|
REPEAT CONTROL OF NOSEBLEED
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
9813090601
|
|
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
|
Professional
|
Both
|
$599.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
9813090601
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$121.14 |
| Max. Negotiated Rate |
$580.14 |
| Rate for Payer: Aetna of VT Commercial |
$563.06
|
| 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 |
$124.77
|
| 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 |
$169.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$464.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$464.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$139.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$464.27
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cigna Commercial |
$194.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$580.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$580.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$356.26
|
| Rate for Payer: Multiplan Commercial |
$557.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$172.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.14
|
| Rate for Payer: United Healthcare Commercial |
$186.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.14
|
| Rate for Payer: United Healthcare VA CCN |
$121.14
|
|
|
REPEAT CONTROL OF NOSEBLEED
|
Professional
|
Both
|
$599.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
9813090602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$121.14 |
| Max. Negotiated Rate |
$580.14 |
| Rate for Payer: Aetna of VT Commercial |
$563.06
|
| 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 |
$124.77
|
| 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 |
$169.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$464.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$464.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$139.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$464.27
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cigna Commercial |
$194.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$580.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$580.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$356.26
|
| Rate for Payer: Multiplan Commercial |
$557.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$172.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.14
|
| Rate for Payer: United Healthcare Commercial |
$186.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.14
|
| Rate for Payer: United Healthcare VA CCN |
$121.14
|
|
|
REPEAT CONTROL OF NOSEBLEED
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
9813090602
|
|
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
|
|
|
REREPAIR ING HERNIA REDUCE
|
Facility
|
OP
|
$1,896.00
|
|
|
Service Code
|
CPT 49520
|
| Hospital Charge Code |
9824952001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$839.74 |
| Max. Negotiated Rate |
$1,801.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,801.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,698.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$839.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,698.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,141.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,611.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,535.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$853.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,507.32
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,516.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,516.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,516.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$853.20
|
| Rate for Payer: Multiplan Commercial |
$1,763.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,611.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$853.20
|
| Rate for Payer: United Healthcare Commercial |
$1,801.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$853.20
|
| Rate for Payer: United Healthcare VA CCN |
$853.20
|
|
|
REREPAIR ING HERNIA REDUCE
|
Facility
|
IP
|
$1,896.00
|
|
|
Service Code
|
CPT 49520
|
| Hospital Charge Code |
9824952001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,403.23 |
| Max. Negotiated Rate |
$1,801.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,801.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,403.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,403.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,611.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,592.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,516.80
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,516.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,516.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,516.80
|
| Rate for Payer: Multiplan Commercial |
$1,763.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,611.60
|
| Rate for Payer: United Healthcare Commercial |
$1,801.20
|
|
|
REREPAIR ING HERNIA REDUCE
|
Professional
|
Both
|
$1,896.00
|
|
|
Service Code
|
CPT 49520
|
| Hospital Charge Code |
9824952001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$582.32 |
| Max. Negotiated Rate |
$1,782.24 |
| Rate for Payer: Aetna of VT Commercial |
$1,782.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,698.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$599.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,698.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$815.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$981.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$981.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$669.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$981.34
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,064.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$990.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$990.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$582.32
|
| Rate for Payer: Multiplan Commercial |
$1,763.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$826.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$582.32
|
| Rate for Payer: United Healthcare Commercial |
$895.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$582.32
|
| Rate for Payer: United Healthcare VA CCN |
$582.32
|
|
|
REREPAIR VENTRL HERN BLOCK
|
Facility
|
IP
|
$2,498.00
|
|
|
Service Code
|
CPT 49566
|
| Hospital Charge Code |
9824956601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,848.77 |
