|
APPLICATION OF LONG LEG CAST
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
5102934501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.17 |
| Max. Negotiated Rate |
$216.01 |
| Rate for Payer: Aetna of VT Commercial |
$114.68
|
| 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 |
$95.97
|
| 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 |
$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 |
$61.00
|
| Rate for Payer: Cash Price |
$61.00
|
| 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 |
$113.46
|
| 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
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT 29355
|
| Hospital Charge Code |
9822935501
|
|
Hospital Revenue Code
|
982
|
| 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
|
Professional
|
Both
|
$635.00
|
|
|
Service Code
|
CPT 29355
|
| Hospital Charge Code |
9602935501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$99.15 |
| Max. Negotiated Rate |
$596.90 |
| Rate for Payer: Aetna of VT Commercial |
$596.90
|
| 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 |
$102.12
|
| 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 |
$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 |
$317.50
|
| Rate for Payer: Cash Price |
$317.50
|
| 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 |
$590.55
|
| 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
|
$122.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
5102934501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.29 |
| 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 |
$90.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$90.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$103.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$102.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$97.60
|
| 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: Multiplan Commercial |
$113.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$103.70
|
| Rate for Payer: United Healthcare Commercial |
$115.90
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
OP
|
$121.50
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
4502934501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.81 |
| 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 |
$108.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$53.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$108.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$103.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$98.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$54.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$96.59
|
| 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: Martins Point Health Care Commercial |
$54.67
|
| Rate for Payer: Multiplan Commercial |
$113.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$103.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$54.67
|
| Rate for Payer: United Healthcare Commercial |
$115.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.67
|
| Rate for Payer: United Healthcare VA CCN |
$54.67
|
|
|
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
|
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
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
9822934501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$93.17 |
| Max. Negotiated Rate |
$324.30 |
| Rate for Payer: Aetna of VT Commercial |
$324.30
|
| 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 |
$95.97
|
| 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 |
$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 |
$172.50
|
| Rate for Payer: Cash Price |
$172.50
|
| 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 |
$320.85
|
| 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
|
|
|
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
|
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
|
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
|
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
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT 29355
|
| Hospital Charge Code |
9822935501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$299.00 |
| 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 |
$299.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$299.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$343.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$339.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$323.20
|
| 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: Multiplan Commercial |
$375.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$343.40
|
| Rate for Payer: United Healthcare Commercial |
$383.80
|
|
|
APPLICATION OF LONG LEG CAST
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
9812934502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$93.17 |
| Max. Negotiated Rate |
$324.30 |
| Rate for Payer: Aetna of VT Commercial |
$324.30
|
| 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 |
$95.97
|
| 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 |
$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 |
$172.50
|
| Rate for Payer: Cash Price |
$172.50
|
| 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 |
$320.85
|
| 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
|
|
|
APPLICATION OF LONG LEG CAST
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
9602934502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$93.17 |
| Max. Negotiated Rate |
$324.30 |
| Rate for Payer: Aetna of VT Commercial |
$324.30
|
| 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 |
$95.97
|
| 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 |
$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 |
$172.50
|
| Rate for Payer: Cash Price |
$172.50
|
| 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 |
$320.85
|
| 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
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
9812934501
|
|
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 LEG CAST
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT 29355
|
| Hospital Charge Code |
9602935502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$299.00 |
| 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 |
$299.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$299.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$343.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$339.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$323.20
|
| 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: Multiplan Commercial |
$375.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$343.40
|
| Rate for Payer: United Healthcare Commercial |
$383.80
|
|
|
APPLICATON ON-BODY INJECTOR
|
Facility
|
OP
|
$144.24
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
2609637701
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$63.88 |
| Max. Negotiated Rate |
$137.03 |
| Rate for Payer: Aetna of VT Commercial |
$137.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$129.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$63.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$129.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$86.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$116.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.67
|
| Rate for Payer: Cash Price |
$72.12
|
| Rate for Payer: Cigna Commercial |
