|
REPAIR ROTATOR CUFF CHRONIC
|
Facility
|
IP
|
$3,575.00
|
|
|
Service Code
|
CPT 23412
|
| Hospital Charge Code |
9822341201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,645.86 |
| 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 |
$2,645.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,645.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,038.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,003.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,860.00
|
| 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: Multiplan Commercial |
$3,324.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,038.75
|
| Rate for Payer: United Healthcare Commercial |
$3,396.25
|
|
|
REPAIR SHOULDER CAPSULE
|
Professional
|
Both
|
$3,613.00
|
|
|
Service Code
|
CPT 23455
|
| Hospital Charge Code |
9822345501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$911.18 |
| Max. Negotiated Rate |
$3,396.22 |
| Rate for Payer: Aetna of VT Commercial |
$3,396.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,236.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$938.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,236.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,275.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,766.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,766.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,047.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,766.16
|
| Rate for Payer: Cash Price |
$1,806.50
|
| Rate for Payer: Cash Price |
$1,806.50
|
| Rate for Payer: Cigna Commercial |
$1,750.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,521.31
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,521.31
|
| Rate for Payer: Martins Point Health Care Commercial |
$911.18
|
| Rate for Payer: Multiplan Commercial |
$3,360.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,293.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$911.18
|
| Rate for Payer: United Healthcare Commercial |
$1,401.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$911.18
|
| Rate for Payer: United Healthcare VA CCN |
$911.18
|
|
|
REPAIR SHOULDER CAPSULE
|
Facility
|
OP
|
$3,770.00
|
|
|
Service Code
|
CPT 23465
|
| Hospital Charge Code |
9822346501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,669.73 |
| Max. Negotiated Rate |
$3,581.50 |
| Rate for Payer: Aetna of VT Commercial |
$3,581.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,377.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,669.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,377.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,269.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,204.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,053.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,696.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,997.15
|
| Rate for Payer: Cash Price |
$1,885.00
|
| Rate for Payer: Cigna Commercial |
$3,016.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,016.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,016.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,696.50
|
| Rate for Payer: Multiplan Commercial |
$3,506.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,204.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,696.50
|
| Rate for Payer: United Healthcare Commercial |
$3,581.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,696.50
|
| Rate for Payer: United Healthcare VA CCN |
$1,696.50
|
|
|
REPAIR SHOULDER CAPSULE
|
Professional
|
Both
|
$3,770.00
|
|
|
Service Code
|
CPT 23465
|
| Hospital Charge Code |
9822346501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,045.73 |
| Max. Negotiated Rate |
$3,543.80 |
| Rate for Payer: Aetna of VT Commercial |
$3,543.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,377.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,077.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,377.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,464.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,022.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,022.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,202.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,022.49
|
| Rate for Payer: Cash Price |
$1,885.00
|
| Rate for Payer: Cash Price |
$1,885.00
|
| Rate for Payer: Cigna Commercial |
$1,981.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,750.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,750.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,045.73
|
| Rate for Payer: Multiplan Commercial |
$3,506.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,484.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,045.73
|
| Rate for Payer: United Healthcare Commercial |
$1,608.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,045.73
|
| Rate for Payer: United Healthcare VA CCN |
$1,045.73
|
|
|
REPAIR SHOULDER CAPSULE
|
Facility
|
OP
|
$3,613.00
|
|
|
Service Code
|
CPT 23455
|
| Hospital Charge Code |
9822345501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,600.20 |
| Max. Negotiated Rate |
$3,432.35 |
| Rate for Payer: Aetna of VT Commercial |
$3,432.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,236.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,600.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,236.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,175.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,071.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,926.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,625.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,872.34
|
| Rate for Payer: Cash Price |
$1,806.50
|
| Rate for Payer: Cigna Commercial |
$2,890.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,890.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,890.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,625.85
|
| Rate for Payer: Multiplan Commercial |
$3,360.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,071.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,625.85
|
| Rate for Payer: United Healthcare Commercial |
$3,432.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,625.85
|
| Rate for Payer: United Healthcare VA CCN |
$1,625.85
|
|
|
REPAIR SHOULDER CAPSULE
|
Facility
|
IP
|
$3,613.00
|
|
|
Service Code
|
CPT 23455
|
| Hospital Charge Code |
9822345501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,673.98 |
| Max. Negotiated Rate |
$3,432.35 |
| Rate for Payer: Aetna of VT Commercial |
$3,432.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,673.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,673.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,071.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,034.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,890.40
|
| Rate for Payer: Cash Price |
$1,806.50
|
| Rate for Payer: Cigna Commercial |
$2,890.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,890.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,890.40
|
| Rate for Payer: Multiplan Commercial |
$3,360.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,071.05
|
| Rate for Payer: United Healthcare Commercial |
$3,432.35
|
|
|
REPAIR SHOULDER CAPSULE
|
Facility
