|
TRAY SUTURE
|
Facility
|
OP
|
$22.71
|
|
| Hospital Charge Code |
2720058161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$21.57 |
| Rate for Payer: Aetna of VT Commercial |
$21.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$20.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$20.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$13.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$19.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$10.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$18.05
|
| Rate for Payer: Cash Price |
$11.36
|
| Rate for Payer: Cigna Commercial |
$18.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.22
|
| Rate for Payer: Multiplan Commercial |
$21.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.22
|
| Rate for Payer: United Healthcare Commercial |
$21.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.22
|
| Rate for Payer: United Healthcare VA CCN |
$10.22
|
|
|
TRAY THORACET/PARACENT
|
Facility
|
OP
|
$31.43
|
|
| Hospital Charge Code |
2720017081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$29.86 |
| Rate for Payer: Aetna of VT Commercial |
$29.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$28.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$28.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$25.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.99
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cigna Commercial |
$25.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.14
|
| Rate for Payer: Multiplan Commercial |
$29.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.14
|
| Rate for Payer: United Healthcare Commercial |
$29.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.14
|
| Rate for Payer: United Healthcare VA CCN |
$14.14
|
|
|
TRAY THORACET/PARACENT
|
Facility
|
IP
|
$31.43
|
|
| Hospital Charge Code |
2720017081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$29.86 |
| Rate for Payer: Aetna of VT Commercial |
$29.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$23.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$23.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.14
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cigna Commercial |
$25.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.14
|
| Rate for Payer: Multiplan Commercial |
$29.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.72
|
| Rate for Payer: United Healthcare Commercial |
$29.86
|
|
|
TREAT ANKLE DISLOCATION
|
Professional
|
Both
|
$740.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
9812784001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$374.51 |
| Max. Negotiated Rate |
$710.17 |
| Rate for Payer: Aetna of VT Commercial |
$695.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$662.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$385.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$662.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$524.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$514.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$514.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$430.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$514.80
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cigna Commercial |
$710.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$621.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$621.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$374.51
|
| Rate for Payer: Multiplan Commercial |
$688.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$531.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$374.51
|
| Rate for Payer: United Healthcare Commercial |
$576.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$374.51
|
| Rate for Payer: United Healthcare VA CCN |
$374.51
|
|
|
TREAT ANKLE DISLOCATION
|
Facility
|
OP
|
$952.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
9812784002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$421.64 |
| Max. Negotiated Rate |
$904.40 |
| Rate for Payer: Aetna of VT Commercial |
$904.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$852.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$421.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$852.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$573.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$809.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$771.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$756.84
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cigna Commercial |
$761.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$761.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$761.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$428.40
|
| Rate for Payer: Multiplan Commercial |
$885.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$809.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$428.40
|
| Rate for Payer: United Healthcare Commercial |
$904.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$428.40
|
| Rate for Payer: United Healthcare VA CCN |
$428.40
|
|
|
TREAT ANKLE DISLOCATION
|
Professional
|
Both
|
$952.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
9812784002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$374.51 |
| Max. Negotiated Rate |
$894.88 |
| Rate for Payer: Aetna of VT Commercial |
$894.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$852.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$385.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$852.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$524.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$514.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$514.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$430.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$514.80
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cigna Commercial |
$710.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$621.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$621.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$374.51
|
| Rate for Payer: Multiplan Commercial |
$885.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$531.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$374.51
|
| Rate for Payer: United Healthcare Commercial |
$576.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$374.51
|
| Rate for Payer: United Healthcare VA CCN |
$374.51
|
|
|
TREAT ANKLE DISLOCATION
|
Facility
|
IP
|
$2,241.00
|
|
|
Service Code
|
CPT 27846
|
| Hospital Charge Code |
9822784601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,658.56 |
| Max. Negotiated Rate |
$2,128.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,128.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,658.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,658.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,904.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,882.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,792.80
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Cigna Commercial |
$1,792.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,792.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,792.80
|
| Rate for Payer: Multiplan Commercial |
$2,084.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,904.85
|
| Rate for Payer: United Healthcare Commercial |
$2,128.95
|
|
|
TREAT ANKLE DISLOCATION
|
Facility
|
OP
|
$2,241.00
|
|
|
Service Code
|
CPT 27846
|
| Hospital Charge Code |
9822784601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$992.54 |
| Max. Negotiated Rate |
$2,128.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,128.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,007.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$992.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,007.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,349.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,904.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,815.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,008.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,781.60
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Cigna Commercial |
$1,792.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,792.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,792.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,008.45
|
| Rate for Payer: Multiplan Commercial |
$2,084.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,904.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,008.45
|
| Rate for Payer: United Healthcare Commercial |
