|
REPAIR FINGER TENDON
|
Facility
|
IP
|
$3,637.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
5102641801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,691.74 |
| Max. Negotiated Rate |
$3,455.15 |
| Rate for Payer: Aetna of VT Commercial |
$3,455.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,691.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,691.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,091.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,055.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,909.60
|
| Rate for Payer: Cash Price |
$1,818.50
|
| Rate for Payer: Cigna Commercial |
$2,909.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,909.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,909.60
|
| Rate for Payer: Multiplan Commercial |
$3,382.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,091.45
|
| Rate for Payer: United Healthcare Commercial |
$3,455.15
|
|
|
REPAIR FINGER TENDON
|
Professional
|
Both
|
$1,690.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
9812641802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$594.85 |
| Max. Negotiated Rate |
$1,588.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,588.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,514.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$612.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,514.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$832.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$990.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$990.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$684.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$990.30
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$971.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$971.52
|
| Rate for Payer: Martins Point Health Care Commercial |
$594.86
|
| Rate for Payer: Multiplan Commercial |
$1,571.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$844.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$594.85
|
| Rate for Payer: United Healthcare Commercial |
$915.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$594.85
|
| Rate for Payer: United Healthcare VA CCN |
$594.85
|
|
|
REPAIR FINGER TENDON
|
Facility
|
OP
|
$3,636.70
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
4502641801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,610.69 |
| Max. Negotiated Rate |
$3,454.86 |
| Rate for Payer: Aetna of VT Commercial |
$3,454.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,258.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,610.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,258.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,189.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,091.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,945.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,636.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,891.18
|
| Rate for Payer: Cash Price |
$1,818.35
|
| Rate for Payer: Cigna Commercial |
$2,909.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,909.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,909.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,636.52
|
| Rate for Payer: Multiplan Commercial |
$3,382.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,091.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,636.52
|
| Rate for Payer: United Healthcare Commercial |
$3,454.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,636.52
|
| Rate for Payer: United Healthcare VA CCN |
$1,636.52
|
|
|
REPAIR FINGER TENDON
|
Professional
|
Both
|
$3,637.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
5102641801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$594.85 |
| Max. Negotiated Rate |
$3,418.78 |
| Rate for Payer: Aetna of VT Commercial |
$3,418.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,258.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$612.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,258.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$832.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$990.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$990.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$684.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$990.30
|
| Rate for Payer: Cash Price |
$1,818.50
|
| Rate for Payer: Cash Price |
$1,818.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$971.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$971.52
|
| Rate for Payer: Martins Point Health Care Commercial |
$594.86
|
| Rate for Payer: Multiplan Commercial |
$3,382.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$844.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$594.85
|
| Rate for Payer: United Healthcare Commercial |
$915.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$594.85
|
| Rate for Payer: United Healthcare VA CCN |
$594.85
|
|
|
REPAIR FINGER TENDON
|
Facility
|
OP
|
$3,637.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
5102641801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,610.83 |
| Max. Negotiated Rate |
$3,455.15 |
| Rate for Payer: Aetna of VT Commercial |
$3,455.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,258.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,610.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,258.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,189.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,091.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,945.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,636.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,891.41
|
| Rate for Payer: Cash Price |
$1,818.50
|
| Rate for Payer: Cigna Commercial |
$2,909.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,909.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,909.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,636.65
|
| Rate for Payer: Multiplan Commercial |
$3,382.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,091.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,636.65
|
| Rate for Payer: United Healthcare Commercial |
$3,455.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,636.65
|
| Rate for Payer: United Healthcare VA CCN |
$1,636.65
|
|
|
REPAIR FINGER TENDON
|
Facility
|
IP
|
$1,690.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
9602641802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,250.77 |
| Max. Negotiated Rate |
$1,605.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,605.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,250.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,250.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,436.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,419.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,352.00
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cigna Commercial |
$1,352.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,352.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,352.00
|
| Rate for Payer: Multiplan Commercial |
$1,571.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,436.50
|
| Rate for Payer: United Healthcare Commercial |
$1,605.50
|
|
|
REPAIR FINGER TENDON
|
Facility
|
IP
|
$1,690.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
9812641802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,250.77 |
| Max. Negotiated Rate |
