|
REPAIR OF THIGH MUSCLE
|
Facility
|
OP
|
$1,191.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
9822738501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$527.49 |
| Max. Negotiated Rate |
$1,131.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,131.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,067.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$527.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,067.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$716.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,012.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$964.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$535.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$946.85
|
| Rate for Payer: Cash Price |
$595.50
|
| Rate for Payer: Cigna Commercial |
$952.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$952.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$952.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$535.95
|
| Rate for Payer: Multiplan Commercial |
$1,107.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,012.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$535.95
|
| Rate for Payer: United Healthcare Commercial |
$1,131.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$535.95
|
| Rate for Payer: United Healthcare VA CCN |
$535.95
|
|
|
REPAIR OF THIGH MUSCLE
|
Professional
|
Both
|
$7,682.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
5102738501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$577.63 |
| Max. Negotiated Rate |
$7,221.08 |
| Rate for Payer: Aetna of VT Commercial |
$7,221.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,882.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$594.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,882.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$808.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$934.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$934.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$664.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$934.22
|
| Rate for Payer: Cash Price |
$3,841.00
|
| Rate for Payer: Cash Price |
$3,841.00
|
| Rate for Payer: Cigna Commercial |
$1,099.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$956.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$956.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$577.63
|
| Rate for Payer: Multiplan Commercial |
$7,144.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$820.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$577.63
|
| Rate for Payer: United Healthcare Commercial |
$888.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$577.63
|
| Rate for Payer: United Healthcare VA CCN |
$577.63
|
|
|
REPAIR OF THIGH MUSCLE
|
Facility
|
OP
|
$7,682.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
5102738501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,402.36 |
| Max. Negotiated Rate |
$7,297.90 |
| Rate for Payer: Aetna of VT Commercial |
$7,297.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,882.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,402.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,882.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,624.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,529.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,222.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,456.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,107.19
|
| Rate for Payer: Cash Price |
$3,841.00
|
| Rate for Payer: Cigna Commercial |
$6,145.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,145.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,145.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,456.90
|
| Rate for Payer: Multiplan Commercial |
$7,144.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,529.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,456.90
|
| Rate for Payer: United Healthcare Commercial |
$7,297.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,456.90
|
| Rate for Payer: United Healthcare VA CCN |
$3,456.90
|
|
|
REPAIR OF THIGH MUSCLE
|
Facility
|
IP
|
$7,682.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
5102738501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,685.45 |
| Max. Negotiated Rate |
$7,297.90 |
| Rate for Payer: Aetna of VT Commercial |
$7,297.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,685.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,685.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,529.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,452.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,145.60
|
| Rate for Payer: Cash Price |
$3,841.00
|
| Rate for Payer: Cigna Commercial |
$6,145.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,145.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,145.60
|
| Rate for Payer: Multiplan Commercial |
$7,144.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,529.70
|
| Rate for Payer: United Healthcare Commercial |
$7,297.90
|
|
|
REPAIR OF THIGH MUSCLE
|
Professional
|
Both
|
$1,191.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
9602738502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$577.63 |
| Max. Negotiated Rate |
$1,119.54 |
| Rate for Payer: Aetna of VT Commercial |
$1,119.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,067.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$594.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,067.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$808.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$934.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$934.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$664.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$934.22
|
| Rate for Payer: Cash Price |
$595.50
|
| Rate for Payer: Cash Price |
$595.50
|
| Rate for Payer: Cigna Commercial |
$1,099.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$956.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$956.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$577.63
|
| Rate for Payer: Multiplan Commercial |
$1,107.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$820.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$577.63
|
| Rate for Payer: United Healthcare Commercial |
$888.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$577.63
|
| Rate for Payer: United Healthcare VA CCN |
$577.63
|
|
|
REPAIR OF THIGH MUSCLE
|
Facility
|
OP
|
$8,872.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
9602738501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,929.41 |
| Max. Negotiated Rate |
$8,428.40 |
| Rate for Payer: Aetna of VT Commercial |
$8,428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7,948.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,929.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7,948.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5,340.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7,541.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7,186.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,992.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,053.24
|
