|
REVISE ULNAR NERVE AT ELBOW
|
Professional
|
Both
|
$5,109.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
5106471801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$576.64 |
| Max. Negotiated Rate |
$4,802.46 |
| Rate for Payer: Aetna of VT Commercial |
$4,802.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,577.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$593.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,577.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$807.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$865.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$865.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$663.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$865.77
|
| Rate for Payer: Cash Price |
$2,554.50
|
| Rate for Payer: Cash Price |
$2,554.50
|
| Rate for Payer: Cigna Commercial |
$799.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$956.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$956.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$576.64
|
| Rate for Payer: Multiplan Commercial |
$4,751.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$818.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$576.64
|
| Rate for Payer: United Healthcare Commercial |
$887.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$576.64
|
| Rate for Payer: United Healthcare VA CCN |
$576.64
|
|
|
REVISE ULNAR NERVE AT ELBOW
|
Facility
|
IP
|
$7,612.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
9606471801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$5,633.64 |
| Max. Negotiated Rate |
$7,231.40 |
| Rate for Payer: Aetna of VT Commercial |
$7,231.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,633.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,633.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,470.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,394.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,089.60
|
| Rate for Payer: Cash Price |
$3,806.00
|
| Rate for Payer: Cigna Commercial |
$6,089.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,089.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,089.60
|
| Rate for Payer: Multiplan Commercial |
$7,079.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,470.20
|
| Rate for Payer: United Healthcare Commercial |
$7,231.40
|
|
|
REVISE ULNAR NERVE AT ELBOW
|
Facility
|
IP
|
$2,503.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
9826471801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,852.47 |
| Max. Negotiated Rate |
$2,377.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,377.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,852.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,852.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,127.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,102.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,002.40
|
| Rate for Payer: Cash Price |
$1,251.50
|
| Rate for Payer: Cigna Commercial |
$2,002.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,002.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,002.40
|
| Rate for Payer: Multiplan Commercial |
$2,327.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,127.55
|
| Rate for Payer: United Healthcare Commercial |
$2,377.85
|
|
|
REVISE ULNAR NERVE AT ELBOW
|
Facility
|
OP
|
$5,109.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
5106471801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,262.78 |
| Max. Negotiated Rate |
$4,853.55 |
| Rate for Payer: Aetna of VT Commercial |
$4,853.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,577.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,262.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,577.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,075.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,342.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,138.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,299.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,061.66
|
| Rate for Payer: Cash Price |
$2,554.50
|
| Rate for Payer: Cigna Commercial |
$4,087.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,087.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,087.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,299.05
|
| Rate for Payer: Multiplan Commercial |
$4,751.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,342.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,299.05
|
| Rate for Payer: United Healthcare Commercial |
$4,853.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,299.05
|
| Rate for Payer: United Healthcare VA CCN |
$2,299.05
|
|
|
REVISE ULNAR NERVE AT ELBOW
|
Professional
|
Both
|
$2,503.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
9606471802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$576.64 |
| Max. Negotiated Rate |
$2,352.82 |
| Rate for Payer: Aetna of VT Commercial |
$2,352.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,242.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$593.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,242.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$807.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$865.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$865.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$663.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$865.77
|
| Rate for Payer: Cash Price |
$1,251.50
|
| Rate for Payer: Cash Price |
$1,251.50
|
| Rate for Payer: Cigna Commercial |
$799.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$956.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$956.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$576.64
|
| Rate for Payer: Multiplan Commercial |
$2,327.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$818.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$576.64
|
| Rate for Payer: United Healthcare Commercial |
$887.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$576.64
|
| Rate for Payer: United Healthcare VA CCN |
$576.64
|
|
|
REVISE ULNAR NERVE AT ELBOW
|
Professional
|
Both
|
$2,503.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
9826471801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$576.64 |
| Max. Negotiated Rate |
$2,352.82 |
| Rate for Payer: Aetna of VT Commercial |
$2,352.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,242.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$593.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,242.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$807.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$865.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$865.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$663.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$865.77
|
| Rate for Payer: Cash Price |
$1,251.50
|
| Rate for Payer: Cash Price |
$1,251.50
|
| Rate for Payer: Cigna Commercial |
$799.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$956.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$956.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$576.64
|
| Rate for Payer: Multiplan Commercial |
$2,327.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$818.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$576.64
|
| Rate for Payer: United Healthcare Commercial |
$887.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$576.64
|
| Rate for Payer: United Healthcare VA CCN |
$576.64
|
|
|
REVISE ULNAR NERVE AT ELBOW
|
Facility
|
OP
|
$2,503.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
9826471801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,108.58 |
| Max. Negotiated Rate |
