|
TREAT SHOULDER BLADE FX
|
Facility
|
OP
|
$614.00
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
9812357001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$271.94 |
| Max. Negotiated Rate |
$583.30 |
| Rate for Payer: Aetna of VT Commercial |
$583.30
|
| 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 |
$271.94
|
| 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 |
$369.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$521.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$497.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$276.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$488.13
|
| Rate for Payer: Cash Price |
$307.00
|
| Rate for Payer: Cigna Commercial |
$491.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$491.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$491.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$276.30
|
| Rate for Payer: Multiplan Commercial |
$571.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$521.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$276.30
|
| Rate for Payer: United Healthcare Commercial |
$583.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$276.30
|
| Rate for Payer: United Healthcare VA CCN |
$276.30
|
|
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
$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
|
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
|
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
|
$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 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 THIGH FRACTURE
|
Facility
|
IP
|
$1,509.64
|
|
|
Service Code
|
CPT 27238
|
| Hospital Charge Code |
4502723801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,117.28 |
| Max. Negotiated Rate |
$1,434.16 |
| Rate for Payer: Aetna of VT Commercial |
$1,434.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,117.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,117.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,283.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,268.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,207.71
|
| Rate for Payer: Cash Price |
$754.82
|
| Rate for Payer: Cigna Commercial |
$1,207.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,207.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,207.71
|
| Rate for Payer: Multiplan Commercial |
$1,403.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,283.19
|
| Rate for Payer: United Healthcare Commercial |
$1,434.16
|
|
|
TREAT THIGH FRACTURE
|
Facility
|
OP
|
$2,733.00
|
|
|
Service Code
|
CPT 27238
|
| Hospital Charge Code |
9602723801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,210.45 |
| Max. Negotiated Rate |
$2,596.35 |
| Rate for Payer: Aetna of VT Commercial |
$2,596.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,448.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,210.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,448.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,645.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,323.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,213.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,229.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,172.74
|
| Rate for Payer: Cash Price |
$1,366.50
|
| Rate for Payer: Cigna Commercial |
$2,186.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,186.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,186.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,229.85
|
| Rate for Payer: Multiplan Commercial |
$2,541.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,323.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,229.85
|
| Rate for Payer: United Healthcare Commercial |
$2,596.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,229.85
|
| Rate for Payer: United Healthcare VA CCN |
$1,229.85
|
|
|
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
|
|
|
TREAT THIGH FRACTURE
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 27238
|
| Hospital Charge Code |
9812723801
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$850.84 |
| 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 |
$463.03
|
| 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 |
$629.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$676.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$676.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$516.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$676.67
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$850.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$746.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$746.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$449.54
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$638.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$449.54
|
| Rate for Payer: United Healthcare Commercial |
$691.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$449.54
|
| Rate for Payer: United Healthcare VA CCN |
$449.54
|
|
|
TREAT THIGH FRACTURE
|
Facility
|
IP
|
$2,733.00
|
|
|
Service Code
|
CPT 27238
|
| Hospital Charge Code |
9602723801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,022.69 |
| Max. Negotiated Rate |
$2,596.35 |
| Rate for Payer: Aetna of VT Commercial |
$2,596.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,022.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,022.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,323.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,295.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,186.40
|
| Rate for Payer: Cash Price |
$1,366.50
|
| Rate for Payer: Cigna Commercial |
$2,186.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,186.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,186.40
|
| Rate for Payer: Multiplan Commercial |
$2,541.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,323.05
|
| Rate for Payer: United Healthcare Commercial |
$2,596.35
|
|
|
TREAT THIGH FRACTURE
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
CPT 27238
|
| Hospital Charge Code |
9812723802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$449.54 |
| Max. Negotiated Rate |
$1,150.56 |
| 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 |
$463.03
|
| 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 |
$629.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$676.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$676.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$516.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$676.67
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna Commercial |
$850.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$746.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$746.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$449.54
|
| Rate for Payer: Multiplan Commercial |
$1,138.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$638.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$449.54
|
| Rate for Payer: United Healthcare Commercial |
$691.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$449.54
|
| Rate for Payer: United Healthcare VA CCN |
$449.54
|
|
|
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
|
IP
|
$1,224.00
|
|
|
Service Code
|
CPT 27238
|
| Hospital Charge Code |
9602723802
|
|
Hospital Revenue Code
|
960
|
| 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
|
|