| Rate for Payer: Cash Price |
$4,436.00
|
| Rate for Payer: Cigna Commercial |
$7,097.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,097.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,097.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,992.40
|
| Rate for Payer: Multiplan Commercial |
$8,250.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,541.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,992.40
|
| Rate for Payer: United Healthcare Commercial |
$8,428.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,992.40
|
| Rate for Payer: United Healthcare VA CCN |
$3,992.40
|
|
|
REPAIR OF THIGH MUSCLE
|
Facility
|
IP
|
$1,191.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
9822738501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$881.46 |
| Max. Negotiated Rate |
$1,131.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,131.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$881.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$881.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,012.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,000.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$952.80
|
| Rate for Payer: Cash Price |
$595.50
|
| Rate for Payer: Cigna Commercial |
$952.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$952.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$952.80
|
| Rate for Payer: Multiplan Commercial |
$1,107.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,012.35
|
| Rate for Payer: United Healthcare Commercial |
$1,131.45
|
|
|
REPAIR OF THIGH MUSCLE
|
Facility
|
IP
|
$8,872.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
9602738501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$6,566.17 |
| Max. Negotiated Rate |
$8,428.40 |
| Rate for Payer: Aetna of VT Commercial |
$8,428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,566.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,566.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7,541.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7,452.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,097.60
|
| Rate for Payer: Cash Price |
$4,436.00
|
| Rate for Payer: Cigna Commercial |
$7,097.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,097.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,097.60
|
| Rate for Payer: Multiplan Commercial |
$8,250.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,541.20
|
| Rate for Payer: United Healthcare Commercial |
$8,428.40
|
|
|
REPAIR OF THIGH MUSCLE
|
Professional
|
Both
|
$1,191.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
9822738501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$577.63 |
| Max. Negotiated Rate |
$1,119.54 |
| Rate for Payer: Aetna of VT Commercial |
$1,119.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,067.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$594.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,067.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$808.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$934.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$934.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$664.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$934.22
|
| Rate for Payer: Cash Price |
$595.50
|
| Rate for Payer: Cash Price |
$595.50
|
| Rate for Payer: Cigna Commercial |
$1,099.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$956.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$956.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$577.63
|
| Rate for Payer: Multiplan Commercial |
$1,107.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$820.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$577.63
|
| Rate for Payer: United Healthcare Commercial |
$888.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$577.63
|
| Rate for Payer: United Healthcare VA CCN |
$577.63
|
|
|
REPAIR OF THIGH MUSCLE
|
Facility
|
IP
|
$1,191.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
9602738502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$881.46 |
| Max. Negotiated Rate |
$1,131.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,131.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$881.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$881.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,012.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,000.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$952.80
|
| Rate for Payer: Cash Price |
$595.50
|
| Rate for Payer: Cigna Commercial |
$952.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$952.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$952.80
|
| Rate for Payer: Multiplan Commercial |
$1,107.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,012.35
|
| Rate for Payer: United Healthcare Commercial |
$1,131.45
|
|
|
REPAIR OF THIGH MUSCLE
|
Professional
|
Both
|
$8,872.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
9602738501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$577.63 |
| Max. Negotiated Rate |
$8,339.68 |
| Rate for Payer: Aetna of VT Commercial |
$8,339.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7,948.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$594.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7,948.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$808.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$934.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$934.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$664.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$934.22
|
| Rate for Payer: Cash Price |
$4,436.00
|
| Rate for Payer: Cash Price |
$4,436.00
|
| Rate for Payer: Cigna Commercial |
$1,099.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$956.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$956.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$577.63
|
| Rate for Payer: Multiplan Commercial |
$8,250.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$820.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$577.63
|
| Rate for Payer: United Healthcare Commercial |
$888.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$577.63
|
| Rate for Payer: United Healthcare VA CCN |
$577.63
|
|
|
REPAIR OF TIBIA
|
Facility
|
OP
|
$3,195.00
|
|
|
Service Code
|
CPT 27720
|
| Hospital Charge Code |
9822772001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,415.07 |
| Max. Negotiated Rate |
$3,035.25 |
| Rate for Payer: Aetna of VT Commercial |
$3,035.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,862.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,415.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,862.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,923.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,715.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,587.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,437.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,540.03
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Cigna Commercial |
$2,556.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,556.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,556.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,437.75
