|
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
|
$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
|
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 ECTOPIC PREGNANCY
|
Facility
|
IP
|
$2,127.00
|
|
|
Service Code
|
CPT 59151
|
| Hospital Charge Code |
9825915101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,574.19 |
| Max. Negotiated Rate |
$2,020.65 |
| Rate for Payer: Aetna of VT Commercial |
$2,020.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,574.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,574.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,807.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,786.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,701.60
|
| Rate for Payer: Cash Price |
$1,063.50
|
| Rate for Payer: Cigna Commercial |
$1,701.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,701.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,701.60
|
| Rate for Payer: Multiplan Commercial |
$1,978.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,807.95
|
| Rate for Payer: United Healthcare Commercial |
$2,020.65
|
|
|
TREAT ECTOPIC PREGNANCY
|
Facility
|
IP
|
$2,145.00
|
|
|
Service Code
|
CPT 59150
|
| Hospital Charge Code |
9825915001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,587.51 |
| Max. Negotiated Rate |
$2,037.75 |
| Rate for Payer: Aetna of VT Commercial |
$2,037.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,587.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,587.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,823.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,801.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,072.50
|
| Rate for Payer: Cigna Commercial |
$1,716.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,716.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,716.00
|
| Rate for Payer: Multiplan Commercial |
$1,994.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,823.25
|
| Rate for Payer: United Healthcare Commercial |
$2,037.75
|
|
|
TREAT ECTOPIC PREGNANCY
|
Facility
|
OP
|
$2,127.00
|
|
|
Service Code
|
CPT 59151
|
| Hospital Charge Code |
9825915101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$942.05 |
| Max. Negotiated Rate |
$2,020.65 |
| Rate for Payer: Aetna of VT Commercial |
$2,020.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,905.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$942.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,905.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,280.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,807.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,722.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$957.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,690.96
|
| Rate for Payer: Cash Price |
$1,063.50
|
| Rate for Payer: Cigna Commercial |
$1,701.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,701.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,701.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$957.15
|
| Rate for Payer: Multiplan Commercial |
$1,978.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,807.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$957.15
|
| Rate for Payer: United Healthcare Commercial |
$2,020.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$957.15
|
| Rate for Payer: United Healthcare VA CCN |
$957.15
|
|
|
TREAT ECTOPIC PREGNANCY
|
Facility
|
OP
|
$2,145.00
|
|
|
Service Code
|
CPT 59150
|
| Hospital Charge Code |
9825915001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$950.02 |
| Max. Negotiated Rate |
$2,037.75 |
| Rate for Payer: Aetna of VT Commercial |
$2,037.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,921.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$950.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,921.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,291.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,823.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,737.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$965.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,705.28
|
| Rate for Payer: Cash Price |
$1,072.50
|
| Rate for Payer: Cigna Commercial |
$1,716.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,716.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,716.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$965.25
|
| Rate for Payer: Multiplan Commercial |
$1,994.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,823.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$965.25
|
| Rate for Payer: United Healthcare Commercial |
$2,037.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$965.25
|
| Rate for Payer: United Healthcare VA CCN |
$965.25
|
|
|
TREAT ECTOPIC PREGNANCY
|
Professional
|
Both
|
$2,127.00
|
|
|
Service Code
|
CPT 59151
|
| Hospital Charge Code |
9825915101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$698.28 |
| Max. Negotiated Rate |
$1,999.38 |
| Rate for Payer: Aetna of VT Commercial |
$1,999.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,905.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$719.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,905.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$977.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,188.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,188.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$803.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,188.23
|
| Rate for Payer: Cash Price |
$1,063.50
|
| Rate for Payer: Cash Price |
$1,063.50
|
| Rate for Payer: Cigna Commercial |
$768.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,203.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,203.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$698.28
|
| Rate for Payer: Multiplan Commercial |
$1,978.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$991.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$698.28
|
| Rate for Payer: United Healthcare Commercial |
$1,074.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$698.28
|
| Rate for Payer: United Healthcare VA CCN |
$698.28
|
|
|
TREAT ECTOPIC PREGNANCY
|
Professional
|
Both
|
$2,145.00
|
|
|
Service Code
|
CPT 59150
|
| Hospital Charge Code |
9825915001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$714.75 |
| Max. Negotiated Rate |
$2,016.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,016.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,921.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$736.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,921.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,000.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,197.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,197.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$821.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,197.20
|
| Rate for Payer: Cash Price |
$1,072.50
|
| Rate for Payer: Cash Price |
$1,072.50
|
| Rate for Payer: Cigna Commercial |
$786.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,231.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,231.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$714.75
|
| Rate for Payer: Multiplan Commercial |
$1,994.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,014.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$714.75
|
| Rate for Payer: United Healthcare Commercial |
$1,099.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$714.75
|
| Rate for Payer: United Healthcare VA CCN |
$714.75
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
OP
|
$1,015.00
|
|
|
Service Code
|
CPT 24600
|
| Hospital Charge Code |
9812460002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$449.54 |
| Max. Negotiated Rate |
$964.25 |
| Rate for Payer: Aetna of VT Commercial |
$964.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$909.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$449.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$909.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$611.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$862.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$822.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$456.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$806.92
