|
APPLICATION LOWER LEG SPLINT
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
9812951502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$47.14 |
| Max. Negotiated Rate |
$159.80 |
| Rate for Payer: Aetna of VT Commercial |
$159.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$90.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$54.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$90.53
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$89.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.91
|
| Rate for Payer: Multiplan Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.14
|
| Rate for Payer: United Healthcare Commercial |
$72.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.14
|
| Rate for Payer: United Healthcare VA CCN |
$47.14
|
|
|
APPLICATION LOWER LEG SPLINT
|
Facility
|
IP
|
$240.43
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
4502951501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$177.94 |
| Max. Negotiated Rate |
$228.41 |
| Rate for Payer: Aetna of VT Commercial |
$228.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$177.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$177.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$204.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$201.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$192.34
|
| Rate for Payer: Cash Price |
$120.22
|
| Rate for Payer: Cigna Commercial |
$192.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$192.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$192.34
|
| Rate for Payer: Multiplan Commercial |
$223.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$204.37
|
| Rate for Payer: United Healthcare Commercial |
$228.41
|
|
|
APPLICATION LOWER LEG SPLINT
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
9812951501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$47.14 |
| Max. Negotiated Rate |
$230.30 |
| Rate for Payer: Aetna of VT Commercial |
$230.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$219.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$219.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$90.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$54.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$90.53
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$89.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.91
|
| Rate for Payer: Multiplan Commercial |
$227.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.14
|
| Rate for Payer: United Healthcare Commercial |
$72.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.14
|
| Rate for Payer: United Healthcare VA CCN |
$47.14
|
|
|
APPLICATION LOWER LEG SPLINT
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
9822951501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$125.82 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Aetna of VT Commercial |
$161.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$136.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.00
|
| Rate for Payer: Multiplan Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$144.50
|
| Rate for Payer: United Healthcare Commercial |
$161.50
|
|
|
APPLICATION LOWER LEG SPLINT
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
9812951501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$181.32 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna of VT Commercial |
$232.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$181.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$181.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$208.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.00
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$196.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.00
|
| Rate for Payer: Multiplan Commercial |
$227.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$208.25
|
| Rate for Payer: United Healthcare Commercial |
$232.75
|
|
|
APPLICATION LOWER LEG SPLINT
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
9822951501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$75.29 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Aetna of VT Commercial |
$161.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$75.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$102.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$137.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.15
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.50
|
| Rate for Payer: Multiplan Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$144.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.50
|
| Rate for Payer: United Healthcare Commercial |
$161.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.50
|
| Rate for Payer: United Healthcare VA CCN |
$76.50
|
|
|
APPLICATION LOWER LEG SPLINT
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
9812951502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$125.82 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Aetna of VT Commercial |
$161.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$136.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.00
|
| Rate for Payer: Multiplan Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$144.50
|
| Rate for Payer: United Healthcare Commercial |
$161.50
|
|
|
APPLICATION LOWER LEG SPLINT
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
9812951501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$108.51 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna of VT Commercial |
$232.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$219.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$108.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$219.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$147.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$208.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$198.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$110.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$194.78
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$196.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$110.25
|
| Rate for Payer: Multiplan Commercial |
$227.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$208.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$110.25
|
| Rate for Payer: United Healthcare Commercial |
$232.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.25
|
| Rate for Payer: United Healthcare VA CCN |
$110.25
|
|
|
APPLICATION LOWER LEG SPLINT
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
9822951501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$47.14 |
| Max. Negotiated Rate |
$159.80 |
| Rate for Payer: Aetna of VT Commercial |
$159.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$90.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$54.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$90.53
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$89.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.91
|
| Rate for Payer: Multiplan Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.14
|
| Rate for Payer: United Healthcare Commercial |
$72.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.14
|
| Rate for Payer: United Healthcare VA CCN |
$47.14
|
|
|
APPLICATION OF FINGER SPLINT
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
9812913002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$26.83 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: Aetna of VT Commercial |
$91.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$57.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.07
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$50.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$40.64
|
| Rate for Payer: Multiplan Commercial |
$90.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.83
|
| Rate for Payer: United Healthcare Commercial |
$41.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.83
|
| Rate for Payer: United Healthcare VA CCN |
$26.83
|
|
|
APPLICATION OF FINGER SPLINT
|
Facility
|
IP
|
$147.86
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
4502913001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.43 |
| Max. Negotiated Rate |
$140.47 |
| Rate for Payer: Aetna of VT Commercial |
$140.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$109.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$109.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$125.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$118.29
|
| Rate for Payer: Cash Price |
$73.93
|
| Rate for Payer: Cigna Commercial |
$118.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$118.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$118.29
|
| Rate for Payer: Multiplan Commercial |
$137.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$125.68
|
| Rate for Payer: United Healthcare Commercial |
$140.47
|
|
|
APPLICATION OF FINGER SPLINT
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
9812913001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$26.83 |
| Max. Negotiated Rate |
$133.48 |
| Rate for Payer: Aetna of VT Commercial |
$133.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$127.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$127.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$57.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.07
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$50.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$40.64
|
| Rate for Payer: Multiplan Commercial |
$132.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.83
|
| Rate for Payer: United Healthcare Commercial |
$41.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.83
|
| Rate for Payer: United Healthcare VA CCN |
$26.83
|
|
|
APPLICATION OF FINGER SPLINT
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
9812913002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$42.96 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Aetna of VT Commercial |
$92.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$42.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$58.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$82.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$77.11
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$77.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$77.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$77.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$43.65
|
| Rate for Payer: Multiplan Commercial |
$90.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$82.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$43.65
|
| Rate for Payer: United Healthcare Commercial |
$92.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.65
|
| Rate for Payer: United Healthcare VA CCN |
$43.65
|
|
|
APPLICATION OF FINGER SPLINT
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
9812913001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$62.89 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Aetna of VT Commercial |