$2,128.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,008.45
|
| Rate for Payer: United Healthcare VA CCN |
$1,008.45
|
|
|
TREAT ANKLE DISLOCATION
|
Professional
|
Both
|
$2,241.00
|
|
|
Service Code
|
CPT 27846
|
| Hospital Charge Code |
9822784601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$684.11 |
| Max. Negotiated Rate |
$2,106.54 |
| Rate for Payer: Aetna of VT Commercial |
$2,106.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,007.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$704.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,007.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$957.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,143.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,143.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$786.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,143.92
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Cigna Commercial |
$1,301.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,138.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,138.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$684.11
|
| Rate for Payer: Multiplan Commercial |
$2,084.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$971.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$684.11
|
| Rate for Payer: United Healthcare Commercial |
$1,052.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$684.11
|
| Rate for Payer: United Healthcare VA CCN |
$684.11
|
|
|
TREAT ANKLE DISLOCATION
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
9812784001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$327.75 |
| Max. Negotiated Rate |
$703.00 |
| Rate for Payer: Aetna of VT Commercial |
$703.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$662.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$327.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$662.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$445.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$629.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$599.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$333.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$588.30
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cigna Commercial |
$592.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$592.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$592.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$333.00
|
| Rate for Payer: Multiplan Commercial |
$688.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$629.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$333.00
|
| Rate for Payer: United Healthcare Commercial |
$703.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$333.00
|
| Rate for Payer: United Healthcare VA CCN |
$333.00
|
|
|
TREAT ANKLE DISLOCATION
|
Facility
|
IP
|
$952.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
9812784002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$704.58 |
| Max. Negotiated Rate |
$904.40 |
| Rate for Payer: Aetna of VT Commercial |
$904.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$704.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$704.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$809.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$799.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$761.60
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cigna Commercial |
$761.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$761.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$761.60
|
| Rate for Payer: Multiplan Commercial |
$885.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$809.20
|
| Rate for Payer: United Healthcare Commercial |
$904.40
|
|
|
TREAT ANKLE DISLOCATION
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
9812784001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$547.67 |
| Max. Negotiated Rate |
$703.00 |
| Rate for Payer: Aetna of VT Commercial |
$703.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$547.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$547.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$629.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$621.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$592.00
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cigna Commercial |
$592.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$592.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$592.00
|
| Rate for Payer: Multiplan Commercial |
$688.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$629.00
|
| Rate for Payer: United Healthcare Commercial |
$703.00
|
|
|
TREAT ANKLE DISLOCATION
|
Facility
|
IP
|
$503.04
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
4502784001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$477.89 |
| Rate for Payer: Aetna of VT Commercial |
$477.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$372.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$372.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$427.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$422.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$402.43
|
| Rate for Payer: Cash Price |
$251.52
|
| Rate for Payer: Cigna Commercial |
$402.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$402.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$402.43
|
| Rate for Payer: Multiplan Commercial |
$467.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$427.58
|
| Rate for Payer: United Healthcare Commercial |
$477.89
|
|
|
TREAT ANKLE DISLOCATION
|
Facility
|
OP
|
$503.04
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
4502784001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$222.80 |
| Max. Negotiated Rate |
$477.89 |
| Rate for Payer: Aetna of VT Commercial |
$477.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$450.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$222.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$450.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$302.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$427.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$407.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$226.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$399.92
|
| Rate for Payer: Cash Price |
$251.52
|
| Rate for Payer: Cigna Commercial |
$402.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$402.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$402.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$226.37
|
| Rate for Payer: Multiplan Commercial |
$467.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$427.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$226.37
|
| Rate for Payer: United Healthcare Commercial |
$477.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$226.37
|
| Rate for Payer: United Healthcare VA CCN |
$226.37
|
|
|
TREAT BIG TOE FRACTURE
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
CPT 28505
|
| Hospital Charge Code |
9602850502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$638.22 |
| Max. Negotiated Rate |
$1,368.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,368.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,290.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$638.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,290.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$867.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,224.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,167.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$648.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,145.60
|
| Rate for Payer: Cash Price |
$720.50
|
| Rate for Payer: Cigna Commercial |
$1,152.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,152.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,152.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$648.45
|
| Rate for Payer: Multiplan Commercial |
$1,340.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,224.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$648.45
|
| Rate for Payer: United Healthcare Commercial |
$1,368.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$648.45
|
| Rate for Payer: United Healthcare VA CCN |
$648.45
|
|
|
TREAT BIG TOE FRACTURE
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
9602849002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$105.09 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Aetna of VT Commercial |
$134.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$119.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.60