|
IP
|
$3,770.00
|
|
|
Service Code
|
CPT 23465
|
| Hospital Charge Code |
9822346501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,790.18 |
| Max. Negotiated Rate |
$3,581.50 |
| Rate for Payer: Aetna of VT Commercial |
$3,581.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,790.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,790.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,204.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,166.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,016.00
|
| Rate for Payer: Cash Price |
$1,885.00
|
| Rate for Payer: Cigna Commercial |
$3,016.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,016.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,016.00
|
| Rate for Payer: Multiplan Commercial |
$3,506.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,204.50
|
| Rate for Payer: United Healthcare Commercial |
$3,581.50
|
|
|
REPAIR SHOULDER CAPSULE
|
Facility
|
OP
|
$3,982.00
|
|
|
Service Code
|
CPT 23466
|
| Hospital Charge Code |
9822346601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,763.63 |
| Max. Negotiated Rate |
$3,782.90 |
| Rate for Payer: Aetna of VT Commercial |
$3,782.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,567.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,763.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,567.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,397.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,384.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,225.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,791.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,165.69
|
| Rate for Payer: Cash Price |
$1,991.00
|
| Rate for Payer: Cigna Commercial |
$3,185.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,185.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,185.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,791.90
|
| Rate for Payer: Multiplan Commercial |
$3,703.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,384.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,791.90
|
| Rate for Payer: United Healthcare Commercial |
$3,782.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,791.90
|
| Rate for Payer: United Healthcare VA CCN |
$1,791.90
|
|
|
REPAIR SHOULDER CAPSULE
|
Professional
|
Both
|
$3,982.00
|
|
|
Service Code
|
CPT 23466
|
| Hospital Charge Code |
9822346601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,050.95 |
| Max. Negotiated Rate |
$3,743.08 |
| Rate for Payer: Aetna of VT Commercial |
$3,743.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,567.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,082.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,567.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,471.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,908.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,908.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,208.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,908.00
|
| Rate for Payer: Cash Price |
$1,991.00
|
| Rate for Payer: Cash Price |
$1,991.00
|
| Rate for Payer: Cigna Commercial |
$1,997.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,754.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,754.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,050.95
|
| Rate for Payer: Multiplan Commercial |
$3,703.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,492.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,050.95
|
| Rate for Payer: United Healthcare Commercial |
$1,616.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,050.95
|
| Rate for Payer: United Healthcare VA CCN |
$1,050.95
|
|
|
REPAIR SHOULDER CAPSULE
|
Facility
|
IP
|
$3,982.00
|
|
|
Service Code
|
CPT 23466
|
| Hospital Charge Code |
9822346601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,947.08 |
| Max. Negotiated Rate |
$3,782.90 |
| Rate for Payer: Aetna of VT Commercial |
$3,782.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,947.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,947.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,384.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,344.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,185.60
|
| Rate for Payer: Cash Price |
$1,991.00
|
| Rate for Payer: Cigna Commercial |
$3,185.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,185.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,185.60
|
| Rate for Payer: Multiplan Commercial |
$3,703.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,384.70
|
| Rate for Payer: United Healthcare Commercial |
$3,782.90
|
|
|
REPAIR TONGUE LACERATION
|
Facility
|
OP
|
$482.62
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
4504125001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.75 |
| Max. Negotiated Rate |
$458.49 |
| Rate for Payer: Aetna of VT Commercial |
$458.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$432.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$213.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$432.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$290.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$410.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$390.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$217.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$383.68
|
| Rate for Payer: Cash Price |
$241.31
|
| Rate for Payer: Cigna Commercial |
$386.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$386.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$386.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$217.18
|
| Rate for Payer: Multiplan Commercial |
$448.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$410.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$217.18
|
| Rate for Payer: United Healthcare Commercial |
$458.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$217.18
|
| Rate for Payer: United Healthcare VA CCN |
$217.18
|
|
|
REPAIR TONGUE LACERATION
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
9814125002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$384.85 |
| Max. Negotiated Rate |
$494.00 |
| Rate for Payer: Aetna of VT Commercial |
$494.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$384.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$384.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$442.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$436.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$416.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$416.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$416.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$416.00
|
| Rate for Payer: Multiplan Commercial |
$483.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$442.00
|
| Rate for Payer: United Healthcare Commercial |
$494.00
|
|
|
REPAIR TONGUE LACERATION
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
9814125001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$230.31 |
| Max. Negotiated Rate |
$494.00 |
| Rate for Payer: Aetna of VT Commercial |
