|
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
|
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
|
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
|
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
|
$355.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
5102940501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$157.23 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Aetna of VT Commercial |
$337.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$318.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$157.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$318.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$213.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$301.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$287.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$159.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$282.23
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$284.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$284.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$284.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$159.75
|
| Rate for Payer: Multiplan Commercial |
$330.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$301.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$159.75
|
| Rate for Payer: United Healthcare Commercial |
$337.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.75
|
| Rate for Payer: United Healthcare VA CCN |
$159.75
|
|
|
APPLY SHORT LEG CAST
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
5102940501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$262.74 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Aetna of VT Commercial |
$337.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$262.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$262.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$301.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$298.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$284.00
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$284.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$284.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$284.00
|
| Rate for Payer: Multiplan Commercial |
$330.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$301.75
|
| Rate for Payer: United Healthcare Commercial |
$337.25
|
|
|
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
|
Professional
|
Both
|
$134.40
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
9602942502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$51.64 |
| Max. Negotiated Rate |
$126.34 |
| Rate for Payer: Aetna of VT Commercial |
$126.34
|
| 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 |
$53.19
|
| 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 |
$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 |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| 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 |
$124.99
|
| 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
|
$355.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
5102940501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.68 |
| Max. Negotiated Rate |
$333.70 |
| Rate for Payer: Aetna of VT Commercial |
$333.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$318.04
|
| 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 |
$318.04
|
| 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 |
$177.50
|
| Rate for Payer: Cash Price |
$177.50
|
| 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 |
$330.15
|
| 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
|
$224.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
9602942501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$99.21 |
| Max. Negotiated Rate |
$212.80 |
| Rate for Payer: Aetna of VT Commercial |
$212.80
|
| 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 |
$99.21
|
| 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 |
$134.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$190.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$181.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$178.08
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cigna Commercial |
$179.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$179.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$179.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$208.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$190.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.80
|
| Rate for Payer: United Healthcare Commercial |
$212.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.80
|
| Rate for Payer: United Healthcare VA CCN |
$100.80
|
|
|
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
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
9812940501
|
|
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 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
|
|
|
AQAPRN-4 ANTB FLO CYTMTRY EA
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
3008605301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$224.20 |
| Rate for Payer: Aetna of VT Commercial |
$224.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$185.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$104.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$185.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$142.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$200.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$191.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$106.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$187.62
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cigna Commercial |
$188.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$188.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$188.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$219.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$200.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$106.20
|
| Rate for Payer: United Healthcare Commercial |
$224.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: United Healthcare VA CCN |
$106.20
|
|
|
AQAPRN-4 ANTB FLO CYTMTRY EA
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
3008605301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.66 |
| Max. Negotiated Rate |
$224.20 |
| Rate for Payer: Aetna of VT Commercial |
$224.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$174.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$174.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$200.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$198.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$188.80
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cigna Commercial |
$188.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$188.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$188.80
