|
TREAT CLAVICLE FRACTURE
|
Facility
|
OP
|
$178.88
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
4502350001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.23 |
| Max. Negotiated Rate |
$169.94 |
| Rate for Payer: Aetna of VT Commercial |
$169.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$142.21
|
| Rate for Payer: Cash Price |
$89.44
|
| Rate for Payer: Cigna Commercial |
$143.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.50
|
| Rate for Payer: Multiplan Commercial |
$166.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.50
|
| Rate for Payer: United Healthcare Commercial |
$169.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.50
|
| Rate for Payer: United Healthcare VA CCN |
$80.50
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
9812350001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$79.28 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Aetna of VT Commercial |
$170.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$142.31
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$143.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.55
|
| Rate for Payer: Multiplan Commercial |
$166.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.55
|
| Rate for Payer: United Healthcare Commercial |
$170.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.55
|
| Rate for Payer: United Healthcare VA CCN |
$80.55
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
9812350002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$132.48 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Aetna of VT Commercial |
$170.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$132.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$132.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.20
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$143.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.20
|
| Rate for Payer: Multiplan Commercial |
$166.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.15
|
| Rate for Payer: United Healthcare Commercial |
$170.05
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
IP
|
$178.88
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
4502350001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.39 |
| Max. Negotiated Rate |
$169.94 |
| Rate for Payer: Aetna of VT Commercial |
$169.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$132.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$132.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.10
|
| Rate for Payer: Cash Price |
$89.44
|
| Rate for Payer: Cigna Commercial |
$143.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.10
|
| Rate for Payer: Multiplan Commercial |
$166.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.05
|
| Rate for Payer: United Healthcare Commercial |
$169.94
|
|
|
TREAT DISLOCATION/FRACTURE
|
Professional
|
Both
|
$1,578.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
9602367502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$482.64 |
| Max. Negotiated Rate |
$1,483.32 |
| Rate for Payer: Aetna of VT Commercial |
$1,483.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,413.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$497.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,413.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$675.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$948.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$948.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$555.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$948.99
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$917.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$887.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$887.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$536.29
|
| Rate for Payer: Multiplan Commercial |
$1,467.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$685.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$482.64
|
| Rate for Payer: United Healthcare Commercial |
$742.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$482.64
|
| Rate for Payer: United Healthcare VA CCN |
$482.64
|
|
|
TREAT DISLOCATION/FRACTURE
|
Professional
|
Both
|
$3,420.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
9602367501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$482.64 |
| Max. Negotiated Rate |
$3,214.80 |
| Rate for Payer: Aetna of VT Commercial |
$3,214.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,063.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$497.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,063.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$675.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$948.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$948.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$555.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$948.99
|
| Rate for Payer: Cash Price |
$1,710.00
|
| Rate for Payer: Cash Price |
$1,710.00
|
| Rate for Payer: Cigna Commercial |
$917.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$887.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$887.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$536.29
|
| Rate for Payer: Multiplan Commercial |
$3,180.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$685.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$482.64
|
| Rate for Payer: United Healthcare Commercial |
$742.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$482.64
|
| Rate for Payer: United Healthcare VA CCN |
$482.64
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
IP
|
$1,842.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
5102367501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,363.26 |
| Max. Negotiated Rate |
$1,749.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,749.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,363.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,363.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,565.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,547.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,473.60
|
| Rate for Payer: Cash Price |
$921.00
|
| Rate for Payer: Cigna Commercial |
$1,473.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,473.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,473.60
|
| Rate for Payer: Multiplan Commercial |
$1,713.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,565.70
|
| Rate for Payer: United Healthcare Commercial |
$1,749.90
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
OP
|
$642.00
|
|
|
Service Code
|
CPT 23665
|
| Hospital Charge Code |
9812366501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$284.34 |
| Max. Negotiated Rate |
$609.90 |
| Rate for Payer: Aetna of VT Commercial |
$609.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$575.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$284.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$575.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$386.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$545.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$520.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$288.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$510.39
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$513.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$513.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$513.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$288.90
|
| Rate for Payer: Multiplan Commercial |
$597.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$545.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$288.90
|
| Rate for Payer: United Healthcare Commercial |
$609.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.90
|
| Rate for Payer: United Healthcare VA CCN |
$288.90
|
|
|
TREAT DISLOCATION/FRACTURE
|
Professional
|
Both
|
$642.00
|
|
|
Service Code
|
CPT 23665
|
| Hospital Charge Code |
9812366501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$389.89 |
| Max. Negotiated Rate |
$738.36 |
| Rate for Payer: Aetna of VT Commercial |
$603.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$575.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$401.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$575.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$545.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$720.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$720.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$448.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$720.17
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$738.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$704.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$704.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$426.18
|
| Rate for Payer: Multiplan Commercial |
$597.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$553.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$389.89
|
| Rate for Payer: United Healthcare Commercial |
$599.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$389.89
|
| Rate for Payer: United Healthcare VA CCN |
$389.89
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
CPT 23665
|
| Hospital Charge Code |
9812366502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$475.14 |
| Max. Negotiated Rate |
$609.90 |
