|
APPLY FOREARM SPLINT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
9812912501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$86.81 |
| 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 |
$175.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$86.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$175.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$117.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$158.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.82
|
| 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: Martins Point Health Care Commercial |
$88.20
|
| Rate for Payer: Multiplan Commercial |
$182.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$166.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$88.20
|
| Rate for Payer: United Healthcare Commercial |
$186.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.20
|
| Rate for Payer: United Healthcare VA CCN |
$88.20
|
|
|
APPLY FOREARM SPLINT
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
9812912501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$38.39 |
| Max. Negotiated Rate |
$184.24 |
| Rate for Payer: Aetna of VT Commercial |
$184.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$175.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$175.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$88.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$88.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.42
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cigna Commercial |
$72.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$65.69
|
| Rate for Payer: Multiplan Commercial |
$182.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.39
|
| Rate for Payer: United Healthcare Commercial |
$59.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.39
|
| Rate for Payer: United Healthcare VA CCN |
$38.39
|
|
|
APPLY FOREARM SPLINT
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
9822912501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$105.83 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Aetna of VT Commercial |
$135.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$121.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$120.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.40
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cigna Commercial |
$114.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$114.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$114.40
|
| Rate for Payer: Multiplan Commercial |
$132.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$121.55
|
| Rate for Payer: United Healthcare Commercial |
$135.85
|
|
|
APPLY FOREARM SPLINT
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
9812912502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$63.33 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Aetna of VT Commercial |
$135.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$128.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$63.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$128.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$86.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$121.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$115.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.69
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cigna Commercial |
$114.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$114.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$114.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$64.35
|
| Rate for Payer: Multiplan Commercial |
$132.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$121.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.35
|
| Rate for Payer: United Healthcare Commercial |
$135.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.35
|
| Rate for Payer: United Healthcare VA CCN |
$64.35
|
|
|
APPLY FOREARM SPLINT
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
9812912502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$105.83 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Aetna of VT Commercial |
$135.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$121.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$120.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.40
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cigna Commercial |
$114.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$114.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$114.40
|
| Rate for Payer: Multiplan Commercial |
$132.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$121.55
|
| Rate for Payer: United Healthcare Commercial |
$135.85
|
|
|
APPLY FOREARM SPLINT
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
9812912502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$38.39 |
| Max. Negotiated Rate |
$134.42 |
| Rate for Payer: Aetna of VT Commercial |
$134.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$128.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$128.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$88.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$88.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.42
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cigna Commercial |
$72.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$65.69
|
| Rate for Payer: Multiplan Commercial |
$132.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.39
|
| Rate for Payer: United Healthcare Commercial |
$59.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.39
|
| Rate for Payer: United Healthcare VA CCN |
$38.39
|
|
|
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
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
9822912501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$38.39 |
| Max. Negotiated Rate |
$134.42 |
| Rate for Payer: Aetna of VT Commercial |
$134.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$128.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$128.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$88.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$88.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.42
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cigna Commercial |
$72.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$65.69
|
| Rate for Payer: Multiplan Commercial |
$132.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.39
|
| Rate for Payer: United Healthcare Commercial |
$59.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.39
|
| Rate for Payer: United Healthcare VA CCN |
$38.39
|
|
|
APPLY HAND/WRIST CAST
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
9812908501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$154.81 |
| 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 |
$66.16
|
| 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 |
$89.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$122.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$73.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.72
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$120.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$154.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$154.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.42
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.23
|
| Rate for Payer: United Healthcare Commercial |
$98.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.23
|
| Rate for Payer: United Healthcare VA CCN |
$64.23
|
|
|
APPLY HAND/WRIST CAST
|
Facility
|
OP
|
$165.44
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
4502908501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.27 |
| Max. Negotiated Rate |
$157.17 |
| Rate for Payer: Aetna of VT Commercial |
$157.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$148.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$73.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$148.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$99.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$140.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$134.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$74.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$131.52
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cigna Commercial |
$132.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$74.45
|
| Rate for Payer: Multiplan Commercial |
$153.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$140.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.45
|
| Rate for Payer: United Healthcare Commercial |
$157.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.45
|
| Rate for Payer: United Healthcare VA CCN |
$74.45
|
|
|
APPLY HAND/WRIST CAST
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
9602908502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$64.23 |
| Max. Negotiated Rate |
$251.92 |
| Rate for Payer: Aetna of VT Commercial |
$251.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$66.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$89.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$122.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$73.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.72
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cigna Commercial |
$120.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$154.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$154.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.42
|
| Rate for Payer: Multiplan Commercial |
$249.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.23
|
| Rate for Payer: United Healthcare Commercial |
$98.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.23
|
| Rate for Payer: United Healthcare VA CCN |
$64.23
|
|
|
APPLY HAND/WRIST CAST
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
5102908501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.23 |
| Max. Negotiated Rate |
$156.04 |
| Rate for Payer: Aetna of VT Commercial |
$156.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$148.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$66.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$148.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$89.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$122.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$73.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.72
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$120.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$154.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$154.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.42
|
| Rate for Payer: Multiplan Commercial |
$154.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.23
|
| Rate for Payer: United Healthcare Commercial |
$98.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.23
|
| Rate for Payer: United Healthcare VA CCN |
$64.23
|
|
|
APPLY HAND/WRIST CAST
