|
APPLICATION OF FOREARM CAST
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
9812907502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$179.84 |
| 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 |
$179.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$179.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$206.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$204.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$194.40
|
| 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: Multiplan Commercial |
$225.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$206.55
|
| Rate for Payer: United Healthcare Commercial |
$230.85
|
|
|
APPLICATION OF FOREARM CAST
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
9812907501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$59.71 |
| Max. Negotiated Rate |
$312.08 |
| Rate for Payer: Aetna of VT Commercial |
$312.08
|
| 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 |
$61.50
|
| 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 |
$83.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$109.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$68.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$109.87
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$111.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$141.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$141.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.04
|
| Rate for Payer: Multiplan Commercial |
$308.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.71
|
| Rate for Payer: United Healthcare Commercial |
$91.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.71
|
| Rate for Payer: United Healthcare VA CCN |
$59.71
|
|
|
APPLICATION OF FOREARM CAST
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
5102907501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.93 |
| Max. Negotiated Rate |
$109.25 |
| Rate for Payer: Aetna of VT Commercial |
$109.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$69.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$93.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$91.42
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$106.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$97.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.75
|
| Rate for Payer: United Healthcare Commercial |
$109.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.75
|
| Rate for Payer: United Healthcare VA CCN |
$51.75
|
|
|
APPLICATION OF FOREARM CAST
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
9812907502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$59.71 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna of VT Commercial |
$228.42
|
| 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 |
$61.50
|
| 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 |
$83.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$109.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$68.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$109.87
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$111.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$141.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$141.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.04
|
| Rate for Payer: Multiplan Commercial |
$225.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.71
|
| Rate for Payer: United Healthcare Commercial |
$91.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.71
|
| Rate for Payer: United Healthcare VA CCN |
$59.71
|
|
|
APPLICATION OF FOREARM CAST
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
9602907502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$179.84 |
| 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 |
$179.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$179.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$206.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$204.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$194.40
|
| 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: Multiplan Commercial |
$225.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$206.55
|
| Rate for Payer: United Healthcare Commercial |
$230.85
|
|
|
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
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
9602907502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$59.71 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna of VT Commercial |
$228.42
|
| 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 |
$61.50
|
| 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 |
$83.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$109.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$68.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$109.87
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$111.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$141.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$141.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.04
|
| Rate for Payer: Multiplan Commercial |
$225.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.71
|
| Rate for Payer: United Healthcare Commercial |
$91.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.71
|
| Rate for Payer: United Healthcare VA CCN |
$59.71
|
|
|
APPLICATION OF FOREARM CAST
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
9822907501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$59.71 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna of VT Commercial |
$228.42
|
| 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 |
$61.50
|
| 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 |
$83.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$109.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$68.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$109.87
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$111.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$141.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$141.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.04
|
| Rate for Payer: Multiplan Commercial |
$225.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.71
|
| Rate for Payer: United Healthcare Commercial |
$91.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.71
|
| Rate for Payer: United Healthcare VA CCN |
$59.71
|
|
|
APPLICATION OF FOREARM CAST
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
9602907501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$59.71 |
| Max. Negotiated Rate |
$336.52 |
| Rate for Payer: Aetna of VT Commercial |
$336.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$320.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$61.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$320.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$83.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$109.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$68.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$109.87
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cigna Commercial |
$111.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$141.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$141.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.04
|
| Rate for Payer: Multiplan Commercial |
$332.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.71
|
| Rate for Payer: United Healthcare Commercial |
$91.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.71
|
| Rate for Payer: United Healthcare VA CCN |
$59.71
|
|
|
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
|
|
|
APPLICATION OF FOREARM CAST
|
Facility
|
IP
|
$114.77
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
4502907501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.94 |
| 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 |
$84.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$84.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$96.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$91.82
|
| 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: Multiplan Commercial |
$106.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$97.55
|
| Rate for Payer: United Healthcare Commercial |
$109.03
|
|
|
APPLICATION OF FOREARM CAST
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
9602907501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$264.96 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Aetna of VT Commercial |
$340.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$264.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$264.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$304.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$300.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$286.40
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cigna Commercial |
$286.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$286.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$286.40
|
| Rate for Payer: Multiplan Commercial |
$332.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$304.30
|
| Rate for Payer: United Healthcare Commercial |
$340.10
|
|
|
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 |
9822907501
|
|
Hospital Revenue Code
|
982
|
| 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
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
5102907501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.71 |
| Max. Negotiated Rate |
$141.43 |
| Rate for Payer: Aetna of VT Commercial |
$108.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$61.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$83.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$109.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$68.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$109.87