$2,377.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,377.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,242.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,108.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,242.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,506.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,127.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,027.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,126.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,989.88
|
| Rate for Payer: Cash Price |
$1,251.50
|
| Rate for Payer: Cigna Commercial |
$2,002.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,002.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,002.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,126.35
|
| Rate for Payer: Multiplan Commercial |
$2,327.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,127.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,126.35
|
| Rate for Payer: United Healthcare Commercial |
$2,377.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,126.35
|
| Rate for Payer: United Healthcare VA CCN |
$1,126.35
|
|
|
REVISE ULNAR NERVE AT ELBOW
|
Facility
|
IP
|
$2,503.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
9606471802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,852.47 |
| Max. Negotiated Rate |
$2,377.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,377.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,852.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,852.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,127.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,102.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,002.40
|
| Rate for Payer: Cash Price |
$1,251.50
|
| Rate for Payer: Cigna Commercial |
$2,002.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,002.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,002.40
|
| Rate for Payer: Multiplan Commercial |
$2,327.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,127.55
|
| Rate for Payer: United Healthcare Commercial |
$2,377.85
|
|
|
REVISE ULNAR NERVE AT ELBOW
|
Facility
|
OP
|
$7,612.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
9606471801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,371.35 |
| Max. Negotiated Rate |
$7,231.40 |
| Rate for Payer: Aetna of VT Commercial |
$7,231.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,819.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,371.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,819.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,582.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,470.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,165.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,425.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,051.54
|
| Rate for Payer: Cash Price |
$3,806.00
|
| Rate for Payer: Cigna Commercial |
$6,089.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,089.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,089.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,425.40
|
| Rate for Payer: Multiplan Commercial |
$7,079.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,470.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,425.40
|
| Rate for Payer: United Healthcare Commercial |
$7,231.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,425.40
|
| Rate for Payer: United Healthcare VA CCN |
$3,425.40
|
|
|
REVISE ULNAR NERVE AT ELBOW
|
Professional
|
Both
|
$7,612.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
9606471801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$576.64 |
| Max. Negotiated Rate |
$7,155.28 |
| Rate for Payer: Aetna of VT Commercial |
$7,155.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,819.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$593.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,819.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$807.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$865.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$865.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$663.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$865.77
|
| Rate for Payer: Cash Price |
$3,806.00
|
| Rate for Payer: Cash Price |
$3,806.00
|
| Rate for Payer: Cigna Commercial |
$799.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$956.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$956.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$576.64
|
| Rate for Payer: Multiplan Commercial |
$7,079.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$818.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$576.64
|
| Rate for Payer: United Healthcare Commercial |
$887.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$576.64
|
| Rate for Payer: United Healthcare VA CCN |
$576.64
|
|
|
REVISE ULNAR NERVE AT ELBOW
|
Facility
|
IP
|
$5,109.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
5106471801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,781.17 |
| Max. Negotiated Rate |
$4,853.55 |
| Rate for Payer: Aetna of VT Commercial |
$4,853.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,781.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,781.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,342.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,291.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,087.20
|
| Rate for Payer: Cash Price |
$2,554.50
|
| Rate for Payer: Cigna Commercial |
$4,087.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,087.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,087.20
|
| Rate for Payer: Multiplan Commercial |
$4,751.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,342.65
|
| Rate for Payer: United Healthcare Commercial |
$4,853.55
|
|
|
REVISE ULNAR NERVE AT WRIST
|
Facility
|
IP
|
$1,466.00
|
|
|
Service Code
|
CPT 64719
|
| Hospital Charge Code |
9826471901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,084.99 |
| Max. Negotiated Rate |
$1,392.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,392.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,084.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,084.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,246.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,231.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,172.80
|
| Rate for Payer: Cash Price |
$733.00
|
| Rate for Payer: Cigna Commercial |
$1,172.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,172.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,172.80
|
| Rate for Payer: Multiplan Commercial |
$1,363.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,246.10
|
| Rate for Payer: United Healthcare Commercial |
$1,392.70
|
|
|
REVISE ULNAR NERVE AT WRIST
|
Professional
|
Both
|
$1,466.00
|
|
|
Service Code
|
CPT 64719
|
| Hospital Charge Code |
9826471901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$390.28 |
| Max. Negotiated Rate |
$1,378.04 |
| Rate for Payer: Aetna of VT Commercial |
$1,378.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,313.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$401.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,313.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$546.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$635.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$635.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$448.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$635.64
|
| Rate for Payer: Cash Price |
$733.00
|
| Rate for Payer: Cash Price |
$733.00
|
| Rate for Payer: Cigna Commercial |