$1,605.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,605.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,250.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,250.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,436.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,419.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,352.00
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cigna Commercial |
$1,352.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,352.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,352.00
|
| Rate for Payer: Multiplan Commercial |
$1,571.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,436.50
|
| Rate for Payer: United Healthcare Commercial |
$1,605.50
|
|
|
REPAIR FINGER TENDON
|
Facility
|
OP
|
$1,758.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
9812641801
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$778.62 |
| Max. Negotiated Rate |
$1,670.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,670.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,574.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$778.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,574.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,058.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,494.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,423.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$791.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,397.61
|
| Rate for Payer: Cash Price |
$879.00
|
| Rate for Payer: Cigna Commercial |
$1,406.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,406.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,406.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$791.10
|
| Rate for Payer: Multiplan Commercial |
$1,634.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,494.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$791.10
|
| Rate for Payer: United Healthcare Commercial |
$1,670.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$791.10
|
| Rate for Payer: United Healthcare VA CCN |
$791.10
|
|
|
REPAIR/GRAFT OF FOOT TENDON
|
Facility
|
IP
|
$649.00
|
|
|
Service Code
|
CPT 28202
|
| Hospital Charge Code |
9822820201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$480.32 |
| Max. Negotiated Rate |
$616.55 |
| Rate for Payer: Aetna of VT Commercial |
$616.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$480.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$480.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$551.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$545.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$519.20
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cigna Commercial |
$519.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$519.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$519.20
|
| Rate for Payer: Multiplan Commercial |
$603.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$551.65
|
| Rate for Payer: United Healthcare Commercial |
$616.55
|
|
|
REPAIR/GRAFT OF FOOT TENDON
|
Facility
|
OP
|
$649.00
|
|
|
Service Code
|
CPT 28202
|
| Hospital Charge Code |
9822820201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$287.44 |
| Max. Negotiated Rate |
$616.55 |
| Rate for Payer: Aetna of VT Commercial |
$616.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$581.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$287.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$581.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$390.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$551.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$525.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$292.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$515.96
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cigna Commercial |
$519.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$519.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$519.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$292.05
|
| Rate for Payer: Multiplan Commercial |
$603.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$551.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$292.05
|
| Rate for Payer: United Healthcare Commercial |
$616.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.05
|
| Rate for Payer: United Healthcare VA CCN |
$292.05
|
|
|
REPAIR/GRAFT OF FOOT TENDON
|
Professional
|
Both
|
$649.00
|
|
|
Service Code
|
CPT 28202
|
| Hospital Charge Code |
9822820201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$413.07 |
| Max. Negotiated Rate |
$1,064.81 |
| Rate for Payer: Aetna of VT Commercial |
$610.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$581.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$425.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$581.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$578.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,064.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,064.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$475.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,064.81
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cigna Commercial |
$777.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$928.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$928.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$570.78
|
| Rate for Payer: Multiplan Commercial |
$603.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$586.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$413.07
|
| Rate for Payer: United Healthcare Commercial |
$635.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$413.07
|
| Rate for Payer: United Healthcare VA CCN |
$413.07
|
|
|
REPAIR/GRAFT OF THIGH MUSCLE
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
CPT 27386
|
| Hospital Charge Code |
9822738601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$655.73 |
| Max. Negotiated Rate |
$841.70 |
| Rate for Payer: Aetna of VT Commercial |
$841.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$655.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$655.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$753.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$744.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$708.80
|
| Rate for Payer: Cash Price |
$443.00
|
| Rate for Payer: Cigna Commercial |
$708.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$708.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$708.80
|
| Rate for Payer: Multiplan Commercial |
$823.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$753.10
|
| Rate for Payer: United Healthcare Commercial |
$841.70
|
|
|
REPAIR/GRAFT OF THIGH MUSCLE
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
CPT 27386
|
| Hospital Charge Code |
9822738601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$793.77 |
| Max. Negotiated Rate |
$1,535.28 |
| Rate for Payer: Aetna of VT Commercial |
$832.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$793.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$832.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$793.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,131.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,491.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,491.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$929.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,491.89
|
| Rate for Payer: Cash Price |
$443.00
|
| Rate for Payer: Cash Price |
$443.00
|
| Rate for Payer: Cigna Commercial |