|
| Rate for Payer: Multiplan Commercial |
$219.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$200.60
|
| Rate for Payer: United Healthcare Commercial |
$224.20
|
|
|
AQAPRN-4 ANTB FLO CYTMTRY EA
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
3008605301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$221.84 |
| Rate for Payer: Aetna of VT Commercial |
$221.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$185.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$185.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$41.28
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cigna Commercial |
$45.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$37.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$37.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.20
|
| Rate for Payer: Multiplan Commercial |
$219.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.73
|
| Rate for Payer: United Healthcare Commercial |
$58.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: United Healthcare VA CCN |
$37.73
|
|
|
AQUATIC THERAPY/EXERCISES
|
Facility
|
IP
|
$117.88
|
|
|
Service Code
|
CPT 97113 GP
|
| Hospital Charge Code |
4209711301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$87.24 |
| Max. Negotiated Rate |
$111.99 |
| Rate for Payer: Aetna of VT Commercial |
$111.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$87.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$87.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$100.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$99.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$94.30
|
| Rate for Payer: Cash Price |
$58.94
|
| Rate for Payer: Cigna Commercial |
$94.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$94.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$94.30
|
| Rate for Payer: Multiplan Commercial |
$109.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.20
|
| Rate for Payer: United Healthcare Commercial |
$111.99
|
|
|
AQUATIC THERAPY/EXERCISES
|
Facility
|
OP
|
$117.88
|
|
|
Service Code
|
CPT 97113 GP
|
| Hospital Charge Code |
4209711301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.21 |
| Max. Negotiated Rate |
$111.99 |
| Rate for Payer: Aetna of VT Commercial |
$111.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$52.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$70.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$100.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$95.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$53.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$93.71
|
| Rate for Payer: Cash Price |
$58.94
|
| Rate for Payer: Cigna Commercial |
$94.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$94.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$94.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$53.05
|
| Rate for Payer: Multiplan Commercial |
$109.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.05
|
| Rate for Payer: United Healthcare Commercial |
$111.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.05
|
| Rate for Payer: United Healthcare VA CCN |
$53.05
|
|
|
ARIPIPRAZOLE INJECTION
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J0400
|
| Hospital Charge Code |
637J040001
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
ARIPIPRAZOLE INJECTION
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J0400
|
| Hospital Charge Code |
637J040001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
ARIPIPRAZOLE INJECTION
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
HCPCS J0400
|
| Hospital Charge Code |
637J040001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$1.00
|
|
|
ARIZONA BRACE
|
Facility
|
IP
|
$2,312.80
|
|
|
Service Code
|
HCPCS L1960 50
|
| Hospital Charge Code |
274L196001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,711.70 |
| Max. Negotiated Rate |
$2,197.16 |
| Rate for Payer: Aetna of VT Commercial |
$2,197.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,711.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,711.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,965.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,942.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,850.24
|
| Rate for Payer: Cash Price |
$1,156.40
|
| Rate for Payer: Cigna Commercial |
$1,850.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,850.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,850.24
|
| Rate for Payer: Multiplan Commercial |
$2,150.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,965.88
|
| Rate for Payer: United Healthcare Commercial |
$2,197.16
|
|
|
ARIZONA BRACE
|
Professional
|
Both
|
$2,312.80
|
|
|
Service Code
|
HCPCS L1960 50
|
| Hospital Charge Code |
274L196001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$674.13 |
| Max. Negotiated Rate |
$2,174.03 |
| Rate for Payer: Aetna of VT Commercial |
$2,174.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,072.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,072.04
|
| Rate for Payer: Cash Price |
$1,156.40
|
| Rate for Payer: Cash Price |
$1,156.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$674.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$674.13
|
| Rate for Payer: Martins Point Health Care Commercial |
$832.61
|
| Rate for Payer: Multiplan Commercial |
$2,150.90
|
| Rate for Payer: United Healthcare Commercial |
$1,965.88
|
| Rate for Payer: United Healthcare VA CCN |
$925.12
|
|
|
ARIZONA BRACE
|
Facility
|
OP
|
$2,312.80
|
|
|
Service Code
|
HCPCS L1960 50
|
| Hospital Charge Code |
274L196001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,024.34 |
| Max. Negotiated Rate |
$2,197.16 |
| Rate for Payer: Aetna of VT Commercial |
$2,197.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,072.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,024.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,072.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,392.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,965.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,873.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,040.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,838.68
|
| Rate for Payer: Cash Price |
$1,156.40
|
| Rate for Payer: Cigna Commercial |
$1,850.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,850.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,850.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,040.76
|
| Rate for Payer: Multiplan Commercial |
$2,150.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,965.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,040.76
|
| Rate for Payer: United Healthcare Commercial |
$2,197.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,040.76
|
| Rate for Payer: United Healthcare VA CCN |
$1,040.76
|
|