$542.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$646.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$646.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$390.28
|
| Rate for Payer: Multiplan Commercial |
$1,363.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$554.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$390.28
|
| Rate for Payer: United Healthcare Commercial |
$600.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$390.28
|
| Rate for Payer: United Healthcare VA CCN |
$390.28
|
|
|
REVISE ULNAR NERVE AT WRIST
|
Facility
|
OP
|
$1,466.00
|
|
|
Service Code
|
CPT 64719
|
| Hospital Charge Code |
9826471901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$649.29 |
| Max. Negotiated Rate |
$1,392.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,392.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,313.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$649.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,313.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$882.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,246.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,187.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$659.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,165.47
|
| Rate for Payer: Cash Price |
$733.00
|
| Rate for Payer: Cigna Commercial |
$1,172.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,172.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,172.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$659.70
|
| Rate for Payer: Multiplan Commercial |
$1,363.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,246.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$659.70
|
| Rate for Payer: United Healthcare Commercial |
$1,392.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$659.70
|
| Rate for Payer: United Healthcare VA CCN |
$659.70
|
|
|
REVISION OF BIG TOE
|
Professional
|
Both
|
$558.00
|
|
|
Service Code
|
CPT 28310
|
| Hospital Charge Code |
9822831001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$351.49 |
| Max. Negotiated Rate |
$848.61 |
| Rate for Payer: Aetna of VT Commercial |
$524.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$499.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$362.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$499.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$492.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$818.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$818.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$404.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$818.31
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna Commercial |
$660.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$848.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$848.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$521.41
|
| Rate for Payer: Multiplan Commercial |
$518.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$499.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$351.49
|
| Rate for Payer: United Healthcare Commercial |
$540.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$351.49
|
| Rate for Payer: United Healthcare VA CCN |
$351.49
|
|
|
REVISION OF BIG TOE
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT 28310
|
| Hospital Charge Code |
9822831001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$247.14 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Aetna of VT Commercial |
$530.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$499.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$247.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$499.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$335.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$474.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$451.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$443.61
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna Commercial |
$446.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$446.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$446.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$518.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$474.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare Commercial |
$530.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare VA CCN |
$251.10
|
|
|
REVISION OF BIG TOE
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT 28310
|
| Hospital Charge Code |
9822831001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$412.98 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Aetna of VT Commercial |
$530.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$412.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$412.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$474.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$468.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$446.40
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna Commercial |
$446.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$446.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$446.40
|
| Rate for Payer: Multiplan Commercial |
$518.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$474.30
|
| Rate for Payer: United Healthcare Commercial |
$530.10
|
|
|
REVISION OF CALF TENDON
|
Professional
|
Both
|
$1,387.00
|
|
|
Service Code
|
CPT 27687
|
| Hospital Charge Code |
9822768701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$434.75 |
| Max. Negotiated Rate |
$1,303.78 |
| Rate for Payer: Aetna of VT Commercial |
$1,303.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,242.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$447.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,242.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$608.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$857.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$857.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$499.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$857.39
|
| Rate for Payer: Cash Price |
$693.50
|
| Rate for Payer: Cash Price |
$693.50
|
| Rate for Payer: Cigna Commercial |
$822.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$716.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$716.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$434.75
|
| Rate for Payer: Multiplan Commercial |
$1,289.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$617.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$434.75
|
| Rate for Payer: United Healthcare Commercial |
$668.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$434.75
|
| Rate for Payer: United Healthcare VA CCN |
$434.75
|
|
|
REVISION OF CALF TENDON
|
Facility
|
IP
|
$1,387.00
|
|
|
Service Code
|
CPT 27687
|
| Hospital Charge Code |
9822768701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,026.52 |
| Max. Negotiated Rate |
$1,317.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,317.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,026.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,026.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,178.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,165.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,109.60
|
| Rate for Payer: Cash Price |
$693.50
|
| Rate for Payer: Cigna Commercial |
$1,109.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,109.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,109.60
|
| Rate for Payer: Multiplan Commercial |
$1,289.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,178.95
|
| Rate for Payer: United Healthcare Commercial |
$1,317.65
|
|
|
REVISION OF CALF TENDON