$1,535.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,344.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,344.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$808.50
|
| Rate for Payer: Multiplan Commercial |
$823.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,148.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$808.50
|
| Rate for Payer: United Healthcare Commercial |
$1,243.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$808.50
|
| Rate for Payer: United Healthcare VA CCN |
$808.50
|
|
|
REPAIR/GRAFT OF THIGH MUSCLE
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
CPT 27386
|
| Hospital Charge Code |
9822738601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$392.41 |
| Max. Negotiated Rate |
$841.70 |
| Rate for Payer: Aetna of VT Commercial |
$841.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$793.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$392.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$793.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$533.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$753.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$717.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$398.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$704.37
|
| Rate for Payer: Cash Price |
$443.00
|
| Rate for Payer: Cigna Commercial |
$708.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$708.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$708.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$398.70
|
| Rate for Payer: Multiplan Commercial |
$823.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$753.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$398.70
|
| Rate for Payer: United Healthcare Commercial |
$841.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$398.70
|
| Rate for Payer: United Healthcare VA CCN |
$398.70
|
|
|
REPAIR/GRAFT WRIST BONE
|
Facility
|
OP
|
$1,946.00
|
|
|
Service Code
|
CPT 25440
|
| Hospital Charge Code |
9822544001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$861.88 |
| Max. Negotiated Rate |
$1,848.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,848.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,743.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$861.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,743.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,171.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,654.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,576.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$875.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,547.07
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cigna Commercial |
$1,556.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,556.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,556.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$875.70
|
| Rate for Payer: Multiplan Commercial |
$1,809.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,654.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$875.70
|
| Rate for Payer: United Healthcare Commercial |
$1,848.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$875.70
|
| Rate for Payer: United Healthcare VA CCN |
$875.70
|
|
|
REPAIR/GRAFT WRIST BONE
|
Professional
|
Both
|
$1,946.00
|
|
|
Service Code
|
CPT 25440
|
| Hospital Charge Code |
9822544001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$729.42 |
| Max. Negotiated Rate |
$1,829.24 |
| Rate for Payer: Aetna of VT Commercial |
$1,829.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,743.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$751.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,743.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,021.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,258.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,258.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$838.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,258.57
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cigna Commercial |
$1,379.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,213.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,213.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$729.42
|
| Rate for Payer: Multiplan Commercial |
$1,809.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,035.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$729.42
|
| Rate for Payer: United Healthcare Commercial |
$1,122.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$729.42
|
| Rate for Payer: United Healthcare VA CCN |
$729.42
|
|
|
REPAIR/GRAFT WRIST BONE
|
Facility
|
IP
|
$1,946.00
|
|
|
Service Code
|
CPT 25440
|
| Hospital Charge Code |
9822544001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,440.23 |
| Max. Negotiated Rate |
$1,848.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,848.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,440.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,440.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,654.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,634.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,556.80
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cigna Commercial |
$1,556.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,556.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,556.80
|
| Rate for Payer: Multiplan Commercial |
$1,809.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,654.10
|
| Rate for Payer: United Healthcare Commercial |
$1,848.70
|
|
|
REPAIR HAND JOINT
|
Facility
|
IP
|
$2,208.00
|
|
|
Service Code
|
CPT 26540
|
| Hospital Charge Code |
9822654001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,634.14 |
| Max. Negotiated Rate |
$2,097.60 |
| Rate for Payer: Aetna of VT Commercial |
$2,097.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,634.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,634.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,876.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,854.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,766.40
|
| Rate for Payer: Cash Price |
$1,104.00
|
| Rate for Payer: Cigna Commercial |
$1,766.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,766.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,766.40
|
| Rate for Payer: Multiplan Commercial |
$2,053.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,876.80
|
| Rate for Payer: United Healthcare Commercial |
$2,097.60
|
|
|
REPAIR HAND JOINT
|
Professional
|
Both
|
$2,208.00
|
|
|
Service Code
|
CPT 26540
|
| Hospital Charge Code |
9822654001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$664.20 |
| Max. Negotiated Rate |
$2,075.52 |
| Rate for Payer: Aetna of VT Commercial |
$2,075.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,978.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$684.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,978.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$929.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,181.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,181.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$763.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,181.73
|
| Rate for Payer: Cash Price |
$1,104.00
|
| Rate for Payer: Cash Price |
$1,104.00
|
| Rate for Payer: Cigna Commercial |
