|
TREAT SHOULDER BLADE FX
|
Professional
|
Both
|
$614.00
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
9812357002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$233.26 |
| Max. Negotiated Rate |
$577.16 |
| Rate for Payer: Aetna of VT Commercial |
$577.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$550.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$248.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$550.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$338.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$310.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$310.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$277.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$310.86
|
| Rate for Payer: Cash Price |
$307.00
|
| Rate for Payer: Cash Price |
$307.00
|
| Rate for Payer: Cigna Commercial |
$454.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$384.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$384.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$233.26
|
| Rate for Payer: Multiplan Commercial |
$571.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$343.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$241.62
|
| Rate for Payer: United Healthcare Commercial |
$371.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$241.62
|
| Rate for Payer: United Healthcare VA CCN |
$241.62
|
|
|
TREAT SHOULDER DISLOCATION
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
9812365002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$295.20 |
| Max. Negotiated Rate |
$812.16 |
| Rate for Payer: Aetna of VT Commercial |
$812.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$774.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$304.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$774.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$413.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$441.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$441.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$339.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$441.70
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$557.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$542.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$542.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$328.61
|
| Rate for Payer: Multiplan Commercial |
$803.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$419.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$295.20
|
| Rate for Payer: United Healthcare Commercial |
$454.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.20
|
| Rate for Payer: United Healthcare VA CCN |
$295.20
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
OP
|
$500.20
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
4502365001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.54 |
| Max. Negotiated Rate |
$475.19 |
| Rate for Payer: Aetna of VT Commercial |
$475.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$448.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$221.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$448.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$301.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$425.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$405.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$225.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$397.66
|
| Rate for Payer: Cash Price |
$250.10
|
| Rate for Payer: Cigna Commercial |
$400.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$400.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$400.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$225.09
|
| Rate for Payer: Multiplan Commercial |
$465.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$425.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$225.09
|
| Rate for Payer: United Healthcare Commercial |
$475.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$225.09
|
| Rate for Payer: United Healthcare VA CCN |
$225.09
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
9812365501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$707.54 |
| Max. Negotiated Rate |
$908.20 |
| Rate for Payer: Aetna of VT Commercial |
$908.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$707.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$707.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$812.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$803.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$764.80
|
| Rate for Payer: Cash Price |
$478.00
|
| Rate for Payer: Cigna Commercial |
$764.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$764.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$764.80
|
| Rate for Payer: Multiplan Commercial |
$889.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$812.60
|
| Rate for Payer: United Healthcare Commercial |
$908.20
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
9812365502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$707.54 |
| Max. Negotiated Rate |
$908.20 |
| Rate for Payer: Aetna of VT Commercial |
$908.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$707.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$707.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$812.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$803.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$764.80
|
| Rate for Payer: Cash Price |
$478.00
|
| Rate for Payer: Cigna Commercial |
$764.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$764.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$764.80
|
| Rate for Payer: Multiplan Commercial |
$889.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$812.60
|
| Rate for Payer: United Healthcare Commercial |
$908.20
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
IP
|
$500.20
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
4502365001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$370.20 |
| Max. Negotiated Rate |
$475.19 |
| Rate for Payer: Aetna of VT Commercial |
$475.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$370.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$370.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$425.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$420.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$400.16
|
| Rate for Payer: Cash Price |
$250.10
|
| Rate for Payer: Cigna Commercial |
$400.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$400.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$400.16
|
| Rate for Payer: Multiplan Commercial |
$465.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$425.17
|
| Rate for Payer: United Healthcare Commercial |
$475.19
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
9812365002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$639.45 |
| Max. Negotiated Rate |
$820.80 |
| Rate for Payer: Aetna of VT Commercial |
$820.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$639.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$639.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$734.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$725.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$691.20
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$691.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$691.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$691.20
|
| Rate for Payer: Multiplan Commercial |
$803.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$734.40
|
| Rate for Payer: United Healthcare Commercial |
$820.80
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
9812365002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$382.67 |
| Max. Negotiated Rate |
$820.80 |
| Rate for Payer: Aetna of VT Commercial |
$820.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$774.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$382.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$774.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$520.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$734.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$699.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$388.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$686.88
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$691.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$691.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$691.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$388.80
|
| Rate for Payer: Multiplan Commercial |
$803.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$734.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$388.80
|
| Rate for Payer: United Healthcare Commercial |
$820.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$388.80
|
| Rate for Payer: United Healthcare VA CCN |
$388.80
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
IP
|
$1,908.92
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
4502365501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,412.79 |
| Max. Negotiated Rate |
$1,813.47 |
| Rate for Payer: Aetna of VT Commercial |
$1,813.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,412.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,412.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,622.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,603.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,527.14
|
| Rate for Payer: Cash Price |
$954.46
|
| Rate for Payer: Cigna Commercial |