|
| Rate for Payer: Multiplan Commercial |
$2,971.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,715.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,437.75
|
| Rate for Payer: United Healthcare Commercial |
$3,035.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,437.75
|
| Rate for Payer: United Healthcare VA CCN |
$1,437.75
|
|
|
REPAIR OF TIBIA
|
Facility
|
IP
|
$3,195.00
|
|
|
Service Code
|
CPT 27720
|
| Hospital Charge Code |
9822772001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,364.62 |
| Max. Negotiated Rate |
$3,035.25 |
| Rate for Payer: Aetna of VT Commercial |
$3,035.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,364.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,364.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,715.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,683.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,556.00
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Cigna Commercial |
$2,556.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,556.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,556.00
|
| Rate for Payer: Multiplan Commercial |
$2,971.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,715.75
|
| Rate for Payer: United Healthcare Commercial |
$3,035.25
|
|
|
REPAIR OF TIBIA
|
Professional
|
Both
|
$3,195.00
|
|
|
Service Code
|
CPT 27720
|
| Hospital Charge Code |
9822772001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$822.40 |
| Max. Negotiated Rate |
$3,003.30 |
| Rate for Payer: Aetna of VT Commercial |
$3,003.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,862.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$847.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,862.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,151.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,579.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,579.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$945.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,579.94
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Cigna Commercial |
$1,556.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,371.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,371.13
|
| Rate for Payer: Martins Point Health Care Commercial |
$822.40
|
| Rate for Payer: Multiplan Commercial |
$2,971.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,167.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$822.40
|
| Rate for Payer: United Healthcare Commercial |
$1,265.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$822.40
|
| Rate for Payer: United Healthcare VA CCN |
$822.40
|
|
|
REPAIR RADIUS OR ULNA
|
Facility
|
IP
|
$1,946.00
|
|
|
Service Code
|
CPT 25400
|
| Hospital Charge Code |
9822540001
|
|
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 RADIUS OR ULNA
|
Professional
|
Both
|
$1,946.00
|
|
|
Service Code
|
CPT 25400
|
| Hospital Charge Code |
9822540001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$758.86 |
| 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 |
$781.63
|
| 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 |
$1,062.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,625.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,625.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$872.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,625.35
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cigna Commercial |
$1,435.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,263.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,263.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$758.86
|
| Rate for Payer: Multiplan Commercial |
$1,809.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,077.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$758.86
|
| Rate for Payer: United Healthcare Commercial |
$1,167.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$758.86
|
| Rate for Payer: United Healthcare VA CCN |
$758.86
|
|
|
REPAIR RADIUS OR ULNA
|
Facility
|
OP
|
$1,946.00
|
|
|
Service Code
|
CPT 25400
|
| Hospital Charge Code |
9822540001
|
|
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 RECTUM & VAGINA
|
Facility
|
OP
|
$1,461.00
|
|
|
Service Code
|
CPT 57250
|
| Hospital Charge Code |
9825725001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$647.08 |
| Max. Negotiated Rate |
$1,387.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,387.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,308.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$647.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,308.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$879.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,241.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,183.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$657.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,161.49
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cigna Commercial |
$1,168.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,168.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,168.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$657.45
|
| Rate for Payer: Multiplan Commercial |
$1,358.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,241.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$657.45
|
| Rate for Payer: United Healthcare Commercial |
$1,387.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.45
|
| Rate for Payer: United Healthcare VA CCN |
$657.45
|
|
|
REPAIR RECTUM & VAGINA
|
Facility
|
IP
|
$1,461.00
|
|
|
Service Code
|
CPT 57250
|
| Hospital Charge Code |
9825725001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,081.29 |
| Max. Negotiated Rate |
$1,387.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,387.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,081.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,081.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,241.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,227.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,168.80
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cigna Commercial |
$1,168.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,168.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,168.80
|
| Rate for Payer: Multiplan Commercial |
$1,358.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,241.85
|
| Rate for Payer: United Healthcare Commercial |
$1,387.95
|
|
|
REPAIR RECTUM & VAGINA
|
Professional
|
Both
|
$1,461.00
|
|
|
Service Code
|
CPT 57250
|
| Hospital Charge Code |
9825725001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$573.69 |
| Max. Negotiated Rate |
$1,373.34 |
| Rate for Payer: Aetna of VT Commercial |
$1,373.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,308.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$590.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,308.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$803.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$816.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$816.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$659.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$816.12