$134.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$127.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$127.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$85.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$115.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.89
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$113.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.90
|
| Rate for Payer: Multiplan Commercial |
$132.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.90
|
| Rate for Payer: United Healthcare Commercial |
$134.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.90
|
| Rate for Payer: United Healthcare VA CCN |
$63.90
|
|
|
APPLICATION OF FINGER SPLINT
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
9812913001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$105.09 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Aetna of VT Commercial |
$134.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$119.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.60
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$113.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.60
|
| Rate for Payer: Multiplan Commercial |
$132.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.70
|
| Rate for Payer: United Healthcare Commercial |
$134.90
|
|
|
APPLICATION OF FINGER SPLINT
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
9812913002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$71.79 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Aetna of VT Commercial |
$92.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$82.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$81.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$77.60
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$77.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$77.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$77.60
|
| Rate for Payer: Multiplan Commercial |
$90.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$82.45
|
| Rate for Payer: United Healthcare Commercial |
$92.15
|
|
|
APPLICATION OF FINGER SPLINT
|
Facility
|
OP
|
$147.86
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
4502913001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$65.49 |
| Max. Negotiated Rate |
$140.47 |
| Rate for Payer: Aetna of VT Commercial |
$140.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$132.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$65.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$132.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$125.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$119.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$66.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$117.55
|
| Rate for Payer: Cash Price |
$73.93
|
| Rate for Payer: Cigna Commercial |
$118.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$118.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$118.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$66.54
|
| Rate for Payer: Multiplan Commercial |
$137.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$125.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.54
|
| Rate for Payer: United Healthcare Commercial |
$140.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.54
|
| Rate for Payer: United Healthcare VA CCN |
$66.54
|
|
|
APPLICATION OF FINGER SPLINT
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
9822913001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$71.79 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Aetna of VT Commercial |
$92.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$82.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$81.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$77.60
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$77.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$77.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$77.60
|
| Rate for Payer: Multiplan Commercial |
$90.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$82.45
|
| Rate for Payer: United Healthcare Commercial |
$92.15
|
|
|
APPLICATION OF FINGER SPLINT
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
9822913001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$26.83 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: Aetna of VT Commercial |
$91.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$57.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.07
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$50.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$40.64
|
| Rate for Payer: Multiplan Commercial |
$90.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.83
|
| Rate for Payer: United Healthcare Commercial |
$41.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.83
|
| Rate for Payer: United Healthcare VA CCN |
$26.83
|
|
|
APPLICATION OF FINGER SPLINT
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
9822913001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$42.96 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Aetna of VT Commercial |
$92.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$42.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$58.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$82.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$77.11
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$77.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$77.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$77.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$43.65
|
| Rate for Payer: Multiplan Commercial |
$90.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$82.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$43.65
|
| Rate for Payer: United Healthcare Commercial |
$92.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.65
|
| Rate for Payer: United Healthcare VA CCN |
$43.65
|
|
|
APPLICATION OF FOREARM CAST
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
9812907502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$107.62 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna of VT Commercial |
$230.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$217.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$107.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$217.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$146.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$206.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$109.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$193.19
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$194.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$194.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$194.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$109.35
|
| Rate for Payer: Multiplan Commercial |
$225.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$206.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$109.35
|
| Rate for Payer: United Healthcare Commercial |
$230.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$109.35
|
| Rate for Payer: United Healthcare VA CCN |
$109.35
|
|
|
APPLICATION OF FOREARM CAST
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
9812907501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$147.04 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Aetna of VT Commercial |
$315.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$297.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$147.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$297.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$199.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$282.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$268.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$263.94
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$265.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$265.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$265.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$149.40
|
| Rate for Payer: Multiplan Commercial |
$308.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$282.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$149.40
|
| Rate for Payer: United Healthcare Commercial |
$315.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.40
|
| Rate for Payer: United Healthcare VA CCN |
$149.40
|
|
|
APPLICATION OF FOREARM CAST
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
9602907502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$107.62 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna of VT Commercial |
$230.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$217.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$107.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$217.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$146.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$206.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$109.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$193.19
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$194.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$194.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$194.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$109.35
|
| Rate for Payer: Multiplan Commercial |
$225.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$206.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$109.35
|
| Rate for Payer: United Healthcare Commercial |
$230.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$109.35
|
| Rate for Payer: United Healthcare VA CCN |
$109.35
|
|
|
APPLICATION OF FOREARM CAST
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
9812907501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$245.71 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Aetna of VT Commercial |
$315.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$245.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$245.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$282.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$265.60
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$265.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$265.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$265.60
|
| Rate for Payer: Multiplan Commercial |
$308.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$282.20
|
| Rate for Payer: United Healthcare Commercial |
$315.40
|
|
|
APPLICATION OF FOREARM CAST
|
Facility
|
OP
|
$114.77
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
4502907501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$109.03 |
| Rate for Payer: Aetna of VT Commercial |
$109.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$69.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$91.24
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cigna Commercial |
$91.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$51.65
|
| Rate for Payer: Multiplan Commercial |
$106.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$97.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.65
|
| Rate for Payer: United Healthcare Commercial |
$109.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.65
|
| Rate for Payer: United Healthcare VA CCN |
$51.65
|
|