| Max. Negotiated Rate |
$2,373.10 |
| Rate for Payer: Aetna of VT Commercial |
$2,373.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,848.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,848.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,123.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,098.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,998.40
|
| Rate for Payer: Cash Price |
$1,249.00
|
| Rate for Payer: Cigna Commercial |
$1,998.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,998.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,998.40
|
| Rate for Payer: Multiplan Commercial |
$2,323.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,123.30
|
| Rate for Payer: United Healthcare Commercial |
$2,373.10
|
|
|
REREPAIR VENTRL HERN BLOCK
|
Facility
|
OP
|
$2,498.00
|
|
|
Service Code
|
CPT 49566
|
| Hospital Charge Code |
9824956601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,106.36 |
| Max. Negotiated Rate |
$2,373.10 |
| Rate for Payer: Aetna of VT Commercial |
$2,373.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,237.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,106.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,237.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,503.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,123.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,023.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,124.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,985.91
|
| Rate for Payer: Cash Price |
$1,249.00
|
| Rate for Payer: Cigna Commercial |
$1,998.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,998.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,998.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,124.10
|
| Rate for Payer: Multiplan Commercial |
$2,323.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,123.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,124.10
|
| Rate for Payer: United Healthcare Commercial |
$2,373.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,124.10
|
| Rate for Payer: United Healthcare VA CCN |
$1,124.10
|
|
|
REREPAIR VENTRL HERN BLOCK
|
Professional
|
Both
|
$2,498.00
|
|
|
Service Code
|
CPT 49566
|
| Hospital Charge Code |
9824956601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$999.20 |
| Max. Negotiated Rate |
$2,348.12 |
| Rate for Payer: Aetna of VT Commercial |
$2,348.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,237.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,237.96
|
| Rate for Payer: Cash Price |
$1,249.00
|
| Rate for Payer: Multiplan Commercial |
$2,323.14
|
| Rate for Payer: United Healthcare Commercial |
$2,123.30
|
| Rate for Payer: United Healthcare VA CCN |
$999.20
|
|
|
RESET DISLOCATED JAW
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
CPT 21480
|
| Hospital Charge Code |
9812148002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$28.65 |
| Max. Negotiated Rate |
$271.66 |
| Rate for Payer: Aetna of VT Commercial |
$271.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$29.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$40.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$173.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$173.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$32.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$173.67
|
| Rate for Payer: Cash Price |
$144.50
|
| Rate for Payer: Cash Price |
$144.50
|
| Rate for Payer: Cigna Commercial |
$53.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$214.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$214.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$132.40
|
| Rate for Payer: Multiplan Commercial |
$268.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$28.65
|
| Rate for Payer: United Healthcare Commercial |
$44.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.65
|
| Rate for Payer: United Healthcare VA CCN |
$28.65
|
|
|
RESET DISLOCATED JAW
|
Facility
|
OP
|
$204.73
|
|
|
Service Code
|
CPT 21480
|
| Hospital Charge Code |
4502148001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$90.67 |
| Max. Negotiated Rate |
$194.49 |
| Rate for Payer: Aetna of VT Commercial |
$194.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$183.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$90.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$183.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$123.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$174.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$165.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$162.76
|
| Rate for Payer: Cash Price |
$102.36
|
| Rate for Payer: Cigna Commercial |
$163.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$163.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$163.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$92.13
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$174.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$92.13
|
| Rate for Payer: United Healthcare Commercial |
$194.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.13
|
| Rate for Payer: United Healthcare VA CCN |
$92.13
|
|
|
RESET DISLOCATED JAW
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 21480
|
| Hospital Charge Code |
9812148001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$213.89 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Aetna of VT Commercial |
$274.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$213.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$213.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$245.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$242.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$231.20
|
| Rate for Payer: Cash Price |
$144.50
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$231.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$231.20
|
| Rate for Payer: Multiplan Commercial |
$268.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$245.65
|
| Rate for Payer: United Healthcare Commercial |
$274.55
|
|
|
RESET DISLOCATED JAW
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 21480
|
| Hospital Charge Code |
9812148002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$213.89 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Aetna of VT Commercial |
$274.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$213.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$213.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$245.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$242.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$231.20