$115.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$64.91
|
| Rate for Payer: Multiplan Commercial |
$134.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.91
|
| Rate for Payer: United Healthcare Commercial |
$137.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.91
|
| Rate for Payer: United Healthcare VA CCN |
$64.91
|
|
|
APPLICATON ON-BODY INJECTOR
|
Facility
|
IP
|
$144.24
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
2609637701
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$106.75 |
| Max. Negotiated Rate |
$137.03 |
| Rate for Payer: Aetna of VT Commercial |
$137.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$121.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$115.39
|
| Rate for Payer: Cash Price |
$72.12
|
| Rate for Payer: Cigna Commercial |
$115.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.39
|
| Rate for Payer: Multiplan Commercial |
$134.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.60
|
| Rate for Payer: United Healthcare Commercial |
$137.03
|
|
|
APPLY BONE FIXATION DEVICE
|
Professional
|
Both
|
$1,419.00
|
|
|
Service Code
|
CPT 20690
|
| Hospital Charge Code |
9822069001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$560.47 |
| Max. Negotiated Rate |
$1,333.86 |
| Rate for Payer: Aetna of VT Commercial |
$1,333.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,271.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$577.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,271.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$784.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$705.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$705.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$644.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$705.06
|
| Rate for Payer: Cash Price |
$709.50
|
| Rate for Payer: Cash Price |
$709.50
|
| Rate for Payer: Cigna Commercial |
$1,060.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$936.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$936.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$560.47
|
| Rate for Payer: Multiplan Commercial |
$1,319.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$795.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$560.47
|
| Rate for Payer: United Healthcare Commercial |
$862.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$560.47
|
| Rate for Payer: United Healthcare VA CCN |
$560.47
|
|
|
APPLY BONE FIXATION DEVICE
|
Facility
|
IP
|
$1,419.00
|
|
|
Service Code
|
CPT 20690
|
| Hospital Charge Code |
9822069001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,050.20 |
| Max. Negotiated Rate |
$1,348.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,348.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,050.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,050.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,206.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,191.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,135.20
|
| Rate for Payer: Cash Price |
$709.50
|
| Rate for Payer: Cigna Commercial |
$1,135.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,135.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,135.20
|
| Rate for Payer: Multiplan Commercial |
$1,319.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,206.15
|
| Rate for Payer: United Healthcare Commercial |
$1,348.05
|
|
|
APPLY BONE FIXATION DEVICE
|
Facility
|
OP
|
$1,419.00
|
|
|
Service Code
|
CPT 20690
|
| Hospital Charge Code |
9822069001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$628.48 |
| Max. Negotiated Rate |
$1,348.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,348.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,271.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$628.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,271.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$854.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,206.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,149.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$638.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,128.11
|
| Rate for Payer: Cash Price |
$709.50
|
| Rate for Payer: Cigna Commercial |
$1,135.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,135.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,135.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$638.55
|
| Rate for Payer: Multiplan Commercial |
$1,319.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,206.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$638.55
|
| Rate for Payer: United Healthcare Commercial |
$1,348.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$638.55
|
| Rate for Payer: United Healthcare VA CCN |
$638.55
|
|
|
APPLY FOREARM SPLINT
|
Facility
|
IP
|
$229.55
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
4502912501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.89 |
| Max. Negotiated Rate |
$218.07 |
| Rate for Payer: Aetna of VT Commercial |
$218.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$169.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$169.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$192.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$183.64
|
| Rate for Payer: Cash Price |
$114.78
|
| Rate for Payer: Cigna Commercial |
$183.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.64
|
| Rate for Payer: Multiplan Commercial |
$213.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.12
|
| Rate for Payer: United Healthcare Commercial |
$218.07
|
|
|
APPLY FOREARM SPLINT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
9812912501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$145.06 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Aetna of VT Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$145.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$145.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$164.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$156.80
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cigna Commercial |
$156.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$156.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$156.80
|
| Rate for Payer: Multiplan Commercial |
$182.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$166.60
|
| Rate for Payer: United Healthcare Commercial |
$186.20
|
|
|
APPLY FOREARM SPLINT
|
Facility
|
OP
|
$229.55
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
4502912501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.67 |
| Max. Negotiated Rate |
$218.07 |
| Rate for Payer: Aetna of VT Commercial |
$218.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$205.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$101.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$205.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$138.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$185.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$182.49
|
| Rate for Payer: Cash Price |
$114.78
|
| Rate for Payer: Cigna Commercial |
$183.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$103.30
|
| Rate for Payer: Multiplan Commercial |
$213.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.30
|
| Rate for Payer: United Healthcare Commercial |
$218.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.30
|
| Rate for Payer: United Healthcare VA CCN |
$103.30
|
|