|
Facility
|
OP
|
$1,387.00
|
|
|
Service Code
|
CPT 27687
|
| Hospital Charge Code |
9822768701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$614.30 |
| Max. Negotiated Rate |
$1,317.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,317.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,242.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$614.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,242.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$834.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,178.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,123.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$624.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,102.66
|
| Rate for Payer: Cash Price |
$693.50
|
| Rate for Payer: Cigna Commercial |
$1,109.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,109.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,109.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$624.15
|
| Rate for Payer: Multiplan Commercial |
$1,289.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,178.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$624.15
|
| Rate for Payer: United Healthcare Commercial |
$1,317.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$624.15
|
| Rate for Payer: United Healthcare VA CCN |
$624.15
|
|
|
REVISION OF FOOT
|
Facility
|
IP
|
$2,020.00
|
|
|
Service Code
|
CPT 28116
|
| Hospital Charge Code |
9822811601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,495.00 |
| Max. Negotiated Rate |
$1,919.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,919.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,495.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,717.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,696.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,616.00
|
| Rate for Payer: Cash Price |
$1,010.00
|
| Rate for Payer: Cigna Commercial |
$1,616.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,616.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,616.00
|
| Rate for Payer: Multiplan Commercial |
$1,878.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,717.00
|
| Rate for Payer: United Healthcare Commercial |
$1,919.00
|
|
|
REVISION OF FOOT
|
Professional
|
Both
|
$2,020.00
|
|
|
Service Code
|
CPT 28116
|
| Hospital Charge Code |
9822811601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$499.94 |
| Max. Negotiated Rate |
$1,898.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,898.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,809.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$514.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,809.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$699.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,071.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,071.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$574.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,071.28
|
| Rate for Payer: Cash Price |
$1,010.00
|
| Rate for Payer: Cash Price |
$1,010.00
|
| Rate for Payer: Cigna Commercial |
$1,050.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,051.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,051.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$647.69
|
| Rate for Payer: Multiplan Commercial |
$1,878.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$709.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$499.94
|
| Rate for Payer: United Healthcare Commercial |
$769.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$499.94
|
| Rate for Payer: United Healthcare VA CCN |
$499.94
|
|
|
REVISION OF FOOT
|
Facility
|
OP
|
$2,020.00
|
|
|
Service Code
|
CPT 28116
|
| Hospital Charge Code |
9822811601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$894.66 |
| Max. Negotiated Rate |
$1,919.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,919.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,809.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$894.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,809.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,216.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,717.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,636.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$909.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,605.90
|
| Rate for Payer: Cash Price |
$1,010.00
|
| Rate for Payer: Cigna Commercial |
$1,616.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,616.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,616.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$909.00
|
| Rate for Payer: Multiplan Commercial |
$1,878.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,717.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$909.00
|
| Rate for Payer: United Healthcare Commercial |
$1,919.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$909.00
|
| Rate for Payer: United Healthcare VA CCN |
$909.00
|
|
|
REVISION OF FOOT TENDON
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
CPT 28261
|
| Hospital Charge Code |
9822826101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$996.52 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Aetna of VT Commercial |
$2,137.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,015.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$996.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,015.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,354.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,912.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,822.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,012.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,788.75
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,800.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,800.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,800.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,012.50
|
| Rate for Payer: Multiplan Commercial |
$2,092.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,912.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,012.50
|
| Rate for Payer: United Healthcare Commercial |
$2,137.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,012.50
|
| Rate for Payer: United Healthcare VA CCN |
$1,012.50
|
|
|
REVISION OF FOOT TENDON
|
Professional
|
Both
|
$1,712.00
|
|
|
Service Code
|
CPT 28238
|
| Hospital Charge Code |
9822823801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$462.67 |
| Max. Negotiated Rate |
$1,609.28 |
| Rate for Payer: Aetna of VT Commercial |
$1,609.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,533.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$476.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,533.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$647.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$969.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$969.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$532.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$969.63
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cigna Commercial |
$884.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,026.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,026.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$629.69
|
| Rate for Payer: Multiplan Commercial |
$1,592.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$656.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$462.67
|
| Rate for Payer: United Healthcare Commercial |
$711.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$462.67
|
| Rate for Payer: United Healthcare VA CCN |
$462.67
|
|
