|
APPLY RIGID LEG CAST
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
5102944501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$157.67 |
| 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 |
$318.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$157.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$318.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$214.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$302.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$288.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$160.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$283.02
|
| 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: Martins Point Health Care Commercial |
$160.20
|
| Rate for Payer: Multiplan Commercial |
$331.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$302.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$160.20
|
| Rate for Payer: United Healthcare Commercial |
$338.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$160.20
|
| Rate for Payer: United Healthcare VA CCN |
$160.20
|
|
|
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
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
9602944501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$376.71 |
| Max. Negotiated Rate |
$483.55 |
| Rate for Payer: Aetna of VT Commercial |
$483.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$376.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$376.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$432.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$427.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$407.20
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$407.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$407.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$407.20
|
| Rate for Payer: Multiplan Commercial |
$473.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$432.65
|
| Rate for Payer: United Healthcare Commercial |
$483.55
|
|
|
APPLY RIGID LEG CAST
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
9822944501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$67.76 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Aetna of VT Commercial |
$145.35
|
| 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 |
$67.76
|
| 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 |
$92.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$123.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$68.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$121.64
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$122.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$122.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$122.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$68.85
|
| Rate for Payer: Multiplan Commercial |
$142.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$68.85
|
| Rate for Payer: United Healthcare Commercial |
$145.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.85
|
| Rate for Payer: United Healthcare VA CCN |
$68.85
|
|
|
APPLY RIGID LEG CAST
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
5102944501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.39 |
| Max. Negotiated Rate |
$334.64 |
| Rate for Payer: Aetna of VT Commercial |
$334.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$318.94
|
| 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 |
$318.94
|
| 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 |
$178.00
|
| Rate for Payer: Cash Price |
$178.00
|
| 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 |
$331.08
|
| 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
|
|
|
APPLY RIGID LEG CAST
|
Professional
|
Both
|
$509.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
9602944501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$92.39 |
| Max. Negotiated Rate |
$478.46 |
| Rate for Payer: Aetna of VT Commercial |
$478.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$456.01
|
| 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 |
$456.01
|
| 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 |
$254.50
|
| Rate for Payer: Cash Price |
$254.50
|
| 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 |
$473.37
|
| 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
|
|
|
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
|
|
|
APPLY RIGID LEG CAST
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
9602944502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$113.24 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Aetna of VT Commercial |
$145.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$128.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.40
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$122.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$122.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$122.40
|
| Rate for Payer: Multiplan Commercial |
$142.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.05
|
| Rate for Payer: United Healthcare Commercial |
$145.35
|
|
|
APPLY RIGID LEG CAST
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
9602944502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$67.76 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Aetna of VT Commercial |
$145.35
|
| 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 |
$67.76
|
| 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 |
$92.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$123.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$68.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$121.64
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$122.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$122.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$122.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$68.85
|
| Rate for Payer: Multiplan Commercial |
$142.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$68.85
|
| Rate for Payer: United Healthcare Commercial |
$145.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.85
|
| Rate for Payer: United Healthcare VA CCN |
$68.85
|
|
|
APPLY RIGID LEG CAST
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
9602944501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$225.44 |
| Max. Negotiated Rate |
$483.55 |
| Rate for Payer: Aetna of VT Commercial |
$483.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$456.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$225.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$456.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$306.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$432.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$412.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$229.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$404.65
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$407.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$407.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$407.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$229.05
|
| Rate for Payer: Multiplan Commercial |
$473.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$432.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$229.05
|
| Rate for Payer: United Healthcare Commercial |
$483.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.05
|
| Rate for Payer: United Healthcare VA CCN |
$229.05
|
|
|
APPLY SHORT LEG CAST
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
9602942501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$51.64 |
| Max. Negotiated Rate |
$210.56 |
| Rate for Payer: Aetna of VT Commercial |
$210.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$200.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$53.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$200.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$72.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.68
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cigna Commercial |
$97.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$120.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$120.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$73.80
|
| Rate for Payer: Multiplan Commercial |
$208.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.64
|
| Rate for Payer: United Healthcare Commercial |
$79.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.64
|
| Rate for Payer: United Healthcare VA CCN |
$51.64
|
|
|
APPLY SHORT LEG CAST
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
9812940502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$55.68 |
| Max. Negotiated Rate |
$216.20 |
| Rate for Payer: Aetna of VT Commercial |
$216.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$206.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$57.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$206.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$77.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.22
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$105.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$128.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$128.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$78.49
|
| Rate for Payer: Multiplan Commercial |
$213.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$55.68
|
| Rate for Payer: United Healthcare Commercial |
$85.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.68
|
| Rate for Payer: United Healthcare VA CCN |
$55.68
|
|
|
APPLY SHORT LEG CAST
|
Facility
|
OP
|
$134.40
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
9602942502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$59.53 |
| Max. Negotiated Rate |
$127.68 |
| Rate for Payer: Aetna of VT Commercial |
$127.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$120.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$59.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$120.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$80.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$114.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$108.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$106.85
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$107.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$107.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$107.52
|
| Rate for Payer: Martins Point Health Care Commercial |
$60.48
|
| Rate for Payer: Multiplan Commercial |
$124.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$60.48
|
| Rate for Payer: United Healthcare Commercial |
$127.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.48
|
| Rate for Payer: United Healthcare VA CCN |
$60.48
|
|
|
APPLY SHORT LEG CAST
|
Professional
|
Both
|
$89.60
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
5102942501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.64 |
| Max. Negotiated Rate |
$120.35 |
| Rate for Payer: Aetna of VT Commercial |