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cigna Commercial |
$812.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$812.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$812.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$456.75
|
| Rate for Payer: Multiplan Commercial |
$943.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$862.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$456.75
|
| Rate for Payer: United Healthcare Commercial |
$964.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$456.75
|
| Rate for Payer: United Healthcare VA CCN |
$456.75
|
|
|
TREAT ELBOW DISLOCATION
|
Professional
|
Both
|
$1,015.00
|
|
|
Service Code
|
CPT 24600
|
| Hospital Charge Code |
9602460002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$333.57 |
| Max. Negotiated Rate |
$954.10 |
| Rate for Payer: Aetna of VT Commercial |
$954.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$909.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$343.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$909.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$467.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$541.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$541.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$383.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$541.37
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cigna Commercial |
$629.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$612.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$612.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$369.54
|
| Rate for Payer: Multiplan Commercial |
$943.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$473.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$333.57
|
| Rate for Payer: United Healthcare Commercial |
$513.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$333.57
|
| Rate for Payer: United Healthcare VA CCN |
$333.57
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
9812464002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$254.59 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna of VT Commercial |
$326.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$254.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$254.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$292.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$288.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$275.20
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna Commercial |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$275.20
|
| Rate for Payer: Multiplan Commercial |
$319.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$292.40
|
| Rate for Payer: United Healthcare Commercial |
$326.80
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
9812464001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$254.59 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna of VT Commercial |
$326.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$254.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$254.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$292.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$288.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$275.20
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna Commercial |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$275.20
|
| Rate for Payer: Multiplan Commercial |
$319.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$292.40
|
| Rate for Payer: United Healthcare Commercial |
$326.80
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
IP
|
$1,543.00
|
|
|
Service Code
|
CPT 24605
|
| Hospital Charge Code |
9822460501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,141.97 |
| Max. Negotiated Rate |
$1,465.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,465.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,141.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,141.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,311.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,296.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,234.40
|
| Rate for Payer: Cash Price |
$771.50
|
| Rate for Payer: Cigna Commercial |
$1,234.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,234.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,234.40
|
| Rate for Payer: Multiplan Commercial |
$1,434.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,311.55
|
| Rate for Payer: United Healthcare Commercial |
$1,465.85
|
|
|
TREAT ELBOW DISLOCATION
|
Professional
|
Both
|
$1,286.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
9602464001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$75.82 |
| Max. Negotiated Rate |
$1,208.84 |
| Rate for Payer: Aetna of VT Commercial |
$1,208.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,152.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$78.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,152.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$106.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$87.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$220.60
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$146.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$160.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$160.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$99.59
|
| Rate for Payer: Multiplan Commercial |
$1,195.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.66
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$75.82
|
| Rate for Payer: United Healthcare Commercial |
$116.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.82
|
| Rate for Payer: United Healthcare VA CCN |
$75.82
|
|
|
TREAT ELBOW DISLOCATION
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
9602464002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$75.82 |
| Max. Negotiated Rate |
$323.36 |
| Rate for Payer: Aetna of VT Commercial |
$323.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$78.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$106.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$87.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$220.60
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna Commercial |
$146.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$160.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$160.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$99.59
|
| Rate for Payer: Multiplan Commercial |
$319.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.66
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$75.82
|
| Rate for Payer: United Healthcare Commercial |
$116.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.82
|
| Rate for Payer: United Healthcare VA CCN |
$75.82
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
IP
|
$669.00
|
|
|
Service Code
|
CPT 24600
|
| Hospital Charge Code |
5102460001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$495.13 |
| Max. Negotiated Rate |
$635.55 |
| Rate for Payer: Aetna of VT Commercial |
$635.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$495.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$495.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$568.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$561.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$535.20
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cigna Commercial |
$535.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$535.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$535.20
|
| Rate for Payer: Multiplan Commercial |
$622.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$568.65
|
| Rate for Payer: United Healthcare Commercial |
$635.55
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
OP
|
$942.49
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
4502464001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.43 |
| Max. Negotiated Rate |
$895.37 |
| Rate for Payer: Aetna of VT Commercial |