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
9812908501
|
|
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
|
|
|
APPLY HAND/WRIST CAST
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
5102908501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$122.86 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Aetna of VT Commercial |
$157.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$122.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$122.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$141.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$139.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$132.80
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.80
|
| Rate for Payer: Multiplan Commercial |
$154.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.10
|
| Rate for Payer: United Healthcare Commercial |
$157.70
|
|
|
APPLY HAND/WRIST CAST
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
5102908501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.52 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Aetna of VT Commercial |
$157.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$148.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$73.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$148.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$99.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$141.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$134.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$74.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$131.97
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$74.70
|
| Rate for Payer: Multiplan Commercial |
$154.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.70
|
| Rate for Payer: United Healthcare Commercial |
$157.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.70
|
| Rate for Payer: United Healthcare VA CCN |
$74.70
|
|
|
APPLY HAND/WRIST CAST
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
9602908502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$198.35 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna of VT Commercial |
$254.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$198.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$198.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$227.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$225.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$214.40
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cigna Commercial |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$214.40
|
| Rate for Payer: Multiplan Commercial |
$249.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$227.80
|
| Rate for Payer: United Healthcare Commercial |
$254.60
|
|
|
APPLY HAND/WRIST CAST
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
9812908501
|
|
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
|
|
|
APPLY HAND/WRIST CAST
|
Facility
|
IP
|
$165.44
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
4502908501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.44 |
| Max. Negotiated Rate |
$157.17 |
| Rate for Payer: Aetna of VT Commercial |
$157.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$122.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$122.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$140.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$138.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$132.35
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cigna Commercial |
$132.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.35
|
| Rate for Payer: Multiplan Commercial |
$153.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$140.62
|
| Rate for Payer: United Healthcare Commercial |
$157.17
|
|
|
APPLY HAND/WRIST CAST
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
9812908502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$198.35 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna of VT Commercial |
$254.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$198.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$198.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$227.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$225.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$214.40
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cigna Commercial |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$214.40
|
| Rate for Payer: Multiplan Commercial |
$249.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$227.80
|
| Rate for Payer: United Healthcare Commercial |
$254.60
|
|
|
APPLY HAND/WRIST CAST
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
9602908501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$64.23 |
| Max. Negotiated Rate |
$407.96 |
| Rate for Payer: Aetna of VT Commercial |
$407.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$388.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$66.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$388.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$89.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$122.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$73.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.72
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cigna Commercial |
$120.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$154.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$154.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.42
|
| Rate for Payer: Multiplan Commercial |
$403.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.23
|
| Rate for Payer: United Healthcare Commercial |
$98.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.23
|
| Rate for Payer: United Healthcare VA CCN |
$64.23
|
|
|
APPLY HAND/WRIST CAST
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
9602908502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$118.70 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna of VT Commercial |
$254.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$118.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$161.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$227.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$213.06
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cigna Commercial |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$214.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.60
|
| Rate for Payer: Multiplan Commercial |
$249.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$227.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$120.60
|
| Rate for Payer: United Healthcare Commercial |
$254.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.60
|
| Rate for Payer: United Healthcare VA CCN |
$120.60
|
|
|
APPLY HAND/WRIST CAST
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
9602908501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna of VT Commercial |
$412.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$321.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$321.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$368.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$364.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$347.20
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cigna Commercial |
$347.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$347.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$347.20
|
| Rate for Payer: Multiplan Commercial |
$403.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$368.90
|
| Rate for Payer: United Healthcare Commercial |
$412.30
|
|
|
APPLY HAND/WRIST CAST
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
9812908502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$118.70 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna of VT Commercial |
$254.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$118.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$161.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$227.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$213.06
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cigna Commercial |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$214.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.60
|
| Rate for Payer: Multiplan Commercial |
$249.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$227.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$120.60
|
| Rate for Payer: United Healthcare Commercial |
$254.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.60
|
| Rate for Payer: United Healthcare VA CCN |
$120.60
|
|
|
APPLY HAND/WRIST CAST
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
9602908501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$192.22 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna of VT Commercial |
$412.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$388.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$192.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$388.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$261.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$368.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$351.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$195.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$345.03
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cigna Commercial |
$347.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$347.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$347.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$195.30
|
| Rate for Payer: Multiplan Commercial |
$403.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$368.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$195.30
|
| Rate for Payer: United Healthcare Commercial |
$412.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.30
|
| Rate for Payer: United Healthcare VA CCN |
$195.30
|
|
|
APPLY HAND/WRIST CAST
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
9812908502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$64.23 |
| Max. Negotiated Rate |
$251.92 |
| Rate for Payer: Aetna of VT Commercial |
$251.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$66.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$89.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$122.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$73.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.72
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cigna Commercial |
$120.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$154.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$154.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.42
|
| Rate for Payer: Multiplan Commercial |
$249.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.23
|
| Rate for Payer: United Healthcare Commercial |
$98.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.23
|
| Rate for Payer: United Healthcare VA CCN |
$64.23
|
|
