|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
5102726501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$199.31 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna of VT Commercial |
$427.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$403.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$199.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$403.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$270.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$364.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$202.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$357.75
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$360.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$360.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$360.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$418.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$382.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$202.50
|
| Rate for Payer: United Healthcare Commercial |
$427.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$202.50
|
| Rate for Payer: United Healthcare VA CCN |
$202.50
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
CPT 27250
|
| Hospital Charge Code |
9812725002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$135.97 |
| Max. Negotiated Rate |
$291.65 |
| Rate for Payer: Aetna of VT Commercial |
$291.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$275.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$135.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$275.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$184.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$260.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$248.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$138.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$244.06
|
| Rate for Payer: Cash Price |
$153.50
|
| Rate for Payer: Cigna Commercial |
$245.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$245.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$245.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$138.15
|
| Rate for Payer: Multiplan Commercial |
$285.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$260.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$138.15
|
| Rate for Payer: United Healthcare Commercial |
$291.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.15
|
| Rate for Payer: United Healthcare VA CCN |
$138.15
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
CPT 27250
|
| Hospital Charge Code |
9812725002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$227.21 |
| Max. Negotiated Rate |
$291.65 |
| Rate for Payer: Aetna of VT Commercial |
$291.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$227.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$227.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$260.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$257.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$245.60
|
| Rate for Payer: Cash Price |
$153.50
|
| Rate for Payer: Cigna Commercial |
$245.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$245.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$245.60
|
| Rate for Payer: Multiplan Commercial |
$285.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$260.95
|
| Rate for Payer: United Healthcare Commercial |
$291.65
|
|
|
TREAT HIP DISLOCATION
|
Professional
|
Both
|
$2,804.00
|
|
|
Service Code
|
CPT 27253
|
| Hospital Charge Code |
9822725301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$879.96 |
| Max. Negotiated Rate |
$2,635.76 |
| Rate for Payer: Aetna of VT Commercial |
$2,635.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,512.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$906.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,512.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,231.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,694.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,694.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,011.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,694.82
|
| Rate for Payer: Cash Price |
$1,402.00
|
| Rate for Payer: Cash Price |
$1,402.00
|
| Rate for Payer: Cigna Commercial |
$1,667.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,472.45
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,472.45
|
| Rate for Payer: Martins Point Health Care Commercial |
$879.96
|
| Rate for Payer: Multiplan Commercial |
$2,607.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,249.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$879.96
|
| Rate for Payer: United Healthcare Commercial |
$1,353.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$879.96
|
| Rate for Payer: United Healthcare VA CCN |
$879.96
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
CPT 27252
|
| Hospital Charge Code |
9822725201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,480.20 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,480.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,480.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,700.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,680.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,600.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,600.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,600.00
|
| Rate for Payer: Multiplan Commercial |
$1,860.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,700.00
|
| Rate for Payer: United Healthcare Commercial |
$1,900.00
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$2,745.27
|
|
|
Service Code
|
CPT 27252
|
| Hospital Charge Code |
4502725201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,215.88 |
| Max. Negotiated Rate |
$2,608.01 |
| Rate for Payer: Aetna of VT Commercial |
$2,608.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,459.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,215.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,459.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,652.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,333.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,223.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,235.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,182.49
|
| Rate for Payer: Cash Price |
$1,372.63
|
| Rate for Payer: Cigna Commercial |
$2,196.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,196.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,196.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,235.37
|
| Rate for Payer: Multiplan Commercial |
$2,553.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,333.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,235.37
|
| Rate for Payer: United Healthcare Commercial |
$2,608.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,235.37
|
| Rate for Payer: United Healthcare VA CCN |
$1,235.37
|
|
|
TREAT HIP DISLOCATION
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
CPT 27252
|
| Hospital Charge Code |
9822725201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$699.77 |
| Max. Negotiated Rate |
$1,880.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,880.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,791.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$720.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,791.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$979.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,084.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,084.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$804.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,084.58
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,331.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,171.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,171.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$699.77
|
| Rate for Payer: Multiplan Commercial |
$1,860.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$993.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$699.78
|
| Rate for Payer: United Healthcare Commercial |
$1,076.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$699.78
|
| Rate for Payer: United Healthcare VA CCN |
$699.78
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
9812726601
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
IP
|
$1,789.85
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
4502726601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,324.67 |
| Max. Negotiated Rate |
$1,700.36 |
| Rate for Payer: Aetna of VT Commercial |
$1,700.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,324.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,324.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,521.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,503.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,431.88
|
| Rate for Payer: Cash Price |
$894.92
|
| Rate for Payer: Cigna Commercial |
$1,431.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,431.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,431.88
|
