|
APPLICATION OF LONG ARM CAST
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
9812906501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
APPLICATION OF LONG ARM CAST
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
9812906502
|
|
Hospital Revenue Code
|
981
|
| 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
|
$111.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
5102906501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.15 |
| 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 |
$82.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$82.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$93.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.80
|
| 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: Multiplan Commercial |
$103.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.35
|
| Rate for Payer: United Healthcare Commercial |
$105.45
|
|
|
APPLICATION OF LONG ARM CAST
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
9812906502
|
|
Hospital Revenue Code
|
981
|
| 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
|
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
|
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
|
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
|
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
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
9602906502
|
|
Hospital Revenue Code
|
960
|
| 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
|
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 LEG CAST
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
9602934501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$344.89 |
| Max. Negotiated Rate |
$442.70 |
| Rate for Payer: Aetna of VT Commercial |
$442.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$344.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$344.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$396.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$391.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$372.80
|
| Rate for Payer: Cash Price |
$233.00
|
| Rate for Payer: Cigna Commercial |
$372.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$372.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$372.80
|
| Rate for Payer: Multiplan Commercial |
$433.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$396.10
|
| Rate for Payer: United Healthcare Commercial |
$442.70
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
9812934501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 29355
|
| Hospital Charge Code |
5102935501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$170.96 |
| Max. Negotiated Rate |
$219.45 |
| Rate for Payer: Aetna of VT Commercial |
$219.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$170.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$170.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$196.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$194.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$184.80
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$184.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$184.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$214.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$196.35
|
| Rate for Payer: United Healthcare Commercial |
$219.45
|
|
|
APPLICATION OF LONG LEG CAST
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
CPT 29355
|
| Hospital Charge Code |
5102935501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.15 |
| Max. Negotiated Rate |
$225.26 |
| Rate for Payer: Aetna of VT Commercial |
$217.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$206.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$102.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$206.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$138.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$184.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$114.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$184.30
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$188.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$225.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$225.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$136.73
|
| Rate for Payer: Multiplan Commercial |
$214.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$140.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.15
|
| Rate for Payer: United Healthcare Commercial |
$152.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.15
|
| Rate for Payer: United Healthcare VA CCN |
$99.15
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
9822934501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Aetna of VT Commercial |
$327.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$309.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$152.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$309.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$207.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$293.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$279.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$155.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$274.27
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$276.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$276.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$155.25
|
| Rate for Payer: Multiplan Commercial |
$320.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$293.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$155.25
|
| Rate for Payer: United Healthcare Commercial |
$327.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.25
|
| Rate for Payer: United Healthcare VA CCN |
$155.25
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT 29355
|
| Hospital Charge Code |
9602935502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$178.93 |
| Max. Negotiated Rate |
$383.80 |
| Rate for Payer: Aetna of VT Commercial |
$383.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$361.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$178.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$361.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$243.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$343.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$327.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$181.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$321.18
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cigna Commercial |
$323.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$323.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$323.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$181.80
|
| Rate for Payer: Multiplan Commercial |
$375.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$343.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$181.80
|
| Rate for Payer: United Healthcare Commercial |
$383.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.80
|
| Rate for Payer: United Healthcare VA CCN |
$181.80
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
9812934502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Aetna of VT Commercial |
$327.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$309.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$152.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$309.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$207.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$293.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$279.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$155.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$274.27
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$276.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$276.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$155.25
|
| Rate for Payer: Multiplan Commercial |
$320.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$293.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$155.25
|
| Rate for Payer: United Healthcare Commercial |
$327.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.25
|
| Rate for Payer: United Healthcare VA CCN |
$155.25
|
|
|
APPLICATION OF LONG LEG CAST
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
CPT 29355
|
| Hospital Charge Code |
9602935502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$99.15 |
| Max. Negotiated Rate |
$379.76 |
| Rate for Payer: Aetna of VT Commercial |
$379.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$361.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$102.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$361.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$138.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$184.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$114.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$184.30
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cigna Commercial |
$188.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$225.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$225.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$136.73
|
| Rate for Payer: Multiplan Commercial |
$375.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$140.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.15
|
| Rate for Payer: United Healthcare Commercial |
$152.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.15
|
| Rate for Payer: United Healthcare VA CCN |
$99.15
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
9822934501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$255.33 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Aetna of VT Commercial |
$327.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$255.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$255.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$293.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$289.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$276.00
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$276.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$276.00
|
| Rate for Payer: Multiplan Commercial |
$320.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$293.25
|
| Rate for Payer: United Healthcare Commercial |
$327.75
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
5102934501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.03 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Aetna of VT Commercial |
$115.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$109.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$109.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$103.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$98.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$54.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$96.99
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$97.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$97.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$97.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.90
|
| Rate for Payer: Multiplan Commercial |
$113.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$103.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$54.90
|
| Rate for Payer: United Healthcare Commercial |
$115.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.90
|
| Rate for Payer: United Healthcare VA CCN |
$54.90
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
9602934501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$206.39 |
| Max. Negotiated Rate |
$442.70 |
| Rate for Payer: Aetna of VT Commercial |
$442.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$417.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$206.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$417.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$280.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$396.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$377.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$209.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$370.47
|
| Rate for Payer: Cash Price |
$233.00
|
| Rate for Payer: Cigna Commercial |
$372.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$372.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$372.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$209.70
|
| Rate for Payer: Multiplan Commercial |
$433.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$396.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$209.70
|
| Rate for Payer: United Healthcare Commercial |
$442.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$209.70
|
| Rate for Payer: United Healthcare VA CCN |
$209.70
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
9602934502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Aetna of VT Commercial |
$327.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$309.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$152.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$309.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$207.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$293.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$279.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$155.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$274.27
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$276.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$276.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$155.25
|
| Rate for Payer: Multiplan Commercial |
$320.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$293.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$155.25
|
| Rate for Payer: United Healthcare Commercial |
$327.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.25
|
| Rate for Payer: United Healthcare VA CCN |
$155.25
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
IP
|
$121.50
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
4502934501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.92 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna of VT Commercial |
$115.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$89.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$89.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$103.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$102.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$97.20
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna Commercial |
$97.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$97.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$113.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$103.28
|
| Rate for Payer: United Healthcare Commercial |
$115.42
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
OP
|
$635.00
|
|
|
Service Code
|
CPT 29355
|
| Hospital Charge Code |
9602935501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$281.24 |
| Max. Negotiated Rate |
$603.25 |
| Rate for Payer: Aetna of VT Commercial |
$603.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$568.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$281.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$568.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$382.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$539.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$514.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$285.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$504.82
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cigna Commercial |
$508.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$508.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$508.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$285.75
|
| Rate for Payer: Multiplan Commercial |
$590.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$539.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$285.75
|
| Rate for Payer: United Healthcare Commercial |
$603.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$285.75
|
| Rate for Payer: United Healthcare VA CCN |
$285.75
|
|
|
APPLICATION OF LONG LEG CAST
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
9602934501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$93.17 |
| Max. Negotiated Rate |
$438.04 |
| Rate for Payer: Aetna of VT Commercial |
$438.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$417.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$95.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$417.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$130.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$179.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$107.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$179.52
|
| Rate for Payer: Cash Price |
$233.00
|
| Rate for Payer: Cash Price |
$233.00
|
| Rate for Payer: Cigna Commercial |
$175.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$216.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$216.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$131.08
|
| Rate for Payer: Multiplan Commercial |
$433.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$93.17
|
| Rate for Payer: United Healthcare Commercial |
$143.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.17
|
| Rate for Payer: United Healthcare VA CCN |
$93.17
|
|