|
| Rate for Payer: Cash Price |
$144.50
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$231.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$231.20
|
| Rate for Payer: Multiplan Commercial |
$268.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$245.65
|
| Rate for Payer: United Healthcare Commercial |
$274.55
|
|
|
RESET DISLOCATED JAW
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 21480
|
| Hospital Charge Code |
9812148002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$128.00 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Aetna of VT Commercial |
$274.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$128.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$173.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$245.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$234.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$130.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$229.75
|
| Rate for Payer: Cash Price |
$144.50
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$231.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$231.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$130.05
|
| Rate for Payer: Multiplan Commercial |
$268.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$245.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$130.05
|
| Rate for Payer: United Healthcare Commercial |
$274.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.05
|
| Rate for Payer: United Healthcare VA CCN |
$130.05
|
|
|
RESET DISLOCATED JAW
|
Facility
|
IP
|
$204.73
|
|
|
Service Code
|
CPT 21480
|
| Hospital Charge Code |
4502148001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.52 |
| Max. Negotiated Rate |
$194.49 |
| Rate for Payer: Aetna of VT Commercial |
$194.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$151.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$151.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$174.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$163.78
|
| Rate for Payer: Cash Price |
$102.36
|
| Rate for Payer: Cigna Commercial |
$163.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$163.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$163.78
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$174.02
|
| Rate for Payer: United Healthcare Commercial |
$194.49
|
|
|
RESET DISLOCATED JAW
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 21480
|
| Hospital Charge Code |
9812148001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$128.00 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Aetna of VT Commercial |
$274.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$128.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$173.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$245.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$234.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$130.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$229.75
|
| Rate for Payer: Cash Price |
$144.50
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$231.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$231.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$130.05
|
| Rate for Payer: Multiplan Commercial |
$268.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$245.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$130.05
|
| Rate for Payer: United Healthcare Commercial |
$274.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.05
|
| Rate for Payer: United Healthcare VA CCN |
$130.05
|
|
|
RESET DISLOCATED JAW
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
CPT 21480
|
| Hospital Charge Code |
9812148001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$28.65 |
| Max. Negotiated Rate |
$271.66 |
| Rate for Payer: Aetna of VT Commercial |
$271.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$29.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$40.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$173.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$173.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$32.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$173.67
|
| Rate for Payer: Cash Price |
$144.50
|
| Rate for Payer: Cash Price |
$144.50
|
| Rate for Payer: Cigna Commercial |
$53.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$214.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$214.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$132.40
|
| Rate for Payer: Multiplan Commercial |
$268.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$28.65
|
| Rate for Payer: United Healthcare Commercial |
$44.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.65
|
| Rate for Payer: United Healthcare VA CCN |
$28.65
|
|
|
RESP VIRUS 12-25 TARGETS
|
Facility
|
OP
|
$1,004.79
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
3008763301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$416.78 |
| Max. Negotiated Rate |
$2,053.68 |
| Rate for Payer: Aetna of VT Commercial |
$954.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,053.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$445.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,053.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$604.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$854.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$813.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$452.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$798.81
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Cigna Commercial |
$803.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$803.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$803.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$452.16
|
| Rate for Payer: Multiplan Commercial |
$934.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$854.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$452.16
|
| Rate for Payer: United Healthcare Commercial |
$954.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$416.78
|
| Rate for Payer: United Healthcare VA CCN |
$452.16
|
|
|
RESP VIRUS 12-25 TARGETS
|
Facility
|
IP
|
$1,004.79
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
3008763301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$743.65 |
| Max. Negotiated Rate |
$954.55 |
| Rate for Payer: Aetna of VT Commercial |
