|
REPAIR NAIL BED
|
Facility
|
OP
|
$373.27
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
4501176001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.32 |
| Max. Negotiated Rate |
$354.61 |
| Rate for Payer: Aetna of VT Commercial |
$354.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$334.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$165.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$334.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$224.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$317.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$302.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$167.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$296.75
|
| Rate for Payer: Cash Price |
$186.64
|
| Rate for Payer: Cigna Commercial |
$298.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$298.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$298.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$167.97
|
| Rate for Payer: Multiplan Commercial |
$347.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$317.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$167.97
|
| Rate for Payer: United Healthcare Commercial |
$354.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$167.97
|
| Rate for Payer: United Healthcare VA CCN |
$167.97
|
|
|
REPAIR OF ABDOMINAL WALL
|
Professional
|
Both
|
$2,121.00
|
|
|
Service Code
|
CPT 49900
|
| Hospital Charge Code |
9824990001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$762.87 |
| Max. Negotiated Rate |
$1,993.74 |
| Rate for Payer: Aetna of VT Commercial |
$1,993.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,900.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$785.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,900.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,068.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,285.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,285.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$877.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,285.98
|
| Rate for Payer: Cash Price |
$1,060.50
|
| Rate for Payer: Cash Price |
$1,060.50
|
| Rate for Payer: Cigna Commercial |
$1,391.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,288.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,288.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$762.87
|
| Rate for Payer: Multiplan Commercial |
$1,972.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,083.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$762.87
|
| Rate for Payer: United Healthcare Commercial |
$1,173.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$762.87
|
| Rate for Payer: United Healthcare VA CCN |
$762.87
|
|
|
REPAIR OF ABDOMINAL WALL
|
Facility
|
OP
|
$2,121.00
|
|
|
Service Code
|
CPT 49900
|
| Hospital Charge Code |
9824990001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$939.39 |
| Max. Negotiated Rate |
$2,014.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,014.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,900.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$939.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,900.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,276.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,802.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,718.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$954.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,686.19
|
| Rate for Payer: Cash Price |
$1,060.50
|
| Rate for Payer: Cigna Commercial |
$1,696.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,696.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,696.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$954.45
|
| Rate for Payer: Multiplan Commercial |
$1,972.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,802.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$954.45
|
| Rate for Payer: United Healthcare Commercial |
$2,014.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$954.45
|
| Rate for Payer: United Healthcare VA CCN |
$954.45
|
|
|
REPAIR OF ABDOMINAL WALL
|
Facility
|
IP
|
$2,121.00
|
|
|
Service Code
|
CPT 49900
|
| Hospital Charge Code |
9824990001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,569.75 |
| Max. Negotiated Rate |
$2,014.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,014.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,569.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,569.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,802.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,781.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,696.80
|
| Rate for Payer: Cash Price |
$1,060.50
|
| Rate for Payer: Cigna Commercial |
$1,696.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,696.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,696.80
|
| Rate for Payer: Multiplan Commercial |
$1,972.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,802.85
|
| Rate for Payer: United Healthcare Commercial |
$2,014.95
|
|
|
REPAIR OF ACHILLES TENDON
|
Facility
|
OP
|
$2,627.00
|
|
|
Service Code
|
CPT 27654
|
| Hospital Charge Code |
9822765401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,163.50 |
| Max. Negotiated Rate |
$2,495.65 |
| Rate for Payer: Aetna of VT Commercial |
$2,495.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,353.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,163.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,353.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,581.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,232.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,127.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,182.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,088.47
|
| Rate for Payer: Cash Price |
$1,313.50
|
| Rate for Payer: Cigna Commercial |
$2,101.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,101.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,101.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,182.15
|
| Rate for Payer: Multiplan Commercial |
$2,443.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,232.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,182.15
|
| Rate for Payer: United Healthcare Commercial |
$2,495.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,182.15
|
| Rate for Payer: United Healthcare VA CCN |
$1,182.15
|
|
|
REPAIR OF ACHILLES TENDON
|
Facility
|
IP
|
$2,627.00
|
|
|
Service Code
|
CPT 27654
|
| Hospital Charge Code |
9822765401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,944.24 |
| Max. Negotiated Rate |
$2,495.65 |
| Rate for Payer: Aetna of VT Commercial |
$2,495.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,944.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,944.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,232.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,206.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,101.60
|
| Rate for Payer: Cash Price |
$1,313.50
|
| Rate for Payer: Cigna Commercial |
$2,101.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,101.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,101.60
|
| Rate for Payer: Multiplan Commercial |
$2,443.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,232.95
|
| Rate for Payer: United Healthcare Commercial |
$2,495.65
|
|
|
REPAIR OF ACHILLES TENDON
|
Professional
|
Both
|
$2,627.00
|
|
|
Service Code
|
CPT 27654
|
| Hospital Charge Code |
9822765401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$682.81 |
| Max. Negotiated Rate |
$2,469.38 |
| Rate for Payer: Aetna of VT Commercial |