| Rate for Payer: Multiplan Commercial |
$1,664.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,521.37
|
| Rate for Payer: United Healthcare Commercial |
$1,700.36
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$978.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
9602726502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$433.16 |
| Max. Negotiated Rate |
$929.10 |
| Rate for Payer: Aetna of VT Commercial |
$929.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$876.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$433.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$876.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$588.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$831.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$792.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$440.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$777.51
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$782.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$782.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$782.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$440.10
|
| Rate for Payer: Multiplan Commercial |
$909.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$831.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$440.10
|
| Rate for Payer: United Healthcare Commercial |
$929.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$440.10
|
| Rate for Payer: United Healthcare VA CCN |
$440.10
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
IP
|
$1,914.00
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
9812726602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,416.55 |
| Max. Negotiated Rate |
$1,818.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,818.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,416.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,416.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,626.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,607.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,531.20
|
| Rate for Payer: Cash Price |
$957.00
|
| Rate for Payer: Cigna Commercial |
$1,531.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,531.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,531.20
|
| Rate for Payer: Multiplan Commercial |
$1,780.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Commercial |
$1,818.30
|
|
|
TREAT HIP DISLOCATION
|
Professional
|
Both
|
$978.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
9602726502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$402.17 |
| Max. Negotiated Rate |
$919.32 |
| Rate for Payer: Aetna of VT Commercial |
$919.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$876.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$414.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$876.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$563.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$720.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$720.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$462.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$720.98
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$761.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$669.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$669.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$402.17
|
| Rate for Payer: Multiplan Commercial |
$909.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$571.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$402.17
|
| Rate for Payer: United Healthcare Commercial |
$618.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$402.17
|
| Rate for Payer: United Healthcare VA CCN |
$402.17
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
CPT 27252
|
| Hospital Charge Code |
9812725202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$885.80 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,791.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$885.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,791.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,204.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,700.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,620.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,590.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,600.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,600.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,600.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$900.00
|
| Rate for Payer: Multiplan Commercial |
$1,860.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,700.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$900.00
|
| Rate for Payer: United Healthcare Commercial |
$1,900.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$900.00
|
| Rate for Payer: United Healthcare VA CCN |
$900.00
|
|
|
TREAT HIP DISLOCATION
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
CPT 27250
|
| Hospital Charge Code |
9812725002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$161.70 |
| Max. Negotiated Rate |
$414.75 |
| Rate for Payer: Aetna of VT Commercial |
$288.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$275.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$166.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$275.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$226.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$414.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$414.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$185.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$414.75
|
| Rate for Payer: Cash Price |
$153.50
|
| Rate for Payer: Cash Price |
$153.50
|
| Rate for Payer: Cigna Commercial |
$308.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$277.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$277.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$161.70
|
| Rate for Payer: Multiplan Commercial |
$285.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$229.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.70
|
| Rate for Payer: United Healthcare Commercial |
$248.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.70
|
| Rate for Payer: United Healthcare VA CCN |
$161.70
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$1,789.85
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
4502726601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$792.72 |
| Max. Negotiated Rate |
$1,700.36 |
| Rate for Payer: Aetna of VT Commercial |
$1,700.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,603.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$792.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,603.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,077.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,521.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,449.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$805.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,422.93
|
| Rate for Payer: Cash Price |
$894.92
|
| Rate for Payer: Cigna Commercial |
$1,431.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,431.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,431.88
|
| Rate for Payer: Martins Point Health Care Commercial |
$805.43
|
| Rate for Payer: Multiplan Commercial |
$1,664.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,521.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$805.43
|
| Rate for Payer: United Healthcare Commercial |
$1,700.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$805.43
|
| Rate for Payer: United Healthcare VA CCN |
$805.43
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
IP
|
$978.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
9602726502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$723.82 |
| Max. Negotiated Rate |
$929.10 |
| Rate for Payer: Aetna of VT Commercial |
$929.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$723.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$723.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$831.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$821.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$782.40
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$782.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$782.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$782.40
|
| Rate for Payer: Multiplan Commercial |
$909.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$831.30
|
| Rate for Payer: United Healthcare Commercial |
$929.10
|
|
|
TREAT HIP DISLOCATION
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
5102726501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$402.17 |
| Max. Negotiated Rate |
$761.51 |
| Rate for Payer: Aetna of VT Commercial |
$423.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$403.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$414.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$403.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$563.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$720.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$720.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$462.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$720.98