$494.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$465.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$230.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$465.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$313.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$442.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$421.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$234.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$413.40
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$416.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$416.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$416.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$483.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$442.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$234.00
|
| Rate for Payer: United Healthcare Commercial |
$494.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.00
|
| Rate for Payer: United Healthcare VA CCN |
$234.00
|
|
|
REPAIR TONGUE LACERATION
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
9814125002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$144.77 |
| Max. Negotiated Rate |
$488.80 |
| Rate for Payer: Aetna of VT Commercial |
$488.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$465.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$465.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$202.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$348.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$348.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$166.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$348.34
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$229.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$437.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$437.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$267.48
|
| Rate for Payer: Multiplan Commercial |
$483.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$205.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$144.77
|
| Rate for Payer: United Healthcare Commercial |
$222.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$144.77
|
| Rate for Payer: United Healthcare VA CCN |
$144.77
|
|
|
REPAIR TONGUE LACERATION
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
9814125002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$230.31 |
| Max. Negotiated Rate |
$494.00 |
| Rate for Payer: Aetna of VT Commercial |
$494.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$465.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$230.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$465.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$313.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$442.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$421.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$234.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$413.40
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$416.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$416.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$416.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$483.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$442.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$234.00
|
| Rate for Payer: United Healthcare Commercial |
$494.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.00
|
| Rate for Payer: United Healthcare VA CCN |
$234.00
|
|
|
REPAIR TONGUE LACERATION
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
9814125001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$144.77 |
| Max. Negotiated Rate |
$488.80 |
| Rate for Payer: Aetna of VT Commercial |
$488.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$465.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$465.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$202.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$348.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$348.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$166.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$348.34
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$229.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$437.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$437.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$267.48
|
| Rate for Payer: Multiplan Commercial |
$483.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$205.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$144.77
|
| Rate for Payer: United Healthcare Commercial |
$222.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$144.77
|
| Rate for Payer: United Healthcare VA CCN |
$144.77
|
|
|
REPAIR TONGUE LACERATION
|
Facility
|
IP
|
$482.62
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
4504125001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$357.19 |
| Max. Negotiated Rate |
$458.49 |
| Rate for Payer: Aetna of VT Commercial |
$458.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$357.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$357.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$410.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$405.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$386.10
|
| Rate for Payer: Cash Price |
$241.31
|
| Rate for Payer: Cigna Commercial |
$386.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$386.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$386.10
|
| Rate for Payer: Multiplan Commercial |
$448.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$410.23
|
| Rate for Payer: United Healthcare Commercial |
$458.49
|
|
|
REPAIR TONGUE LACERATION
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
9814125001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$384.85 |
| Max. Negotiated Rate |
$494.00 |
| Rate for Payer: Aetna of VT Commercial |
$494.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$384.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$384.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$442.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$436.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$416.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$416.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$416.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$416.00
|
| Rate for Payer: Multiplan Commercial |
$483.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$442.00
|
| Rate for Payer: United Healthcare Commercial |
$494.00
|
|
|
REPAIR WRIST JOINTS
|
Facility
|
OP
|
$1,989.00
|
|
|
Service Code
|
CPT 25447
|
| Hospital Charge Code |
9822544701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$880.93 |
| Max. Negotiated Rate |
$1,889.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,889.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,781.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$880.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,781.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,197.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,690.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,611.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$895.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,581.26
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cigna Commercial |
