|
CLOSED TX TALUS FRACTURE W/O M
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
9822843001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$105.41 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Aetna of VT Commercial |
$226.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$213.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$105.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$213.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$143.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$202.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$192.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$189.21
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$190.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$190.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$107.10
|
| Rate for Payer: Multiplan Commercial |
$221.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$202.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$107.10
|
| Rate for Payer: United Healthcare Commercial |
$226.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.10
|
| Rate for Payer: United Healthcare VA CCN |
$107.10
|
|
|
CLOSED TX TALUS FRACTURE W/O M
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
5102843001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.47 |
| Max. Negotiated Rate |
$407.68 |
| Rate for Payer: Aetna of VT Commercial |
$122.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$116.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$213.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$116.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$290.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$407.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$407.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$238.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$407.68
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$392.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$386.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$386.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$236.52
|
| Rate for Payer: Multiplan Commercial |
$120.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$207.61
|
| Rate for Payer: United Healthcare Commercial |
$319.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$207.61
|
| Rate for Payer: United Healthcare VA CCN |
$207.61
|
|
|
CLOSED TX TALUS FRACTURE W/O M
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
9602843001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$207.61 |
| Max. Negotiated Rate |
$407.68 |
| Rate for Payer: Aetna of VT Commercial |
$344.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$328.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$213.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$328.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$290.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$407.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$407.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$238.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$407.68
|
| Rate for Payer: Cash Price |
$183.50
|
| Rate for Payer: Cash Price |
$183.50
|
| Rate for Payer: Cigna Commercial |
$392.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$386.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$386.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$236.52
|
| Rate for Payer: Multiplan Commercial |
$341.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$207.61
|
| Rate for Payer: United Healthcare Commercial |
$319.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$207.61
|
| Rate for Payer: United Healthcare VA CCN |
$207.61
|
|
|
CLOSED TX TALUS FRACTURE W/O M
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
9602843002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$105.41 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Aetna of VT Commercial |
$226.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$213.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$105.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$213.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$143.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$202.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$192.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$189.21
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$190.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$190.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$107.10
|
| Rate for Payer: Multiplan Commercial |
$221.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$202.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$107.10
|
| Rate for Payer: United Healthcare Commercial |
$226.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.10
|
| Rate for Payer: United Healthcare VA CCN |
$107.10
|
|
|
CLOSED TX TALUS FRACTURE W/O M
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
9602843001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$162.54 |
| Max. Negotiated Rate |
$348.65 |
| Rate for Payer: Aetna of VT Commercial |
$348.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$328.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$328.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$220.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$311.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$297.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$165.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$291.76
|
| Rate for Payer: Cash Price |
$183.50
|
| Rate for Payer: Cigna Commercial |
$293.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$293.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$293.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$165.15
|
| Rate for Payer: Multiplan Commercial |
$341.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$311.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$165.15
|
| Rate for Payer: United Healthcare Commercial |
$348.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.15
|
| Rate for Payer: United Healthcare VA CCN |
$165.15
|
|
|
CLOSED TX TALUS FRACTURE W/O M
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
9602843001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$271.62 |
| Max. Negotiated Rate |
$348.65 |
| Rate for Payer: Aetna of VT Commercial |
$348.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$271.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$271.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$311.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$308.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$293.60
|
| Rate for Payer: Cash Price |
$183.50
|
| Rate for Payer: Cigna Commercial |
$293.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$293.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$293.60
|
| Rate for Payer: Multiplan Commercial |
$341.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$311.95
|
| Rate for Payer: United Healthcare Commercial |
$348.65
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
9821202001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$515.11 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Aetna of VT Commercial |
$661.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$515.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$515.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$591.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$584.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$556.80
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.80
|
| Rate for Payer: Multiplan Commercial |
$647.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$591.60
|
| Rate for Payer: United Healthcare Commercial |
$661.20
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
9821202001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$308.26 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Aetna of VT Commercial |
$661.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$308.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$591.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$563.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$313.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$553.32
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$313.20
|
| Rate for Payer: Multiplan Commercial |
$647.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$591.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$313.20