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$113.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.60
|
| Rate for Payer: Multiplan Commercial |
$132.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.70
|
| Rate for Payer: United Healthcare Commercial |
$134.90
|
|
|
TREAT BIG TOE FRACTURE
|
Facility
|
IP
|
$179.92
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
4502849001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.16 |
| Max. Negotiated Rate |
$170.92 |
| Rate for Payer: Aetna of VT Commercial |
$170.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$133.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$133.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$151.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.94
|
| Rate for Payer: Cash Price |
$89.96
|
| Rate for Payer: Cigna Commercial |
$143.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.94
|
| Rate for Payer: Multiplan Commercial |
$167.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.93
|
| Rate for Payer: United Healthcare Commercial |
$170.92
|
|
|
TREAT BIG TOE FRACTURE
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
9812849002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$62.89 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Aetna of VT Commercial |
$134.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$127.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$127.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$85.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$115.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.89
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$113.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.90
|
| Rate for Payer: Multiplan Commercial |
$132.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.90
|
| Rate for Payer: United Healthcare Commercial |
$134.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.90
|
| Rate for Payer: United Healthcare VA CCN |
$63.90
|
|
|
TREAT BIG TOE FRACTURE
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
9812849001
|
|
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
|
|
|
TREAT BIG TOE FRACTURE
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
9822849001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$62.89 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Aetna of VT Commercial |
$134.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$127.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$127.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$85.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$115.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.89
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$113.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.90
|
| Rate for Payer: Multiplan Commercial |
$132.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.90
|
| Rate for Payer: United Healthcare Commercial |
$134.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.90
|
| Rate for Payer: United Healthcare VA CCN |
$63.90
|
|
|
TREAT BIG TOE FRACTURE
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
5102849001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.72 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of VT Commercial |
$171.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$108.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.10
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$144.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$167.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$81.00
|
| Rate for Payer: United Healthcare Commercial |
$171.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.00
|
| Rate for Payer: United Healthcare VA CCN |
$81.00
|
|
|
TREAT BIG TOE FRACTURE
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
9602849001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$124.04 |
| Max. Negotiated Rate |
$302.68 |
| Rate for Payer: Aetna of VT Commercial |
$302.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$288.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$127.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$288.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$173.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$191.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$191.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$191.92
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$233.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$229.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$229.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$141.07
|
| Rate for Payer: Multiplan Commercial |
$299.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$176.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$124.04
|
| Rate for Payer: United Healthcare Commercial |
$190.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.04
|
| Rate for Payer: United Healthcare VA CCN |
$124.04
|
|
|
TREAT BIG TOE FRACTURE
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
9812849002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$124.04 |
| Max. Negotiated Rate |
$233.36 |
| Rate for Payer: Aetna of VT Commercial |
$133.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$127.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$127.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$127.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$173.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$191.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$191.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$191.92
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$233.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$229.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$229.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$141.07
|
| Rate for Payer: Multiplan Commercial |
$132.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$176.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$124.04
|
| Rate for Payer: United Healthcare Commercial |
$190.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.04
|
| Rate for Payer: United Healthcare VA CCN |
$124.04
|
|
|
TREAT BIG TOE FRACTURE
|
Facility
|
IP
|
$8,195.00
|
|
|
Service Code
|
CPT 28505
|
| Hospital Charge Code |
5102850501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6,065.12 |
| Max. Negotiated Rate |
$7,785.25 |
| Rate for Payer: Aetna of VT Commercial |
$7,785.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,065.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,065.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,965.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,883.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,556.00
|
| Rate for Payer: Cash Price |
$4,097.50
|
| Rate for Payer: Cigna Commercial |
$6,556.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,556.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,556.00
|
| Rate for Payer: Multiplan Commercial |
$7,621.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,965.75
|
| Rate for Payer: United Healthcare Commercial |
$7,785.25
|
|
|
TREAT BIG TOE FRACTURE
|
Facility
|
OP
|
$8,195.00
|
|
|
Service Code
|
CPT 28505
|
| Hospital Charge Code |
5102850501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,629.57 |
| Max. Negotiated Rate |
$7,785.25 |
| Rate for Payer: Aetna of VT Commercial |
$7,785.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7,341.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,629.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7,341.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,933.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,965.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,637.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,687.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,515.02
|
| Rate for Payer: Cash Price |
$4,097.50
|
| Rate for Payer: Cigna Commercial |
$6,556.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,556.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,556.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,687.75
|
| Rate for Payer: Multiplan Commercial |
$7,621.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,965.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,687.75
|
| Rate for Payer: United Healthcare Commercial |
$7,785.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,687.75
|
| Rate for Payer: United Healthcare VA CCN |
$3,687.75
|
|