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cigna Commercial |
$1,013.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$954.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$954.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$573.69
|
| Rate for Payer: Multiplan Commercial |
$1,358.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$814.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$573.69
|
| Rate for Payer: United Healthcare Commercial |
$882.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$573.69
|
| Rate for Payer: United Healthcare VA CCN |
$573.69
|
|
|
REPAIR ROTATOR CUFF ACUTE
|
Professional
|
Both
|
$2,447.00
|
|
|
Service Code
|
CPT 23410
|
| Hospital Charge Code |
9822341001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$773.26 |
| Max. Negotiated Rate |
$2,300.18 |
| Rate for Payer: Aetna of VT Commercial |
$2,300.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,192.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$796.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,192.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,082.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,419.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,419.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$889.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,419.30
|
| Rate for Payer: Cash Price |
$1,223.50
|
| Rate for Payer: Cash Price |
$1,223.50
|
| Rate for Payer: Cigna Commercial |
$1,463.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,289.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,289.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$773.26
|
| Rate for Payer: Multiplan Commercial |
$2,275.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,098.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$773.26
|
| Rate for Payer: United Healthcare Commercial |
$1,189.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$773.26
|
| Rate for Payer: United Healthcare VA CCN |
$773.26
|
|
|
REPAIR ROTATOR CUFF ACUTE
|
Facility
|
IP
|
$2,447.00
|
|
|
Service Code
|
CPT 23410
|
| Hospital Charge Code |
9822341001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,811.02 |
| Max. Negotiated Rate |
$2,324.65 |
| Rate for Payer: Aetna of VT Commercial |
$2,324.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,811.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,811.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,079.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,055.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,957.60
|
| Rate for Payer: Cash Price |
$1,223.50
|
| Rate for Payer: Cigna Commercial |
$1,957.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,957.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,957.60
|
| Rate for Payer: Multiplan Commercial |
$2,275.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,079.95
|
| Rate for Payer: United Healthcare Commercial |
$2,324.65
|
|
|
REPAIR ROTATOR CUFF ACUTE
|
Facility
|
OP
|
$2,447.00
|
|
|
Service Code
|
CPT 23410
|
| Hospital Charge Code |
9822341001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,083.78 |
| Max. Negotiated Rate |
$2,324.65 |
| Rate for Payer: Aetna of VT Commercial |
$2,324.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,192.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,083.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,192.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,473.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,079.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,982.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,101.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,945.37
|
| Rate for Payer: Cash Price |
$1,223.50
|
| Rate for Payer: Cigna Commercial |
$1,957.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,957.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,957.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,101.15
|
| Rate for Payer: Multiplan Commercial |
$2,275.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,079.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,101.15
|
| Rate for Payer: United Healthcare Commercial |
$2,324.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,101.15
|
| Rate for Payer: United Healthcare VA CCN |
$1,101.15
|
|
|
REPAIR ROTATOR CUFF CHRONIC
|
Facility
|
OP
|
$3,575.00
|
|
|
Service Code
|
CPT 23412
|
| Hospital Charge Code |
9822341201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,583.37 |
| Max. Negotiated Rate |
$3,396.25 |
| Rate for Payer: Aetna of VT Commercial |
$3,396.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,202.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,583.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,202.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,152.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,038.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,895.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,608.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,842.12
|
| Rate for Payer: Cash Price |
$1,787.50
|
| Rate for Payer: Cigna Commercial |
$2,860.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,860.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,860.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,608.75
|
| Rate for Payer: Multiplan Commercial |
$3,324.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,038.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,608.75
|
| Rate for Payer: United Healthcare Commercial |
$3,396.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,608.75
|
| Rate for Payer: United Healthcare VA CCN |
$1,608.75
|
|
|
REPAIR ROTATOR CUFF CHRONIC
|
Professional
|
Both
|
$3,575.00
|
|
|
Service Code
|
CPT 23412
|
| Hospital Charge Code |
9822341201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$802.86 |
| Max. Negotiated Rate |
$3,360.50 |
| Rate for Payer: Aetna of VT Commercial |
$3,360.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,202.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$826.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,202.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,124.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,587.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,587.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$923.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,587.38
|
| Rate for Payer: Cash Price |
$1,787.50
|
| Rate for Payer: Cash Price |
$1,787.50
|
| Rate for Payer: Cigna Commercial |
$1,520.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,339.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,339.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$802.86
|
| Rate for Payer: Multiplan Commercial |
$3,324.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,140.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$802.86
|
| Rate for Payer: United Healthcare Commercial |
$1,235.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$802.86
|
| Rate for Payer: United Healthcare VA CCN |
$802.86
|
|