|
| Rate for Payer: United Healthcare Commercial |
$661.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.20
|
| Rate for Payer: United Healthcare VA CCN |
$313.20
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
9601202002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$515.11 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Aetna of VT Commercial |
$661.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$515.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$515.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$591.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$584.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$556.80
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.80
|
| Rate for Payer: Multiplan Commercial |
$647.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$591.60
|
| Rate for Payer: United Healthcare Commercial |
$661.20
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
9811202102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$515.11 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Aetna of VT Commercial |
$661.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$515.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$515.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$591.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$584.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$556.80
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.80
|
| Rate for Payer: Multiplan Commercial |
$647.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$591.60
|
| Rate for Payer: United Healthcare Commercial |
$661.20
|
|
|
CLOSURE OF SPLIT WOUND
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
9811202102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$132.33 |
| Max. Negotiated Rate |
$654.24 |
| Rate for Payer: Aetna of VT Commercial |
$654.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$136.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$185.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$235.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$235.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$152.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$235.86
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$243.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$272.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$272.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$166.06
|
| Rate for Payer: Multiplan Commercial |
$647.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$132.33
|
| Rate for Payer: United Healthcare Commercial |
$203.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.33
|
| Rate for Payer: United Healthcare VA CCN |
$132.33
|
|
|
CLOSURE OF SPLIT WOUND
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
9811202002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$177.72 |
| Max. Negotiated Rate |
$654.24 |
| Rate for Payer: Aetna of VT Commercial |
$654.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$183.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$248.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$398.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$398.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$204.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$398.75
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$323.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$461.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$461.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$282.43
|
| Rate for Payer: Multiplan Commercial |
$647.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$252.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$177.72
|
| Rate for Payer: United Healthcare Commercial |
$273.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.72
|
| Rate for Payer: United Healthcare VA CCN |
$177.72
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
9811202002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$515.11 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Aetna of VT Commercial |
$661.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$515.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$515.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$591.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$584.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$556.80
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.80
|
| Rate for Payer: Multiplan Commercial |
$647.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$591.60
|
| Rate for Payer: United Healthcare Commercial |
$661.20
|
|
|
CLOSURE OF SPLIT WOUND
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
9811202001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$177.72 |
| Max. Negotiated Rate |
$654.24 |
| Rate for Payer: Aetna of VT Commercial |
$654.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$183.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$248.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$398.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$398.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$204.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$398.75
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$323.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$461.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$461.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$282.43
|
| Rate for Payer: Multiplan Commercial |
$647.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$252.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$177.72
|
| Rate for Payer: United Healthcare Commercial |
$273.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.72
|
| Rate for Payer: United Healthcare VA CCN |
$177.72
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
9601202001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$429.17 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Aetna of VT Commercial |
$920.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$868.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$429.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$868.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$583.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$823.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$784.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$770.36
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$775.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$775.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$775.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$436.05
|
| Rate for Payer: Multiplan Commercial |
$901.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$823.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$436.05
|
| Rate for Payer: United Healthcare Commercial |
$920.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$436.05
|
| Rate for Payer: United Healthcare VA CCN |
$436.05
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
9601202001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$717.16 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Aetna of VT Commercial |
$920.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$717.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$717.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$823.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$813.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$775.20
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$775.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$775.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$775.20
|
| Rate for Payer: Multiplan Commercial |
$901.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$823.65
|
| Rate for Payer: United Healthcare Commercial |
$920.55
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
9811202101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$515.11 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Aetna of VT Commercial |
$661.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$515.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$515.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$591.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$584.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$556.80
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.80
