Healthcare Commercial |
$8,679.20
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
IP
|
$11,438.00
|
|
|
Service Code
|
CPT 26123
|
| Hospital Charge Code |
9602612301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$8,465.26 |
| Max. Negotiated Rate |
$10,866.10 |
| Rate for Payer: Aetna of VT Commercial |
$10,866.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8,465.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8,465.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9,722.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9,607.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9,150.40
|
| Rate for Payer: Cash Price |
$5,719.00
|
| Rate for Payer: Cigna Commercial |
$9,150.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$9,150.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$9,150.40
|
| Rate for Payer: Multiplan Commercial |
$10,637.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,722.30
|
| Rate for Payer: United Healthcare Commercial |
$10,866.10
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
IP
|
$2,288.00
|
|
|
Service Code
|
CPT 26121
|
| Hospital Charge Code |
9822612101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,693.35 |
| Max. Negotiated Rate |
$2,173.60 |
| Rate for Payer: Aetna of VT Commercial |
$2,173.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,693.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,693.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,944.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,921.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,830.40
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cigna Commercial |
$1,830.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,830.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,830.40
|
| Rate for Payer: Multiplan Commercial |
$2,127.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,944.80
|
| Rate for Payer: United Healthcare Commercial |
$2,173.60
|
|
|
RELEASE PALM CONTRACTURE
|
Professional
|
Both
|
$2,288.00
|
|
|
Service Code
|
CPT 26121
|
| Hospital Charge Code |
9822612101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$574.18 |
| Max. Negotiated Rate |
$2,150.72 |
| Rate for Payer: Aetna of VT Commercial |
$2,150.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,049.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$591.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,049.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$803.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,221.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,221.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$660.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,221.75
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cigna Commercial |
$1,085.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$952.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$952.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$574.18
|
| Rate for Payer: Multiplan Commercial |
$2,127.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$815.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$574.18
|
| Rate for Payer: United Healthcare Commercial |
$883.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$574.18
|
| Rate for Payer: United Healthcare VA CCN |
$574.18
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
OP
|
$11,438.00
|
|
|
Service Code
|
CPT 26123
|
| Hospital Charge Code |
9602612301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$5,065.89 |
| Max. Negotiated Rate |
$10,866.10 |
| Rate for Payer: Aetna of VT Commercial |
$10,866.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$10,247.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5,065.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$10,247.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$6,885.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9,722.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9,264.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$5,147.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9,093.21
|
| Rate for Payer: Cash Price |
$5,719.00
|
| Rate for Payer: Cigna Commercial |
$9,150.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$9,150.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$9,150.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$5,147.10
|
| Rate for Payer: Multiplan Commercial |
$10,637.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,722.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5,147.10
|
| Rate for Payer: United Healthcare Commercial |
$10,866.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,147.10
|
| Rate for Payer: United Healthcare VA CCN |
$5,147.10
|
|
|
RELEASE PALM CONTRACTURE
|
Professional
|
Both
|
$2,303.00
|
|
|
Service Code
|
CPT 26123
|
| Hospital Charge Code |
9602612302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$800.44 |
| Max. Negotiated Rate |
$2,164.82 |
| Rate for Payer: Aetna of VT Commercial |
$2,164.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,063.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$824.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,063.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,120.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,275.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,275.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$920.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,275.50
|
| Rate for Payer: Cash Price |
$1,151.50
|
| Rate for Payer: Cash Price |
$1,151.50
|
| Rate for Payer: Cigna Commercial |
$1,512.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,327.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,327.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$800.44
|
| Rate for Payer: Multiplan Commercial |
$2,141.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,136.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$800.45
|
| Rate for Payer: United Healthcare Commercial |
$1,231.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$800.45
|
| Rate for Payer: United Healthcare VA CCN |
$800.45
|
|