$2,469.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,353.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$703.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,353.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$955.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,277.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,277.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$785.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,277.47
|
| Rate for Payer: Cash Price |
$1,313.50
|
| Rate for Payer: Cash Price |
$1,313.50
|
| Rate for Payer: Cigna Commercial |
$1,289.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,127.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,127.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$682.81
|
| Rate for Payer: Multiplan Commercial |
$2,443.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$969.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$682.81
|
| Rate for Payer: United Healthcare Commercial |
$1,050.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$682.81
|
| Rate for Payer: United Healthcare VA CCN |
$682.81
|
|
|
REPAIR OF ANKLE LIGAMENT
|
Facility
|
IP
|
$1,694.00
|
|
|
Service Code
|
CPT 27695
|
| Hospital Charge Code |
9822769501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,253.73 |
| Max. Negotiated Rate |
$1,609.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,609.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,253.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,253.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,439.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,422.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,355.20
|
| Rate for Payer: Cash Price |
$847.00
|
| Rate for Payer: Cigna Commercial |
$1,355.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,355.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,355.20
|
| Rate for Payer: Multiplan Commercial |
$1,575.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,439.90
|
| Rate for Payer: United Healthcare Commercial |
$1,609.30
|
|
|
REPAIR OF ANKLE LIGAMENT
|
Professional
|
Both
|
$1,694.00
|
|
|
Service Code
|
CPT 27695
|
| Hospital Charge Code |
9822769501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$464.60 |
| Max. Negotiated Rate |
$1,592.36 |
| Rate for Payer: Aetna of VT Commercial |
$1,592.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,517.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$478.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,517.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$650.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$865.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$865.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$534.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$865.90
|
| Rate for Payer: Cash Price |
$847.00
|
| Rate for Payer: Cash Price |
$847.00
|
| Rate for Payer: Cigna Commercial |
$879.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$766.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$766.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$464.61
|
| Rate for Payer: Multiplan Commercial |
$1,575.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$659.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$464.60
|
| Rate for Payer: United Healthcare Commercial |
$714.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$464.60
|
| Rate for Payer: United Healthcare VA CCN |
$464.60
|
|
|
REPAIR OF ANKLE LIGAMENT
|
Facility
|
OP
|
$1,694.00
|
|
|
Service Code
|
CPT 27695
|
| Hospital Charge Code |
9822769501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$750.27 |
| Max. Negotiated Rate |
$1,609.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,609.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,517.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$750.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,517.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,019.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,439.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,372.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$762.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,346.73
|
| Rate for Payer: Cash Price |
$847.00
|
| Rate for Payer: Cigna Commercial |
$1,355.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,355.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,355.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$762.30
|
| Rate for Payer: Multiplan Commercial |
$1,575.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,439.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$762.30
|
| Rate for Payer: United Healthcare Commercial |
$1,609.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$762.30
|
| Rate for Payer: United Healthcare VA CCN |
$762.30
|
|
|
REPAIR OF BLADDER WOUND
|
Facility
|
IP
|
$2,782.00
|
|
|
Service Code
|
CPT 51860
|
| Hospital Charge Code |
9825186001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,058.96 |
| Max. Negotiated Rate |
$2,642.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,642.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,058.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,058.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,364.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,336.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,225.60
|
| Rate for Payer: Cash Price |
$1,391.00
|
| Rate for Payer: Cigna Commercial |
$2,225.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,225.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,225.60
|
| Rate for Payer: Multiplan Commercial |
$2,587.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,364.70
|
| Rate for Payer: United Healthcare Commercial |
$2,642.90
|
|
|
REPAIR OF BLADDER WOUND
|
Professional
|
Both
|
$2,782.00
|
|
|
Service Code
|
CPT 51860
|
| Hospital Charge Code |
9825186001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$692.68 |
| Max. Negotiated Rate |
$2,615.08 |
| Rate for Payer: Aetna of VT Commercial |
$2,615.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,492.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$713.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,492.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$969.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,220.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,220.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$796.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,220.01
|
| Rate for Payer: Cash Price |
$1,391.00
|
| Rate for Payer: Cash Price |
$1,391.00
|
| Rate for Payer: Cigna Commercial |
$1,210.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,151.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,151.52
|
| Rate for Payer: Martins Point Health Care Commercial |
$692.68
|
| Rate for Payer: Multiplan Commercial |
$2,587.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$983.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$692.68
|
| Rate for Payer: United Healthcare Commercial |
$1,065.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$692.68
|
| Rate for Payer: United Healthcare VA CCN |
$692.68
|
|
|
REPAIR OF BLADDER WOUND
|
Facility
|
OP
|
$2,782.00
|
|
|
Service Code
|
CPT 51860
|
| Hospital Charge Code |
9825186001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,232.15 |
| Max. Negotiated Rate |
$2,642.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,642.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,492.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,232.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,492.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,674.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,364.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,253.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,251.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,211.69
