|
APPLY LONG ARM SPLINT
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
9822910501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$37.87 |
| Max. Negotiated Rate |
$196.46 |
| Rate for Payer: Aetna of VT Commercial |
$196.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$187.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$187.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.93
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$72.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.27
|
| Rate for Payer: Multiplan Commercial |
$194.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.87
|
| Rate for Payer: United Healthcare Commercial |
$58.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.87
|
| Rate for Payer: United Healthcare VA CCN |
$37.87
|
|
|
APPLY LONG ARM SPLINT
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
9812910502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$154.68 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Aetna of VT Commercial |
$198.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$154.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$154.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$177.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$175.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$167.20
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$167.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$167.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$167.20
|
| Rate for Payer: Multiplan Commercial |
$194.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$177.65
|
| Rate for Payer: United Healthcare Commercial |
$198.55
|
|
|
APPLY LONG ARM SPLINT
|
Facility
|
IP
|
$238.34
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
4502910501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$226.42 |
| Rate for Payer: Aetna of VT Commercial |
$226.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$202.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$200.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$190.67
|
| Rate for Payer: Cash Price |
$119.17
|
| Rate for Payer: Cigna Commercial |
$190.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$190.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$190.67
|
| Rate for Payer: Multiplan Commercial |
$221.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$202.59
|
| Rate for Payer: United Healthcare Commercial |
$226.42
|
|
|
APPLY LONG ARM SPLINT
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
9812910501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$173.92 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Aetna of VT Commercial |
$223.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$173.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$173.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$199.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$197.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$188.00
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$188.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$188.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$188.00
|
| Rate for Payer: Multiplan Commercial |
$218.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.75
|
| Rate for Payer: United Healthcare Commercial |
$223.25
|
|
|
APPLY LONG ARM SPLINT
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
9812910502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$37.87 |
| Max. Negotiated Rate |
$196.46 |
| Rate for Payer: Aetna of VT Commercial |
$196.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$187.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$187.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.93
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$72.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.27
|
| Rate for Payer: Multiplan Commercial |
$194.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.87
|
| Rate for Payer: United Healthcare Commercial |
$58.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.87
|
| Rate for Payer: United Healthcare VA CCN |
$37.87
|
|
|
APPLY LONG ARM SPLINT
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
9812910501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$37.87 |
| Max. Negotiated Rate |
$220.90 |
| Rate for Payer: Aetna of VT Commercial |
$220.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$210.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$210.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.93
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$72.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.27
|
| Rate for Payer: Multiplan Commercial |
$218.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.87
|
| Rate for Payer: United Healthcare Commercial |
$58.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.87
|
| Rate for Payer: United Healthcare VA CCN |
$37.87
|
|
|
APPLY LONG ARM SPLINT
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
9822910501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$154.68 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Aetna of VT Commercial |
$198.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$154.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$154.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$177.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$175.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$167.20
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$167.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$167.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$167.20
|
| Rate for Payer: Multiplan Commercial |
$194.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$177.65
|
| Rate for Payer: United Healthcare Commercial |
$198.55
|
|
|
APPLY LONG ARM SPLINT
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
9822910501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$92.57 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Aetna of VT Commercial |
$198.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$187.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$187.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$177.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$94.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$166.16
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$167.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$167.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$167.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.05
|
| Rate for Payer: Multiplan Commercial |
$194.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$177.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$94.05
|
| Rate for Payer: United Healthcare Commercial |
$198.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.05
|
| Rate for Payer: United Healthcare VA CCN |
$94.05
|
|
|
APPLY LONG ARM SPLINT
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
9812910501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$104.08 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Aetna of VT Commercial |
$223.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$210.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$104.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$210.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$141.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$199.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$190.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$105.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$186.82
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$188.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$188.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$188.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$105.75
|
| Rate for Payer: Multiplan Commercial |
$218.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.75
|
| Rate for Payer: United Healthcare Commercial |
$223.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.75
|
| Rate for Payer: United Healthcare VA CCN |
$105.75
|
|
|
APPLY LONG ARM SPLINT
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
9812910502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$92.57 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Aetna of VT Commercial |
$198.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$187.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$187.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$177.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$94.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$166.16
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$167.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$167.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$167.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.05
|
| Rate for Payer: Multiplan Commercial |
$194.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$177.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$94.05
|
| Rate for Payer: United Healthcare Commercial |
$198.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.05
|
| Rate for Payer: United Healthcare VA CCN |
$94.05
|
|
|
APPLY LONG ARM SPLINT
|
Facility
|
OP
|
$238.34
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
4502910501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.56 |
| Max. Negotiated Rate |
$226.42 |
| Rate for Payer: Aetna of VT Commercial |
$226.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$213.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$105.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$213.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$143.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$202.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$193.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$107.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$189.48
|
| Rate for Payer: Cash Price |
$119.17
|
| Rate for Payer: Cigna Commercial |
$190.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$190.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$190.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$107.25
|
| Rate for Payer: Multiplan Commercial |
$221.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$202.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$107.25
|
| Rate for Payer: United Healthcare Commercial |
$226.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.25
|
| Rate for Payer: United Healthcare VA CCN |
$107.25
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
9602958101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$417.42 |
| Max. Negotiated Rate |
$535.80 |
| Rate for Payer: Aetna of VT Commercial |
$535.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$417.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$417.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$479.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$473.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$451.20
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$451.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$451.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$451.20
|
| Rate for Payer: Multiplan Commercial |
$524.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$479.40
|
| Rate for Payer: United Healthcare Commercial |
$535.80
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
5102958101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$244.97 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Aetna of VT Commercial |
$314.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$244.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$244.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$281.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$264.80