$895.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$844.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$417.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$844.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$567.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$801.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$763.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$424.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$749.28
|
| Rate for Payer: Cash Price |
$471.24
|
| Rate for Payer: Cigna Commercial |
$753.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$753.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$753.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$424.12
|
| Rate for Payer: Multiplan Commercial |
$876.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$801.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$424.12
|
| Rate for Payer: United Healthcare Commercial |
$895.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$424.12
|
| Rate for Payer: United Healthcare VA CCN |
$424.12
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
OP
|
$1,286.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
9602464001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$569.57 |
| Max. Negotiated Rate |
$1,221.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,221.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,152.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$569.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,152.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$774.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,093.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,041.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$578.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,022.37
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$1,028.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,028.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,028.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$578.70
|
| Rate for Payer: Multiplan Commercial |
$1,195.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,093.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$578.70
|
| Rate for Payer: United Healthcare Commercial |
$1,221.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$578.70
|
| Rate for Payer: United Healthcare VA CCN |
$578.70
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
9602464002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$152.36 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna of VT Commercial |
$326.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$152.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$207.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$292.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$154.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$273.48
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna Commercial |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$275.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$154.80
|
| Rate for Payer: Multiplan Commercial |
$319.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$292.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$154.80
|
| Rate for Payer: United Healthcare Commercial |
$326.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.80
|
| Rate for Payer: United Healthcare VA CCN |
$154.80
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
OP
|
$1,015.00
|
|
|
Service Code
|
CPT 24600
|
| Hospital Charge Code |
9812460001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$449.54 |
| Max. Negotiated Rate |
$964.25 |
| Rate for Payer: Aetna of VT Commercial |
$964.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$909.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$449.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$909.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$611.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$862.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$822.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$456.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$806.92
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cigna Commercial |
$812.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$812.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$812.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$456.75
|
| Rate for Payer: Multiplan Commercial |
$943.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$862.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$456.75
|
| Rate for Payer: United Healthcare Commercial |
$964.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$456.75
|
| Rate for Payer: United Healthcare VA CCN |
$456.75
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
IP
|
$1,015.00
|
|
|
Service Code
|
CPT 24600
|
| Hospital Charge Code |
9812460002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$751.20 |
| Max. Negotiated Rate |
$964.25 |
| Rate for Payer: Aetna of VT Commercial |
$964.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$751.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$751.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$862.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$852.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$812.00
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cigna Commercial |
$812.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$812.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$812.00
|
| Rate for Payer: Multiplan Commercial |
$943.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$862.75
|
| Rate for Payer: United Healthcare Commercial |
$964.25
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
5102464001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$417.65 |
| Max. Negotiated Rate |
$895.85 |
| Rate for Payer: Aetna of VT Commercial |
$895.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$844.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$417.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$844.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$567.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$801.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$763.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$424.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$749.68
|
| Rate for Payer: Cash Price |
$471.50
|
| Rate for Payer: Cigna Commercial |
$754.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$754.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$754.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$424.35
|
| Rate for Payer: Multiplan Commercial |
$876.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$801.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$424.35
|
| Rate for Payer: United Healthcare Commercial |
$895.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$424.35
|
| Rate for Payer: United Healthcare VA CCN |
$424.35
|
|
|
TREAT ELBOW DISLOCATION
|
Professional
|
Both
|
$943.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
5102464001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.82 |
| Max. Negotiated Rate |
$886.42 |
| Rate for Payer: Aetna of VT Commercial |
$886.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$844.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$78.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$844.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$106.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$87.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$220.60
|
| Rate for Payer: Cash Price |
$471.50
|
| Rate for Payer: Cash Price |
$471.50
|
| Rate for Payer: Cigna Commercial |
$146.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$160.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$160.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$99.59
|
| Rate for Payer: Multiplan Commercial |
$876.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.66
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$75.82
|
| Rate for Payer: United Healthcare Commercial |
$116.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.82
|
| Rate for Payer: United Healthcare VA CCN |
$75.82
|
|