$1,527.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,527.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,527.14
|
| Rate for Payer: Multiplan Commercial |
$1,775.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,622.58
|
| Rate for Payer: United Healthcare Commercial |
$1,813.47
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
9812365001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$382.67 |
| Max. Negotiated Rate |
$820.80 |
| Rate for Payer: Aetna of VT Commercial |
$820.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$774.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$382.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$774.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$520.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$734.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$699.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$388.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$686.88
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$691.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$691.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$691.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$388.80
|
| Rate for Payer: Multiplan Commercial |
$803.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$734.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$388.80
|
| Rate for Payer: United Healthcare Commercial |
$820.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$388.80
|
| Rate for Payer: United Healthcare VA CCN |
$388.80
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
9812365001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$639.45 |
| Max. Negotiated Rate |
$820.80 |
| Rate for Payer: Aetna of VT Commercial |
$820.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$639.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$639.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$734.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$725.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$691.20
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$691.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$691.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$691.20
|
| Rate for Payer: Multiplan Commercial |
$803.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$734.40
|
| Rate for Payer: United Healthcare Commercial |
$820.80
|
|
|
TREAT SHOULDER DISLOCATION
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
9812365001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$295.20 |
| Max. Negotiated Rate |
$812.16 |
| Rate for Payer: Aetna of VT Commercial |
$812.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$774.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$304.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$774.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$413.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$441.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$441.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$339.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$441.70
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$557.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$542.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$542.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$328.61
|
| Rate for Payer: Multiplan Commercial |
$803.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$419.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$295.20
|
| Rate for Payer: United Healthcare Commercial |
$454.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.20
|
| Rate for Payer: United Healthcare VA CCN |
$295.20
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
9812365502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$423.41 |
| Max. Negotiated Rate |
$908.20 |
| Rate for Payer: Aetna of VT Commercial |
$908.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$856.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$423.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$856.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$575.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$812.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$774.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$430.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$760.02
|
| Rate for Payer: Cash Price |
$478.00
|
| Rate for Payer: Cigna Commercial |
$764.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$764.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$764.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$430.20
|
| Rate for Payer: Multiplan Commercial |
$889.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$812.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$430.20
|
| Rate for Payer: United Healthcare Commercial |
$908.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$430.20
|
| Rate for Payer: United Healthcare VA CCN |
$430.20
|
|
|
TREAT SHOULDER DISLOCATION
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
9812365502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$393.78 |
| Max. Negotiated Rate |
$898.64 |
| Rate for Payer: Aetna of VT Commercial |
$898.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$856.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$405.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$856.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$551.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$531.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$531.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$452.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$531.24
|
| Rate for Payer: Cash Price |
$478.00
|
| Rate for Payer: Cash Price |
$478.00
|
| Rate for Payer: Cigna Commercial |
$746.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$652.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$652.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$393.78
|
| Rate for Payer: Multiplan Commercial |
$889.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$559.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$393.78
|
| Rate for Payer: United Healthcare Commercial |
$605.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$393.78
|
| Rate for Payer: United Healthcare VA CCN |
$393.78
|
|
|
TREAT SHOULDER DISLOCATION
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
9812365501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$393.78 |
| Max. Negotiated Rate |
$898.64 |
| Rate for Payer: Aetna of VT Commercial |
$898.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$856.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$405.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$856.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$551.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$531.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$531.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$452.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$531.24
|
| Rate for Payer: Cash Price |
$478.00
|
| Rate for Payer: Cash Price |
$478.00
|
| Rate for Payer: Cigna Commercial |
$746.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$652.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$652.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$393.78
|
| Rate for Payer: Multiplan Commercial |
$889.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$559.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$393.78
|
| Rate for Payer: United Healthcare Commercial |
$605.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$393.78
|
| Rate for Payer: United Healthcare VA CCN |
$393.78
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
OP
|
$1,908.92
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
4502365501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$845.46 |
| Max. Negotiated Rate |
$1,813.47 |
| Rate for Payer: Aetna of VT Commercial |
$1,813.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,710.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$845.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,710.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,149.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,622.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,546.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$859.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,517.59
|
| Rate for Payer: Cash Price |
$954.46
|
| Rate for Payer: Cigna Commercial |
$1,527.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,527.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,527.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$859.01
|
| Rate for Payer: Multiplan Commercial |
$1,775.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,622.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$859.01
|
| Rate for Payer: United Healthcare Commercial |
$1,813.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$859.01
|
| Rate for Payer: United Healthcare VA CCN |
$859.01
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
9812365501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$423.41 |
| Max. Negotiated Rate |
$908.20 |
| Rate for Payer: Aetna of VT Commercial |
$908.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$856.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$423.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$856.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$575.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$812.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$774.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$430.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$760.02