|
| Rate for Payer: Cash Price |
$1,391.00
|
| Rate for Payer: Cigna Commercial |
$2,225.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,225.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,225.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,251.90
|
| Rate for Payer: Multiplan Commercial |
$2,587.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,364.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,251.90
|
| Rate for Payer: United Healthcare Commercial |
$2,642.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,251.90
|
| Rate for Payer: United Healthcare VA CCN |
$1,251.90
|
|
|
REPAIR OF FOOT TENDON
|
Professional
|
Both
|
$1,141.00
|
|
|
Service Code
|
CPT 28200
|
| Hospital Charge Code |
9822820001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$313.98 |
| Max. Negotiated Rate |
$1,072.54 |
| Rate for Payer: Aetna of VT Commercial |
$1,072.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,022.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$323.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,022.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$439.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$709.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$709.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$361.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$709.71
|
| Rate for Payer: Cash Price |
$570.50
|
| Rate for Payer: Cash Price |
$570.50
|
| Rate for Payer: Cigna Commercial |
$594.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$761.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$761.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$468.16
|
| Rate for Payer: Multiplan Commercial |
$1,061.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$445.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$313.98
|
| Rate for Payer: United Healthcare Commercial |
$483.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.98
|
| Rate for Payer: United Healthcare VA CCN |
$313.98
|
|
|
REPAIR OF FOOT TENDON
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
CPT 28200
|
| Hospital Charge Code |
9822820001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$505.35 |
| Max. Negotiated Rate |
$1,083.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,083.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,022.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$505.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,022.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$686.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$969.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$924.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$513.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$907.10
|
| Rate for Payer: Cash Price |
$570.50
|
| Rate for Payer: Cigna Commercial |
$912.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$912.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$912.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$513.45
|
| Rate for Payer: Multiplan Commercial |
$1,061.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$969.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$513.45
|
| Rate for Payer: United Healthcare Commercial |
$1,083.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$513.45
|
| Rate for Payer: United Healthcare VA CCN |
$513.45
|
|
|
REPAIR OF FOOT TENDON
|
Facility
|
OP
|
$1,030.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
9822820801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$456.19 |
| Max. Negotiated Rate |
$978.50 |
| Rate for Payer: Aetna of VT Commercial |
$978.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$922.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$456.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$922.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$620.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$875.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$834.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$463.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$818.85
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$824.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$824.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$824.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$463.50
|
| Rate for Payer: Multiplan Commercial |
$957.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$875.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$463.50
|
| Rate for Payer: United Healthcare Commercial |
$978.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$463.50
|
| Rate for Payer: United Healthcare VA CCN |
$463.50
|
|
|
REPAIR OF FOOT TENDON
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
CPT 28200
|
| Hospital Charge Code |
9822820001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$844.45 |
| Max. Negotiated Rate |
$1,083.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,083.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$844.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$844.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$969.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$958.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$912.80
|
| Rate for Payer: Cash Price |
$570.50
|
| Rate for Payer: Cigna Commercial |
$912.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$912.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$912.80
|
| Rate for Payer: Multiplan Commercial |
$1,061.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$969.85
|
| Rate for Payer: United Healthcare Commercial |
$1,083.95
|
|
|
REPAIR OF FOOT TENDON
|
Facility
|
IP
|
$1,030.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
9822820801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$762.30 |
| Max. Negotiated Rate |
$978.50 |
| Rate for Payer: Aetna of VT Commercial |
$978.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$762.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$762.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$875.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$865.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$824.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$824.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$824.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$824.00
|
| Rate for Payer: Multiplan Commercial |
$957.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$875.50
|
| Rate for Payer: United Healthcare Commercial |
$978.50
|
|
|
REPAIR OF FOOT TENDON
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
9822820801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$307.50 |
| Max. Negotiated Rate |
$968.20 |
| Rate for Payer: Aetna of VT Commercial |
$968.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$922.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$316.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$922.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$430.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$596.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$596.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$353.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$596.13
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$584.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$742.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$742.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$456.53
|