| Rate for Payer: Aetna of VT Commercial |
$609.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$475.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$475.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$545.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$539.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$513.60
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$513.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$513.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$513.60
|
| Rate for Payer: Multiplan Commercial |
$597.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$545.70
|
| Rate for Payer: United Healthcare Commercial |
$609.90
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
IP
|
$3,420.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
9602367501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,531.14 |
| Max. Negotiated Rate |
$3,249.00 |
| Rate for Payer: Aetna of VT Commercial |
$3,249.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,531.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,531.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,907.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,872.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,736.00
|
| Rate for Payer: Cash Price |
$1,710.00
|
| Rate for Payer: Cigna Commercial |
$2,736.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,736.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,736.00
|
| Rate for Payer: Multiplan Commercial |
$3,180.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,907.00
|
| Rate for Payer: United Healthcare Commercial |
$3,249.00
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
IP
|
$1,578.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
9812367501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,167.88 |
| Max. Negotiated Rate |
$1,499.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,499.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,167.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,167.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,341.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,325.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,262.40
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$1,262.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,262.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,262.40
|
| Rate for Payer: Multiplan Commercial |
$1,467.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,341.30
|
| Rate for Payer: United Healthcare Commercial |
$1,499.10
|
|
|
TREAT DISLOCATION/FRACTURE
|
Professional
|
Both
|
$1,578.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
9812367502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$482.64 |
| Max. Negotiated Rate |
$1,483.32 |
| Rate for Payer: Aetna of VT Commercial |
$1,483.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,413.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$497.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,413.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$675.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$948.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$948.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$555.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$948.99
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$917.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$887.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$887.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$536.29
|
| Rate for Payer: Multiplan Commercial |
$1,467.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$685.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$482.64
|
| Rate for Payer: United Healthcare Commercial |
$742.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$482.64
|
| Rate for Payer: United Healthcare VA CCN |
$482.64
|
|
|
TREAT DISLOCATION/FRACTURE
|
Professional
|
Both
|
$642.00
|
|
|
Service Code
|
CPT 23665
|
| Hospital Charge Code |
9812366502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$389.89 |
| Max. Negotiated Rate |
$738.36 |
| Rate for Payer: Aetna of VT Commercial |
$603.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$575.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$401.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$575.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$545.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$720.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$720.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$448.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$720.17
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$738.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$704.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$704.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$426.18
|
| Rate for Payer: Multiplan Commercial |
$597.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$553.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$389.89
|
| Rate for Payer: United Healthcare Commercial |
$599.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$389.89
|
| Rate for Payer: United Healthcare VA CCN |
$389.89
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
OP
|
$1,181.86
|
|
|
Service Code
|
CPT 23665
|
| Hospital Charge Code |
4502366501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$523.45 |
| Max. Negotiated Rate |
$1,122.77 |
| Rate for Payer: Aetna of VT Commercial |
$1,122.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,058.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$523.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,058.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$711.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,004.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$957.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$531.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$939.58
|
| Rate for Payer: Cash Price |
$590.93
|
| Rate for Payer: Cigna Commercial |
$945.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$945.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$945.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$531.84
|
| Rate for Payer: Multiplan Commercial |
$1,099.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,004.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$531.84
|
| Rate for Payer: United Healthcare Commercial |
$1,122.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$531.84
|
| Rate for Payer: United Healthcare VA CCN |
$531.84
|
|
|
TREAT DISLOCATION/FRACTURE
|
Professional
|
Both
|
$1,578.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
9812367501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$482.64 |
| Max. Negotiated Rate |
$1,483.32 |
| Rate for Payer: Aetna of VT Commercial |
$1,483.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,413.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$497.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,413.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$675.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$948.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$948.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$555.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$948.99
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$917.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$887.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$887.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$536.29
|
| Rate for Payer: Multiplan Commercial |
$1,467.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$685.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$482.64
|
| Rate for Payer: United Healthcare Commercial |
$742.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$482.64
|
| Rate for Payer: United Healthcare VA CCN |
$482.64
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
IP
|
$1,578.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
9812367502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,167.88 |
| Max. Negotiated Rate |
$1,499.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,499.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,167.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,167.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,341.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,325.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,262.40
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$1,262.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,262.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,262.40
|
| Rate for Payer: Multiplan Commercial |
$1,467.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,341.30
|
| Rate for Payer: United Healthcare Commercial |
$1,499.10
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
OP
|
$1,841.81
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
4502367501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$815.74 |
| Max. Negotiated Rate |
$1,749.72 |
| Rate for Payer: Aetna of VT Commercial |