$954.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$743.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$743.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$854.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$844.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$803.83
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Cigna Commercial |
$803.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$803.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$803.83
|
| Rate for Payer: Multiplan Commercial |
$934.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$854.07
|
| Rate for Payer: United Healthcare Commercial |
$954.55
|
|
|
RESP VIRUS 3-5 TARGETS
|
Facility
|
IP
|
$406.36
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
3008763101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$300.75 |
| Max. Negotiated Rate |
$386.04 |
| Rate for Payer: Aetna of VT Commercial |
$386.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$300.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$300.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$345.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$325.09
|
| Rate for Payer: Cash Price |
$203.18
|
| Rate for Payer: Cigna Commercial |
$325.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$325.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$325.09
|
| Rate for Payer: Multiplan Commercial |
$377.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$345.41
|
| Rate for Payer: United Healthcare Commercial |
$386.04
|
|
|
RESP VIRUS 3-5 TARGETS
|
Facility
|
OP
|
$406.36
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
3008763101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.63 |
| Max. Negotiated Rate |
$702.81 |
| Rate for Payer: Aetna of VT Commercial |
$386.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$702.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$179.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$702.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$244.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$345.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$329.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$182.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$323.06
|
| Rate for Payer: Cash Price |
$203.18
|
| Rate for Payer: Cash Price |
$203.18
|
| Rate for Payer: Cigna Commercial |
$325.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$325.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$325.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$182.86
|
| Rate for Payer: Multiplan Commercial |
$377.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$345.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$182.86
|
| Rate for Payer: United Healthcare Commercial |
$386.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.63
|
| Rate for Payer: United Healthcare VA CCN |
$182.86
|
|
|
REVISE ARM/LEG NERVE
|
Facility
|
OP
|
$2,146.00
|
|
|
Service Code
|
CPT 64708
|
| Hospital Charge Code |
9826470801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$950.46 |
| Max. Negotiated Rate |
$2,038.70 |
| Rate for Payer: Aetna of VT Commercial |
$2,038.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,922.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$950.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,922.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,291.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,824.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,738.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$965.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,706.07
|
| Rate for Payer: Cash Price |
$1,073.00
|
| Rate for Payer: Cigna Commercial |
$1,716.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,716.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,716.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$965.70
|
| Rate for Payer: Multiplan Commercial |
$1,995.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,824.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$965.70
|
| Rate for Payer: United Healthcare Commercial |
$2,038.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$965.70
|
| Rate for Payer: United Healthcare VA CCN |
$965.70
|
|
|
REVISE ARM/LEG NERVE
|
Professional
|
Both
|
$2,146.00
|
|
|
Service Code
|
CPT 64708
|
| Hospital Charge Code |
9826470801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$485.48 |
| Max. Negotiated Rate |
$2,017.24 |
| Rate for Payer: Aetna of VT Commercial |
$2,017.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,922.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$500.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,922.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$679.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$645.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$645.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$558.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$645.98
|
| Rate for Payer: Cash Price |
$1,073.00
|
| Rate for Payer: Cash Price |
$1,073.00
|
| Rate for Payer: Cigna Commercial |
$676.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$797.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$797.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$485.48
|
| Rate for Payer: Multiplan Commercial |
$1,995.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$689.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$485.49
|
| Rate for Payer: United Healthcare Commercial |
$746.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$485.49
|
| Rate for Payer: United Healthcare VA CCN |
$485.49
|
|
|
REVISE ARM/LEG NERVE
|
Facility
|
IP
|
$2,146.00
|
|
|
Service Code
|
CPT 64708
|
| Hospital Charge Code |
9826470801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,588.25 |
| Max. Negotiated Rate |
$2,038.70 |
| Rate for Payer: Aetna of VT Commercial |
$2,038.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,588.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,588.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,824.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,802.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,716.80
|
| Rate for Payer: Cash Price |
$1,073.00
|
| Rate for Payer: Cigna Commercial |
$1,716.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,716.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,716.80
|
| Rate for Payer: Multiplan Commercial |
$1,995.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,824.10
|
| Rate for Payer: United Healthcare Commercial |
$2,038.70
|
|