| Rate for Payer: Multiplan Commercial |
$957.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$436.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$307.50
|
| Rate for Payer: United Healthcare Commercial |
$473.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$307.50
|
| Rate for Payer: United Healthcare VA CCN |
$307.50
|
|
|
REPAIR OF HUMERUS
|
Facility
|
IP
|
$3,573.00
|
|
|
Service Code
|
CPT 24430
|
| Hospital Charge Code |
9822443001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,644.38 |
| Max. Negotiated Rate |
$3,394.35 |
| Rate for Payer: Aetna of VT Commercial |
$3,394.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,644.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,644.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,037.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,001.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,858.40
|
| Rate for Payer: Cash Price |
$1,786.50
|
| Rate for Payer: Cigna Commercial |
$2,858.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,858.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,858.40
|
| Rate for Payer: Multiplan Commercial |
$3,322.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,037.05
|
| Rate for Payer: United Healthcare Commercial |
$3,394.35
|
|
|
REPAIR OF HUMERUS
|
Professional
|
Both
|
$3,573.00
|
|
|
Service Code
|
CPT 24430
|
| Hospital Charge Code |
9822443001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$990.86 |
| Max. Negotiated Rate |
$3,358.62 |
| Rate for Payer: Aetna of VT Commercial |
$3,358.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,201.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,020.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,201.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,387.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,461.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,461.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,139.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,461.22
|
| Rate for Payer: Cash Price |
$1,786.50
|
| Rate for Payer: Cash Price |
$1,786.50
|
| Rate for Payer: Cigna Commercial |
$1,875.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,656.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,656.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$990.86
|
| Rate for Payer: Multiplan Commercial |
$3,322.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,407.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$990.86
|
| Rate for Payer: United Healthcare Commercial |
$1,524.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$990.86
|
| Rate for Payer: United Healthcare VA CCN |
$990.86
|
|
|
REPAIR OF HUMERUS
|
Facility
|
OP
|
$3,573.00
|
|
|
Service Code
|
CPT 24430
|
| Hospital Charge Code |
9822443001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,582.48 |
| Max. Negotiated Rate |
$3,394.35 |
| Rate for Payer: Aetna of VT Commercial |
$3,394.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,201.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,582.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,201.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,150.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,037.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,894.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,607.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,840.53
|
| Rate for Payer: Cash Price |
$1,786.50
|
| Rate for Payer: Cigna Commercial |
$2,858.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,858.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,858.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,607.85
|
| Rate for Payer: Multiplan Commercial |
$3,322.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,037.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,607.85
|
| Rate for Payer: United Healthcare Commercial |
$3,394.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,607.85
|
| Rate for Payer: United Healthcare VA CCN |
$1,607.85
|
|
|
REPAIR OF KNEECAP TENDON
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
CPT 27380
|
| Hospital Charge Code |
9822738001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$871.63 |
| Max. Negotiated Rate |
$1,869.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,869.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,763.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$871.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,763.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,184.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,672.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,594.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$885.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,564.56
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cigna Commercial |
$1,574.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,574.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,574.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$885.60
|
| Rate for Payer: Multiplan Commercial |
$1,830.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,672.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$885.60
|
| Rate for Payer: United Healthcare Commercial |
$1,869.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$885.60
|
| Rate for Payer: United Healthcare VA CCN |
$885.60
|
|
|
REPAIR OF KNEECAP TENDON
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
CPT 27380
|
| Hospital Charge Code |
9822738001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,456.52 |
| Max. Negotiated Rate |
$1,869.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,869.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,456.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,456.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,672.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,653.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,574.40
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cigna Commercial |
$1,574.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,574.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,574.40
|
| Rate for Payer: Multiplan Commercial |
$1,830.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,672.80
|
| Rate for Payer: United Healthcare Commercial |
$1,869.60
|
|
|
REPAIR OF KNEECAP TENDON
|
Professional
|
Both
|
$1,968.00
|
|
|
Service Code
|
CPT 27380
|
| Hospital Charge Code |
9822738001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$590.99 |
| Max. Negotiated Rate |
$1,849.92 |
| Rate for Payer: Aetna of VT Commercial |
$1,849.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,763.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$608.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,763.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$827.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,070.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,070.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$679.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,070.30
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cigna Commercial |
$1,124.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$979.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$979.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$590.99
|
| Rate for Payer: Multiplan Commercial |
$1,830.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$839.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$590.99
|
| Rate for Payer: United Healthcare Commercial |
$909.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$590.99
|
| Rate for Payer: United Healthcare VA CCN |
$590.99
|
|