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$761.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$669.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$669.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$402.17
|
| Rate for Payer: Multiplan Commercial |
$418.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$571.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$402.17
|
| Rate for Payer: United Healthcare Commercial |
$618.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$402.17
|
| Rate for Payer: United Healthcare VA CCN |
$402.17
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$1,914.00
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
9822726601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$847.71 |
| Max. Negotiated Rate |
$1,818.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,818.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,714.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$847.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,714.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,152.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,626.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,550.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$861.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,521.63
|
| Rate for Payer: Cash Price |
$957.00
|
| Rate for Payer: Cigna Commercial |
$1,531.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,531.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,531.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$861.30
|
| Rate for Payer: Multiplan Commercial |
$1,780.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,626.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$861.30
|
| Rate for Payer: United Healthcare Commercial |
$1,818.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$861.30
|
| Rate for Payer: United Healthcare VA CCN |
$861.30
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$978.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
9812726502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$433.16 |
| Max. Negotiated Rate |
$929.10 |
| Rate for Payer: Aetna of VT Commercial |
$929.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$876.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$433.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$876.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$588.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$831.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$792.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$440.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$777.51
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$782.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$782.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$782.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$440.10
|
| Rate for Payer: Multiplan Commercial |
$909.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$831.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$440.10
|
| Rate for Payer: United Healthcare Commercial |
$929.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$440.10
|
| Rate for Payer: United Healthcare VA CCN |
$440.10
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
IP
|
$2,804.00
|
|
|
Service Code
|
CPT 27253
|
| Hospital Charge Code |
9822725301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,075.24 |
| Max. Negotiated Rate |
$2,663.80 |
| Rate for Payer: Aetna of VT Commercial |
$2,663.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,075.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,075.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,383.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,355.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,243.20
|
| Rate for Payer: Cash Price |
$1,402.00
|
| Rate for Payer: Cigna Commercial |
$2,243.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,243.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,243.20
|
| Rate for Payer: Multiplan Commercial |
$2,607.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,383.40
|
| Rate for Payer: United Healthcare Commercial |
$2,663.80
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
9812726601
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
IP
|
$1,427.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
9602726501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,056.12 |
| Max. Negotiated Rate |
$1,355.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,355.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,056.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,056.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,212.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,198.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,141.60
|
| Rate for Payer: Cash Price |
$713.50
|
| Rate for Payer: Cigna Commercial |
$1,141.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,141.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,141.60
|
| Rate for Payer: Multiplan Commercial |
$1,327.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,212.95
|
| Rate for Payer: United Healthcare Commercial |
$1,355.65
|
|
|
TREAT HIP DISLOCATION
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
9812726501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$761.51 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$414.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$563.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$720.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$720.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$462.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$720.98
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$761.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$669.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$669.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$402.17
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$571.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$402.17
|
| Rate for Payer: United Healthcare Commercial |
$618.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$402.17
|
| Rate for Payer: United Healthcare VA CCN |
$402.17
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$1,427.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
9602726501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$632.02 |
| Max. Negotiated Rate |
$1,355.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,355.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,278.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$632.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,278.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$859.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,212.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,155.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$642.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,134.46
|
| Rate for Payer: Cash Price |
$713.50
|
| Rate for Payer: Cigna Commercial |
$1,141.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,141.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,141.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$642.15
|
| Rate for Payer: Multiplan Commercial |
$1,327.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,212.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$642.15
|
| Rate for Payer: United Healthcare Commercial |
$1,355.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$642.15
|
| Rate for Payer: United Healthcare VA CCN |
$642.15
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$445.65
|
|
|
Service Code
|
CPT 27250
|
| Hospital Charge Code |
4502725001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$197.38 |
| Max. Negotiated Rate |
$423.37 |
| Rate for Payer: Aetna of VT Commercial |
$423.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$399.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$197.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$399.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$268.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$378.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$360.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$200.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$354.29
|
| Rate for Payer: Cash Price |
$222.82
|
| Rate for Payer: Cigna Commercial |
$356.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$356.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$356.52
|
| Rate for Payer: Martins Point Health Care Commercial |
$200.54
|
| Rate for Payer: Multiplan Commercial |
$414.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$378.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$200.54
|
| Rate for Payer: United Healthcare Commercial |
$423.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.54
|
| Rate for Payer: United Healthcare VA CCN |
$200.54
|
|