|
| Rate for Payer: Cash Price |
$478.00
|
| Rate for Payer: Cigna Commercial |
$764.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$764.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$764.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$430.20
|
| Rate for Payer: Multiplan Commercial |
$889.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$812.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$430.20
|
| Rate for Payer: United Healthcare Commercial |
$908.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$430.20
|
| Rate for Payer: United Healthcare VA CCN |
$430.20
|
|
|
TREAT THIGH FRACTURE
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 27238
|
| Hospital Charge Code |
9812723801
|
|
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 THIGH FRACTURE
|
Facility
|
IP
|
$1,224.00
|
|
|
Service Code
|
CPT 27245
|
| Hospital Charge Code |
9822724501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$905.88 |
| Max. Negotiated Rate |
$1,162.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,162.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$905.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$905.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,040.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,028.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$979.20
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$979.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$979.20
|
| Rate for Payer: Multiplan Commercial |
$1,138.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,040.40
|
| Rate for Payer: United Healthcare Commercial |
$1,162.80
|
|
|
TREAT THIGH FRACTURE
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
CPT 27245
|
| Hospital Charge Code |
9822724501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,096.58 |
| Max. Negotiated Rate |
$2,193.84 |
| Rate for Payer: Aetna of VT Commercial |
$1,150.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,096.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,178.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,096.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,602.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,193.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,193.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,316.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,193.84
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna Commercial |
$2,167.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,915.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,915.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,144.36
|
| Rate for Payer: Multiplan Commercial |
$1,138.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,624.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,144.35
|
| Rate for Payer: United Healthcare Commercial |
$1,760.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,144.35
|
| Rate for Payer: United Healthcare VA CCN |
$1,144.35
|
|
|
TREAT THIGH FRACTURE
|
Facility
|
IP
|
$1,510.00
|
|
|
Service Code
|
CPT 27238
|
| Hospital Charge Code |
5102723801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,117.55 |
| Max. Negotiated Rate |
$1,434.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,434.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,117.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,117.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,283.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,268.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,208.00
|
| Rate for Payer: Cash Price |
$755.00
|
| Rate for Payer: Cigna Commercial |
$1,208.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,208.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,208.00
|
| Rate for Payer: Multiplan Commercial |
$1,404.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,283.50
|
| Rate for Payer: United Healthcare Commercial |
$1,434.50
|
|
|
TREAT THIGH FRACTURE
|
Professional
|
Both
|
$4,061.00
|
|
|
Service Code
|
CPT 27236
|
| Hospital Charge Code |
9822723601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,113.95 |
| Max. Negotiated Rate |
$3,817.34 |
| Rate for Payer: Aetna of VT Commercial |
$3,817.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,638.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,147.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,638.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,559.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,979.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,979.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,281.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,979.45
|
| Rate for Payer: Cash Price |
$2,030.50
|
| Rate for Payer: Cash Price |
$2,030.50
|
| Rate for Payer: Cigna Commercial |
$2,111.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,864.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,864.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,113.95
|
| Rate for Payer: Multiplan Commercial |
$3,776.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,581.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,113.95
|
| Rate for Payer: United Healthcare Commercial |
$1,713.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,113.95
|
| Rate for Payer: United Healthcare VA CCN |
$1,113.95
|
|
|
TREAT THIGH FRACTURE
|
Facility
|
OP
|
$4,061.00
|
|
|
Service Code
|
CPT 27236
|
| Hospital Charge Code |
9822723601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,798.62 |
| Max. Negotiated Rate |
$3,857.95 |
| Rate for Payer: Aetna of VT Commercial |
$3,857.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,638.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,798.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,638.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,444.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,451.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,289.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,827.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,228.49
|
| Rate for Payer: Cash Price |
$2,030.50
|
| Rate for Payer: Cigna Commercial |
$3,248.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,248.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,248.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,827.45
|
| Rate for Payer: Multiplan Commercial |
$3,776.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,451.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,827.45
|
| Rate for Payer: United Healthcare Commercial |
$3,857.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,827.45
|
| Rate for Payer: United Healthcare VA CCN |
$1,827.45
|
|
|
TREAT THIGH FRACTURE
|
Facility
|
OP
|
$1,224.00
|
|
|
Service Code
|
CPT 27238
|
| Hospital Charge Code |
9602723802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$542.11 |
| Max. Negotiated Rate |
$1,162.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,162.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,096.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$542.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,096.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$736.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,040.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$991.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$550.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$973.08
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$979.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$979.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$550.80
|
| Rate for Payer: Multiplan Commercial |
$1,138.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,040.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$550.80
|
| Rate for Payer: United Healthcare Commercial |
$1,162.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$550.80
|
| Rate for Payer: United Healthcare VA CCN |
$550.80
|
|
|
TREAT THIGH FRACTURE
|
Facility
|
OP
|
$3,768.00
|
|
|
Service Code
|
CPT 27235
|
| Hospital Charge Code |
9822723501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,668.85 |
| Max. Negotiated Rate |
$3,579.60 |
| Rate for Payer: Aetna of VT Commercial |
$3,579.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,375.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,668.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,375.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,268.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,202.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,052.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,695.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,995.56
|
| Rate for Payer: Cash Price |
$1,884.00
|
| Rate for Payer: Cigna Commercial |
$3,014.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,014.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,014.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,695.60
|
| Rate for Payer: Multiplan Commercial |
$3,504.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,202.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,695.60
|
| Rate for Payer: United Healthcare Commercial |
$3,579.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,695.60
|
| Rate for Payer: United Healthcare VA CCN |
$1,695.60
|
|