$84.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$80.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$53.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$80.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$72.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.68
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cigna Commercial |
$97.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$120.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$120.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$73.80
|
| Rate for Payer: Multiplan Commercial |
$83.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.64
|
| Rate for Payer: United Healthcare Commercial |
$79.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.64
|
| Rate for Payer: United Healthcare VA CCN |
$51.64
|
|
|
APPLY SHORT LEG CAST
|
Professional
|
Both
|
$585.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
9602940501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$55.68 |
| Max. Negotiated Rate |
$549.90 |
| Rate for Payer: Aetna of VT Commercial |
$549.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$524.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$57.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$524.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$77.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.22
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$105.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$128.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$128.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$78.49
|
| Rate for Payer: Multiplan Commercial |
$544.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$55.68
|
| Rate for Payer: United Healthcare Commercial |
$85.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.68
|
| Rate for Payer: United Healthcare VA CCN |
$55.68
|
|
|
APPLY SHORT LEG CAST
|
Facility
|
IP
|
$585.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
9602940501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$432.96 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: Aetna of VT Commercial |
$555.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$432.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$432.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$497.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$491.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$468.00
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$468.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$468.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$544.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$497.25
|
| Rate for Payer: United Healthcare Commercial |
$555.75
|
|
|
APPLY SHORT LEG CAST
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
9812940501
|
|
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 SHORT LEG CAST
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
9812940502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$101.87 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Aetna of VT Commercial |
$218.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$206.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$101.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$206.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$138.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$182.85
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$184.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$184.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$184.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$103.50
|
| Rate for Payer: Multiplan Commercial |
$213.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.50
|
| Rate for Payer: United Healthcare Commercial |
$218.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.50
|
| Rate for Payer: United Healthcare VA CCN |
$103.50
|
|
|
APPLY SHORT LEG CAST
|
Facility
|
OP
|
$585.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
9602940501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$259.10 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: Aetna of VT Commercial |
$555.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$524.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$259.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$524.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$352.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$497.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$473.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$263.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$465.07
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$468.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$468.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$468.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$263.25
|
| Rate for Payer: Multiplan Commercial |
$544.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$497.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$263.25
|
| Rate for Payer: United Healthcare Commercial |
$555.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$263.25
|
| Rate for Payer: United Healthcare VA CCN |
$263.25
|
|
|
APPLY SHORT LEG CAST
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
9602940502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.22 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Aetna of VT Commercial |
$218.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$170.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$170.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$193.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$184.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$184.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$184.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$184.00
|
| Rate for Payer: Multiplan Commercial |
$213.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.50
|
| Rate for Payer: United Healthcare Commercial |
$218.50
|
|
|
APPLY SHORT LEG CAST
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
9822940501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$55.68 |
| Max. Negotiated Rate |
$216.20 |
| Rate for Payer: Aetna of VT Commercial |
$216.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$206.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$57.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$206.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$77.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.22
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$105.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$128.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$128.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$78.49
|
| Rate for Payer: Multiplan Commercial |
$213.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$55.68
|
| Rate for Payer: United Healthcare Commercial |
$85.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.68
|
| Rate for Payer: United Healthcare VA CCN |
$55.68
|
|
|
APPLY SHORT LEG CAST
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
9602940502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$55.68 |
| Max. Negotiated Rate |
$216.20 |
| Rate for Payer: Aetna of VT Commercial |
$216.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$206.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$57.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$206.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$77.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.22
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$105.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$128.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$128.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$78.49
|
| Rate for Payer: Multiplan Commercial |
$213.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$55.68
|
| Rate for Payer: United Healthcare Commercial |
$85.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.68
|
| Rate for Payer: United Healthcare VA CCN |
$55.68
|
|
|
APPLY SHORT LEG CAST
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
9602940502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$101.87 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Aetna of VT Commercial |
$218.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$206.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$101.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$206.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$138.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$182.85
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$184.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$184.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$184.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$103.50
|
| Rate for Payer: Multiplan Commercial |
$213.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.50
|
| Rate for Payer: United Healthcare Commercial |
$218.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.50
|
| Rate for Payer: United Healthcare VA CCN |
$103.50
|
|
|
APPLY SHORT LEG CAST
|
Facility
|
OP
|
$89.60
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
5102942501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.68 |
| Max. Negotiated Rate |
$85.12 |
| Rate for Payer: Aetna of VT Commercial |
$85.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$80.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$80.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$76.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$71.23
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cigna Commercial |
$71.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$71.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$71.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$40.32
|
| Rate for Payer: Multiplan Commercial |
$83.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$76.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.32
|
| Rate for Payer: United Healthcare Commercial |
$85.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.32
|
| Rate for Payer: United Healthcare VA CCN |
$40.32
|
|
|
APPLY SHORT LEG CAST
|
Facility
|
IP
|
$354.69
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
4502940501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$262.51 |
| Max. Negotiated Rate |
$336.96 |
| Rate for Payer: Aetna of VT Commercial |
$336.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$262.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$262.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$301.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$297.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$283.75
|
| Rate for Payer: Cash Price |
$177.34
|
| Rate for Payer: Cigna Commercial |
$283.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$283.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$283.75
|
| Rate for Payer: Multiplan Commercial |
$329.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$301.49
|
| Rate for Payer: United Healthcare Commercial |
$336.96
|
|