$1,749.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,650.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$815.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,650.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,108.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,565.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,491.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$828.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,464.24
|
| Rate for Payer: Cash Price |
$920.90
|
| Rate for Payer: Cigna Commercial |
$1,473.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,473.45
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,473.45
|
| Rate for Payer: Martins Point Health Care Commercial |
$828.81
|
| Rate for Payer: Multiplan Commercial |
$1,712.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,565.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$828.81
|
| Rate for Payer: United Healthcare Commercial |
$1,749.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$828.81
|
| Rate for Payer: United Healthcare VA CCN |
$828.81
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
CPT 23665
|
| Hospital Charge Code |
9812366501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$475.14 |
| Max. Negotiated Rate |
$609.90 |
| Rate for Payer: Aetna of VT Commercial |
$609.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$475.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$475.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$545.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$539.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$513.60
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$513.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$513.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$513.60
|
| Rate for Payer: Multiplan Commercial |
$597.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$545.70
|
| Rate for Payer: United Healthcare Commercial |
$609.90
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
OP
|
$1,842.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
5102367501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$815.82 |
| Max. Negotiated Rate |
$1,749.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,749.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,650.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$815.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,650.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,108.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,565.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,492.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$828.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,464.39
|
| Rate for Payer: Cash Price |
$921.00
|
| Rate for Payer: Cigna Commercial |
$1,473.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,473.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,473.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$828.90
|
| Rate for Payer: Multiplan Commercial |
$1,713.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,565.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$828.90
|
| Rate for Payer: United Healthcare Commercial |
$1,749.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$828.90
|
| Rate for Payer: United Healthcare VA CCN |
$828.90
|
|
|
TREAT DISLOCATION/FRACTURE
|
Professional
|
Both
|
$1,842.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
5102367501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$482.64 |
| Max. Negotiated Rate |
$1,731.48 |
| Rate for Payer: Aetna of VT Commercial |
$1,731.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,650.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$497.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,650.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$675.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$948.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$948.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$555.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$948.99
|
| Rate for Payer: Cash Price |
$921.00
|
| Rate for Payer: Cash Price |
$921.00
|
| Rate for Payer: Cigna Commercial |
$917.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$887.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$887.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$536.29
|
| Rate for Payer: Multiplan Commercial |
$1,713.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$685.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$482.64
|
| Rate for Payer: United Healthcare Commercial |
$742.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$482.64
|
| Rate for Payer: United Healthcare VA CCN |
$482.64
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
9812367501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$698.90 |
| Max. Negotiated Rate |
$1,499.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,499.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,413.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$698.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,413.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$949.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,341.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,278.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$710.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,254.51
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$1,262.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,262.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,262.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$710.10
|
| Rate for Payer: Multiplan Commercial |
$1,467.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,341.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$710.10
|
| Rate for Payer: United Healthcare Commercial |
$1,499.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$710.10
|
| Rate for Payer: United Healthcare VA CCN |
$710.10
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
IP
|
$1,578.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
9602367502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,167.88 |
| Max. Negotiated Rate |
$1,499.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,499.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,167.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,167.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,341.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,325.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,262.40
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$1,262.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,262.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,262.40
|
| Rate for Payer: Multiplan Commercial |
$1,467.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,341.30
|
| Rate for Payer: United Healthcare Commercial |
$1,499.10
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
9602367502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$698.90 |
| Max. Negotiated Rate |
$1,499.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,499.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,413.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$698.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,413.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$949.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,341.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,278.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$710.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,254.51
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$1,262.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,262.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,262.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$710.10
|
| Rate for Payer: Multiplan Commercial |
$1,467.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,341.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$710.10
|
| Rate for Payer: United Healthcare Commercial |
$1,499.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$710.10
|
| Rate for Payer: United Healthcare VA CCN |
$710.10
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
OP
|
$3,420.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
9602367501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,514.72 |
| Max. Negotiated Rate |
$3,249.00 |
| Rate for Payer: Aetna of VT Commercial |
$3,249.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,063.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,514.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,063.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,058.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,907.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,770.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,539.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,718.90
|
| Rate for Payer: Cash Price |
$1,710.00
|
| Rate for Payer: Cigna Commercial |
$2,736.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,736.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,736.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,539.00
|
| Rate for Payer: Multiplan Commercial |
$3,180.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,907.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,539.00
|
| Rate for Payer: United Healthcare Commercial |
$3,249.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,539.00
|
| Rate for Payer: United Healthcare VA CCN |
$1,539.00
|
|