$1,272.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,091.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,091.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$664.20
|
| Rate for Payer: Multiplan Commercial |
$2,053.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$943.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$664.20
|
| Rate for Payer: United Healthcare Commercial |
$1,021.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$664.20
|
| Rate for Payer: United Healthcare VA CCN |
$664.20
|
|
|
REPAIR HAND JOINT
|
Facility
|
OP
|
$2,208.00
|
|
|
Service Code
|
CPT 26540
|
| Hospital Charge Code |
9822654001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$977.92 |
| Max. Negotiated Rate |
$2,097.60 |
| Rate for Payer: Aetna of VT Commercial |
$2,097.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,978.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$977.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,978.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,329.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,876.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,788.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$993.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,755.36
|
| Rate for Payer: Cash Price |
$1,104.00
|
| Rate for Payer: Cigna Commercial |
$1,766.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,766.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,766.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$993.60
|
| Rate for Payer: Multiplan Commercial |
$2,053.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,876.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$993.60
|
| Rate for Payer: United Healthcare Commercial |
$2,097.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$993.60
|
| Rate for Payer: United Healthcare VA CCN |
$993.60
|
|
|
REPAIR HAND TENDON
|
Facility
|
IP
|
$3,086.61
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
4502641001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,284.40 |
| Max. Negotiated Rate |
$2,932.28 |
| Rate for Payer: Aetna of VT Commercial |
$2,932.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,284.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,284.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,623.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,592.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,469.29
|
| Rate for Payer: Cash Price |
$1,543.31
|
| Rate for Payer: Cigna Commercial |
$2,469.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,469.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,469.29
|
| Rate for Payer: Multiplan Commercial |
$2,870.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,623.62
|
| Rate for Payer: United Healthcare Commercial |
$2,932.28
|
|
|
REPAIR HAND TENDON
|
Professional
|
Both
|
$1,742.00
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
9812641002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$571.03 |
| Max. Negotiated Rate |
$1,637.48 |
| Rate for Payer: Aetna of VT Commercial |
$1,637.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,560.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$588.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,560.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$799.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$978.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$978.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$656.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$978.72
|
| Rate for Payer: Cash Price |
$871.00
|
| Rate for Payer: Cash Price |
$871.00
|
| Rate for Payer: Cigna Commercial |
$1,098.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$934.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$934.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$571.03
|
| Rate for Payer: Multiplan Commercial |
$1,620.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$810.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$571.03
|
| Rate for Payer: United Healthcare Commercial |
$878.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$571.03
|
| Rate for Payer: United Healthcare VA CCN |
$571.03
|
|
|
REPAIR HAND TENDON
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
9812641001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1,098.96 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$588.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$799.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$978.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$978.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$656.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$978.72
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$1,098.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$934.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$934.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$571.03
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$810.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$571.03
|
| Rate for Payer: United Healthcare Commercial |
$878.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$571.03
|
| Rate for Payer: United Healthcare VA CCN |
$571.03
|
|
|
REPAIR HAND TENDON
|
Facility
|
IP
|
$1,742.00
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
9822641001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,289.25 |
| Max. Negotiated Rate |
$1,654.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,654.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,289.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,289.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,480.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,463.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,393.60
|
| Rate for Payer: Cash Price |
$871.00
|
| Rate for Payer: Cigna Commercial |
$1,393.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,393.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,393.60
|
| Rate for Payer: Multiplan Commercial |
$1,620.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,480.70
|
| Rate for Payer: United Healthcare Commercial |
$1,654.90
|
|
|
REPAIR HAND TENDON
|
Facility
|
OP
|
$3,086.61
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
4502641001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,367.06 |
| Max. Negotiated Rate |
$2,932.28 |
| Rate for Payer: Aetna of VT Commercial |
$2,932.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,765.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,367.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,765.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,858.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,623.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,500.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,388.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,453.85
|
| Rate for Payer: Cash Price |
$1,543.31
|
| Rate for Payer: Cigna Commercial |
$2,469.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,469.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,469.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,388.97
|
| Rate for Payer: Multiplan Commercial |
$2,870.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,623.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,388.97
|
| Rate for Payer: United Healthcare Commercial |
$2,932.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,388.97
|
| Rate for Payer: United Healthcare VA CCN |
$1,388.97
|
|