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$111.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$141.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$141.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.04
|
| Rate for Payer: Multiplan Commercial |
$106.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.71
|
| Rate for Payer: United Healthcare Commercial |
$91.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.71
|
| Rate for Payer: United Healthcare VA CCN |
$59.71
|
|
|
APPLICATION OF LONG ARM CAST
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
9602906501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$291.60 |
| Max. Negotiated Rate |
$374.30 |
| Rate for Payer: Aetna of VT Commercial |
$374.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$291.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$291.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$334.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$330.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$315.20
|
| Rate for Payer: Cash Price |
$197.00
|
| Rate for Payer: Cigna Commercial |
$315.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$315.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$315.20
|
| Rate for Payer: Multiplan Commercial |
$366.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$334.90
|
| Rate for Payer: United Healthcare Commercial |
$374.30
|
|
|
APPLICATION OF LONG ARM CAST
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
9812906501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$155.32 |
| 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 |
$66.49
|
| 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 |
$90.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$122.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$74.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.32
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$121.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.74
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.66
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.55
|
| Rate for Payer: United Healthcare Commercial |
$99.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.55
|
| Rate for Payer: United Healthcare VA CCN |
$64.55
|
|
|
APPLICATION OF LONG ARM CAST
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
9602906502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$125.34 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Aetna of VT Commercial |
$268.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$253.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$125.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$253.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$170.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$240.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$229.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$127.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$224.99
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cigna Commercial |
$226.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$226.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$226.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$127.35
|
| Rate for Payer: Multiplan Commercial |
$263.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$127.35
|
| Rate for Payer: United Healthcare Commercial |
$268.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.35
|
| Rate for Payer: United Healthcare VA CCN |
$127.35
|
|
|
APPLICATION OF LONG ARM CAST
|
Facility
|
IP
|
$110.90
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
4502906501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.08 |
| Max. Negotiated Rate |
$105.36 |
| Rate for Payer: Aetna of VT Commercial |
$105.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$82.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$82.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$93.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.72
|
| Rate for Payer: Cash Price |
$55.45
|
| Rate for Payer: Cigna Commercial |
$88.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.72
|
| Rate for Payer: Multiplan Commercial |
$103.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.27
|
| Rate for Payer: United Healthcare Commercial |
$105.36
|
|
|
APPLICATION OF LONG ARM CAST
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
9602906502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$209.45 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Aetna of VT Commercial |
$268.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$209.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$209.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$240.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$237.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$226.40
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cigna Commercial |
$226.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$226.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$226.40
|
| Rate for Payer: Multiplan Commercial |
$263.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.55
|
| Rate for Payer: United Healthcare Commercial |
$268.85
|
|
|
APPLICATION OF LONG ARM CAST
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
9822906501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$64.55 |
| Max. Negotiated Rate |
$266.02 |
| Rate for Payer: Aetna of VT Commercial |
$266.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$253.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$66.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$253.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$90.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$122.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$74.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.32
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cigna Commercial |
$121.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.74
|
| Rate for Payer: Multiplan Commercial |
$263.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.66
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.55
|
| Rate for Payer: United Healthcare Commercial |
$99.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.55
|
| Rate for Payer: United Healthcare VA CCN |
$64.55
|
|
|
APPLICATION OF LONG ARM CAST
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
9822906501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$209.45 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Aetna of VT Commercial |
$268.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$209.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$209.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$240.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$237.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$226.40
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cigna Commercial |
$226.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$226.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$226.40
|
| Rate for Payer: Multiplan Commercial |
$263.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.55
|
| Rate for Payer: United Healthcare Commercial |
$268.85
|
|
|
APPLICATION OF LONG ARM CAST
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
5102906501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.55 |
| Max. Negotiated Rate |
$155.32 |
| Rate for Payer: Aetna of VT Commercial |
$104.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$66.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$90.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$122.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$74.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.32
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$121.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.74
|
| Rate for Payer: Multiplan Commercial |
$103.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.66
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.55
|
| Rate for Payer: United Healthcare Commercial |
$99.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.55
|
| Rate for Payer: United Healthcare VA CCN |
$64.55
|
|
|
APPLICATION OF LONG ARM CAST
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
5102906501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Aetna of VT Commercial |
$105.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$66.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.25
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$88.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.95
|
| Rate for Payer: Multiplan Commercial |
$103.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.95
|
| Rate for Payer: United Healthcare Commercial |
$105.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.95
|
| Rate for Payer: United Healthcare VA CCN |
$49.95
|
|
|
APPLICATION OF LONG ARM CAST
|
Facility
|
OP
|
$110.90
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
4502906501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$49.12 |
| Max. Negotiated Rate |
$105.36 |
| Rate for Payer: Aetna of VT Commercial |
$105.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$66.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.17
|
| Rate for Payer: Cash Price |
$55.45
|
| Rate for Payer: Cigna Commercial |
$88.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.91
|
| Rate for Payer: Multiplan Commercial |
$103.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.91
|
| Rate for Payer: United Healthcare Commercial |
$105.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.91
|
| Rate for Payer: United Healthcare VA CCN |
$49.91
|
|