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$264.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$264.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$264.80
|
| Rate for Payer: Multiplan Commercial |
$307.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$281.35
|
| Rate for Payer: United Healthcare Commercial |
$314.45
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
9602958102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$172.44 |
| Max. Negotiated Rate |
$221.35 |
| Rate for Payer: Aetna of VT Commercial |
$221.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$195.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$186.40
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cigna Commercial |
$186.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$186.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$186.40
|
| Rate for Payer: Multiplan Commercial |
$216.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.05
|
| Rate for Payer: United Healthcare Commercial |
$221.35
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
5102958101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.60 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Aetna of VT Commercial |
$314.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$296.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$146.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$296.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$199.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$281.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$268.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$148.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$263.14
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$264.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$264.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$264.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$148.95
|
| Rate for Payer: Multiplan Commercial |
$307.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$281.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$148.95
|
| Rate for Payer: United Healthcare Commercial |
$314.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.95
|
| Rate for Payer: United Healthcare VA CCN |
$148.95
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
9602958101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$249.80 |
| Max. Negotiated Rate |
$535.80 |
| Rate for Payer: Aetna of VT Commercial |
$535.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$505.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$249.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$505.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$339.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$479.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$456.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$253.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$448.38
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$451.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$451.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$451.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$253.80
|
| Rate for Payer: Multiplan Commercial |
$524.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$479.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$253.80
|
| Rate for Payer: United Healthcare Commercial |
$535.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$253.80
|
| Rate for Payer: United Healthcare VA CCN |
$253.80
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
9602958102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$103.20 |
| Max. Negotiated Rate |
$221.35 |
| Rate for Payer: Aetna of VT Commercial |
$221.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$208.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$208.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$140.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$188.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$104.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$185.24
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cigna Commercial |
$186.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$186.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$186.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$104.85
|
| Rate for Payer: Multiplan Commercial |
$216.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$104.85
|
| Rate for Payer: United Healthcare Commercial |
$221.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$104.85
|
| Rate for Payer: United Healthcare VA CCN |
$104.85
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
9602958101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$530.16 |
| Rate for Payer: Aetna of VT Commercial |
$530.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$505.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$505.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$35.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$118.94
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$48.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.81
|
| Rate for Payer: Multiplan Commercial |
$524.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.36
|
| Rate for Payer: United Healthcare Commercial |
$39.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.36
|
| Rate for Payer: United Healthcare VA CCN |
$25.36
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
9822958101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$172.44 |
| Max. Negotiated Rate |
$221.35 |
| Rate for Payer: Aetna of VT Commercial |
$221.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$195.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$186.40
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cigna Commercial |
$186.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$186.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$186.40
|
| Rate for Payer: Multiplan Commercial |
$216.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.05
|
| Rate for Payer: United Healthcare Commercial |
$221.35
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
9822958101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$103.20 |
| Max. Negotiated Rate |
$221.35 |
| Rate for Payer: Aetna of VT Commercial |
$221.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$208.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$208.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$140.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$188.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$104.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$185.24
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cigna Commercial |
$186.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$186.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$186.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$104.85
|
| Rate for Payer: Multiplan Commercial |
$216.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$104.85
|
| Rate for Payer: United Healthcare Commercial |
$221.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$104.85
|
| Rate for Payer: United Healthcare VA CCN |
$104.85
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
9822958101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$219.02 |
| Rate for Payer: Aetna of VT Commercial |
$219.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$208.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$208.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$35.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$118.94
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cigna Commercial |
$48.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.81
|
| Rate for Payer: Multiplan Commercial |
$216.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.36
|
| Rate for Payer: United Healthcare Commercial |
$39.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.36
|
| Rate for Payer: United Healthcare VA CCN |
$25.36
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
5102958101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$311.14 |
| Rate for Payer: Aetna of VT Commercial |
$311.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$296.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$296.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$35.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$118.94
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$48.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.81
|
| Rate for Payer: Multiplan Commercial |
$307.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.36
|
| Rate for Payer: United Healthcare Commercial |
$39.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.36
|
| Rate for Payer: United Healthcare VA CCN |
$25.36
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
9602958102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$219.02 |
| Rate for Payer: Aetna of VT Commercial |
$219.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$208.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$208.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$35.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$118.94
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cigna Commercial |
$48.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.81
|
| Rate for Payer: Multiplan Commercial |
$216.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.36
|
| Rate for Payer: United Healthcare Commercial |
$39.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.36
|
| Rate for Payer: United Healthcare VA CCN |
$25.36
|
|
|
APPLY RIGID LEG CAST
|
Facility
|
IP
|
$356.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
5102944501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$263.48 |
| Max. Negotiated Rate |
$338.20 |
| Rate for Payer: Aetna of VT Commercial |
$338.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$263.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$263.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$302.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$299.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$284.80
|
| Rate for Payer: Cash Price |
$178.00
|
| Rate for Payer: Cigna Commercial |
$284.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$284.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$284.80
|
| Rate for Payer: Multiplan Commercial |
$331.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$302.60
|
| Rate for Payer: United Healthcare Commercial |
$338.20
|
|
|
APPLY RIGID LEG CAST
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
9822944501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$92.39 |
| Max. Negotiated Rate |
$263.89 |
| Rate for Payer: Aetna of VT Commercial |
$143.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$95.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$129.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$263.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$263.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$106.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$263.89
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$175.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$200.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$200.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$122.59
|
| Rate for Payer: Multiplan Commercial |
$142.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$92.39
|
| Rate for Payer: United Healthcare Commercial |
$142.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.39
|
| Rate for Payer: United Healthcare VA CCN |
$92.39
|
|