$1,591.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,591.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,591.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$895.05
|
| Rate for Payer: Multiplan Commercial |
$1,849.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,690.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$895.05
|
| Rate for Payer: United Healthcare Commercial |
$1,889.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$895.05
|
| Rate for Payer: United Healthcare VA CCN |
$895.05
|
|
|
REPAIR WRIST JOINTS
|
Professional
|
Both
|
$1,989.00
|
|
|
Service Code
|
CPT 25447
|
| Hospital Charge Code |
9822544701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$761.62 |
| Max. Negotiated Rate |
$1,869.66 |
| Rate for Payer: Aetna of VT Commercial |
$1,869.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,781.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$784.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,781.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,066.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,264.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,264.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$875.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,264.37
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cigna Commercial |
$1,497.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,264.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,264.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$761.62
|
| Rate for Payer: Multiplan Commercial |
$1,849.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,081.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$761.62
|
| Rate for Payer: United Healthcare Commercial |
$1,171.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$761.62
|
| Rate for Payer: United Healthcare VA CCN |
$761.62
|
|
|
REPAIR WRIST JOINTS
|
Facility
|
IP
|
$1,989.00
|
|
|
Service Code
|
CPT 25447
|
| Hospital Charge Code |
9822544701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,472.06 |
| Max. Negotiated Rate |
$1,889.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,889.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,472.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,472.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,690.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,670.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,591.20
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cigna Commercial |
$1,591.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,591.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,591.20
|
| Rate for Payer: Multiplan Commercial |
$1,849.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,690.65
|
| Rate for Payer: United Healthcare Commercial |
$1,889.55
|
|
|
REPEAT CONTROL OF NOSEBLEED
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
9813090601
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$443.32 |
| Max. Negotiated Rate |
$569.05 |
| Rate for Payer: Aetna of VT Commercial |
$569.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$443.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$443.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$509.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$503.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$479.20
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cigna Commercial |
$479.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$479.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$479.20
|
| Rate for Payer: Multiplan Commercial |
$557.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$509.15
|
| Rate for Payer: United Healthcare Commercial |
$569.05
|
|
|
REPEAT CONTROL OF NOSEBLEED
|
Facility
|
IP
|
$470.88
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
4503090601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$348.50 |
| Max. Negotiated Rate |
$447.34 |
| Rate for Payer: Aetna of VT Commercial |
$447.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$348.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$348.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$400.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$395.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$376.70
|
| Rate for Payer: Cash Price |
$235.44
|
| Rate for Payer: Cigna Commercial |
$376.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$376.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$376.70
|
| Rate for Payer: Multiplan Commercial |
$437.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$400.25
|
| Rate for Payer: United Healthcare Commercial |
$447.34
|
|
|
REPEAT CONTROL OF NOSEBLEED
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
9813090602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$265.30 |
| Max. Negotiated Rate |
$569.05 |
| Rate for Payer: Aetna of VT Commercial |
$569.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$536.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$265.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$536.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$360.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$509.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$485.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$269.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$476.20
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cigna Commercial |
$479.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$479.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$479.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$269.55
|
| Rate for Payer: Multiplan Commercial |
$557.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$509.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$269.55
|
| Rate for Payer: United Healthcare Commercial |
$569.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$269.55
|
| Rate for Payer: United Healthcare VA CCN |
$269.55
|
|
|
REPEAT CONTROL OF NOSEBLEED
|
Facility
|
OP
|
$470.88
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
4503090601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$208.55 |
| Max. Negotiated Rate |
$447.34 |
| Rate for Payer: Aetna of VT Commercial |
$447.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$421.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$208.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$421.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$283.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$400.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$381.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$211.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$374.35
|
| Rate for Payer: Cash Price |
$235.44
|
| Rate for Payer: Cigna Commercial |
$376.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$376.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$376.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$211.90
|
| Rate for Payer: Multiplan Commercial |
$437.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$400.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$211.90
|
| Rate for Payer: United Healthcare Commercial |
$447.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.90
|
| Rate for Payer: United Healthcare VA CCN |
$211.90
|
|