|
| Rate for Payer: Multiplan Commercial |
$647.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$591.60
|
| Rate for Payer: United Healthcare Commercial |
$661.20
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
IP
|
$382.58
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
4501202101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$283.15 |
| Max. Negotiated Rate |
$363.45 |
| Rate for Payer: Aetna of VT Commercial |
$363.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$283.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$283.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$325.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$321.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$306.06
|
| Rate for Payer: Cash Price |
$191.29
|
| Rate for Payer: Cigna Commercial |
$306.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$306.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$306.06
|
| Rate for Payer: Multiplan Commercial |
$355.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$325.19
|
| Rate for Payer: United Healthcare Commercial |
$363.45
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
IP
|
$272.20
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
4501202001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$201.46 |
| Max. Negotiated Rate |
$258.59 |
| Rate for Payer: Aetna of VT Commercial |
$258.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$201.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$201.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$228.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$217.76
|
| Rate for Payer: Cash Price |
$136.10
|
| Rate for Payer: Cigna Commercial |
$217.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.76
|
| Rate for Payer: Multiplan Commercial |
$253.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$231.37
|
| Rate for Payer: United Healthcare Commercial |
$258.59
|
|
|
CLOSURE OF SPLIT WOUND
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
5101202001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$177.72 |
| Max. Negotiated Rate |
$461.85 |
| Rate for Payer: Aetna of VT Commercial |
$256.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$244.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$183.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$244.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$248.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$398.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$398.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$204.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$398.75
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cigna Commercial |
$323.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$461.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$461.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$282.43
|
| Rate for Payer: Multiplan Commercial |
$253.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$252.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$177.72
|
| Rate for Payer: United Healthcare Commercial |
$273.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.72
|
| Rate for Payer: United Healthcare VA CCN |
$177.72
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
9601202002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$308.26 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Aetna of VT Commercial |
$661.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$308.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$591.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$563.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$313.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$553.32
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$313.20
|
| Rate for Payer: Multiplan Commercial |
$647.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$591.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$313.20
|
| Rate for Payer: United Healthcare Commercial |
$661.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.20
|
| Rate for Payer: United Healthcare VA CCN |
$313.20
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
OP
|
$382.58
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
4501202101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.44 |
| Max. Negotiated Rate |
$363.45 |
| Rate for Payer: Aetna of VT Commercial |
$363.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$342.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$169.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$342.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$230.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$325.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$309.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$172.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$304.15
|
| Rate for Payer: Cash Price |
$191.29
|
| Rate for Payer: Cigna Commercial |
$306.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$306.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$306.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$172.16
|
| Rate for Payer: Multiplan Commercial |
$355.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$325.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$172.16
|
| Rate for Payer: United Healthcare Commercial |
$363.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.16
|
| Rate for Payer: United Healthcare VA CCN |
$172.16
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
9811202001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$308.26 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Aetna of VT Commercial |
$661.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$308.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$591.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$563.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$313.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$553.32
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$313.20
|
| Rate for Payer: Multiplan Commercial |
$647.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$591.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$313.20
|
| Rate for Payer: United Healthcare Commercial |
$661.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.20
|
| Rate for Payer: United Healthcare VA CCN |
$313.20
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
9811202102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$308.26 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Aetna of VT Commercial |
$661.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$308.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$623.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$591.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$563.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$313.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$553.32
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$313.20
|
| Rate for Payer: Multiplan Commercial |
$647.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$591.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$313.20
|
| Rate for Payer: United Healthcare Commercial |
$661.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.20
|
| Rate for Payer: United Healthcare VA CCN |
$313.20
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
OP
|
$272.20
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
4501202001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.56 |
| Max. Negotiated Rate |
$258.59 |
| Rate for Payer: Aetna of VT Commercial |
$258.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$243.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$120.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$243.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$163.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$122.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.40
|
| Rate for Payer: Cash Price |
$136.10
|
| Rate for Payer: Cigna Commercial |
$217.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$122.49
|
| Rate for Payer: Multiplan Commercial |
$253.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$231.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$122.49
|
| Rate for Payer: United Healthcare Commercial |
$258.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.49
|
| Rate for Payer: United Healthcare VA CCN |
$122.49
|
|
