|
TREAT BIG TOE FRACTURE
|
Professional
|
Both
|
$8,195.00
|
|
|
Service Code
|
CPT 28505
|
| Hospital Charge Code |
5102850501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$474.31 |
| Max. Negotiated Rate |
$7,703.30 |
| Rate for Payer: Aetna of VT Commercial |
$7,703.30
|
| 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 |
$488.54
|
| 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 |
$664.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$880.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$880.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$545.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$880.05
|
| Rate for Payer: Cash Price |
$4,097.50
|
| Rate for Payer: Cash Price |
$4,097.50
|
| Rate for Payer: Cigna Commercial |
$900.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,004.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,004.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$615.64
|
| Rate for Payer: Multiplan Commercial |
$7,621.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$673.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$474.31
|
| Rate for Payer: United Healthcare Commercial |
$729.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$474.31
|
| Rate for Payer: United Healthcare VA CCN |
$474.31
|
|
|
TREAT BIG TOE FRACTURE
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
9602849001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$142.61 |
| Max. Negotiated Rate |
$305.90 |
| Rate for Payer: Aetna of VT Commercial |
$305.90
|
| 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 |
$142.61
|
| 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 |
$193.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$273.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$260.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$255.99
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$257.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$257.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$257.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$144.90
|
| Rate for Payer: Multiplan Commercial |
$299.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$273.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$144.90
|
| Rate for Payer: United Healthcare Commercial |
$305.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$144.90
|
| Rate for Payer: United Healthcare VA CCN |
$144.90
|
|
|
TREAT BIG TOE FRACTURE
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
9602849001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$238.31 |
| Max. Negotiated Rate |
$305.90 |
| Rate for Payer: Aetna of VT Commercial |
$305.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$238.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$238.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$273.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$270.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$257.60
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$257.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$257.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$257.60
|
| Rate for Payer: Multiplan Commercial |
$299.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$273.70
|
| Rate for Payer: United Healthcare Commercial |
$305.90
|
|
|
TREAT BIG TOE FRACTURE
|
Professional
|
Both
|
$1,441.00
|
|
|
Service Code
|
CPT 28505
|
| Hospital Charge Code |
9602850502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$474.31 |
| Max. Negotiated Rate |
$1,354.54 |
| Rate for Payer: Aetna of VT Commercial |
$1,354.54
|
| 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 |
$488.54
|
| 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 |
$664.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$880.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$880.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$545.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$880.05
|
| Rate for Payer: Cash Price |
$720.50
|
| Rate for Payer: Cash Price |
$720.50
|
| Rate for Payer: Cigna Commercial |
$900.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,004.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,004.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$615.64
|
| Rate for Payer: Multiplan Commercial |
$1,340.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$673.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$474.31
|
| Rate for Payer: United Healthcare Commercial |
$729.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$474.31
|
| Rate for Payer: United Healthcare VA CCN |
$474.31
|
|
|
TREAT BIG TOE FRACTURE
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
9822849001
|
|
Hospital Revenue Code
|
982
|
| 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
|
$142.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
9822849001
|
|
Hospital Revenue Code
|
982
|
| 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
|
OP
|
$179.92
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
4502849001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.69 |
| 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 |
$161.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$161.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$108.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.04
|
| 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: Martins Point Health Care Commercial |
$80.96
|
| Rate for Payer: Multiplan Commercial |
$167.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.96
|
| Rate for Payer: United Healthcare Commercial |
$170.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.96
|
| Rate for Payer: United Healthcare VA CCN |
$80.96
|
|
|
TREAT BIG TOE FRACTURE
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
9812849001
|
|
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
|
|
|
TREAT BIG TOE FRACTURE
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
9812849001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$233.36 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$127.76
|
| 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 |
$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 |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| 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 |
$0.93
|
| 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
|
OP
|
$1,441.00
|
|
|
Service Code
|
CPT 28505
|
| Hospital Charge Code |
9822850501
|
|
Hospital Revenue Code
|
982
|
| 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
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
5102849001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.04 |
| Max. Negotiated Rate |
$233.36 |
| Rate for Payer: Aetna of VT Commercial |
$169.20
|
| 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 |
$127.76
|
| 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 |
$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 |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| 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 |
$167.40
|
| 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
|
$1,441.00
|
|
|
Service Code
|
CPT 28505
|
| Hospital Charge Code |
9602850502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,066.48 |
| 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 |
$1,066.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,066.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,224.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,210.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,152.80
|
| 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: Multiplan Commercial |
$1,340.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,224.85
|
| Rate for Payer: United Healthcare Commercial |
$1,368.95
|
|
|
TREAT BIG TOE FRACTURE
|
Professional
|
Both
|
$9,635.00
|
|
|
Service Code
|
CPT 28505
|
| Hospital Charge Code |
9602850501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$474.31 |
| Max. Negotiated Rate |
$9,056.90 |
| Rate for Payer: Aetna of VT Commercial |
$9,056.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8,632.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$488.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8,632.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$664.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$880.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$880.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$545.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$880.05
|
| Rate for Payer: Cash Price |
$4,817.50
|
| Rate for Payer: Cash Price |
$4,817.50
|
| Rate for Payer: Cigna Commercial |
$900.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,004.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,004.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$615.64
|
| Rate for Payer: Multiplan Commercial |
$8,960.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$673.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$474.31
|
| Rate for Payer: United Healthcare Commercial |
$729.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$474.31
|
| Rate for Payer: United Healthcare VA CCN |
$474.31
|
|
|
TREAT BIG TOE FRACTURE
|
Facility
|
OP
|
$9,635.00
|
|
|
Service Code
|
CPT 28505
|
| Hospital Charge Code |
9602850501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4,267.34 |
| Max. Negotiated Rate |
$9,153.25 |
| Rate for Payer: Aetna of VT Commercial |
$9,153.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8,632.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4,267.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8,632.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5,800.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8,189.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7,804.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4,335.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,659.82
|
| Rate for Payer: Cash Price |
$4,817.50
|
| Rate for Payer: Cigna Commercial |
$7,708.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,708.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,708.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$4,335.75
|
| Rate for Payer: Multiplan Commercial |
$8,960.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,189.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4,335.75
|
| Rate for Payer: United Healthcare Commercial |
$9,153.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,335.75
|
| Rate for Payer: United Healthcare VA CCN |
$4,335.75
|
|
|
TREAT BIG TOE FRACTURE
|
Facility
|
IP
|
$9,635.00
|
|
|
Service Code
|
CPT 28505
|
| Hospital Charge Code |
9602850501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$7,130.86 |
| Max. Negotiated Rate |
$9,153.25 |
| Rate for Payer: Aetna of VT Commercial |
$9,153.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7,130.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7,130.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8,189.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8,093.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,708.00
|
| Rate for Payer: Cash Price |
$4,817.50
|
| Rate for Payer: Cigna Commercial |
$7,708.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,708.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,708.00
|
| Rate for Payer: Multiplan Commercial |
$8,960.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,189.75
|
| Rate for Payer: United Healthcare Commercial |
$9,153.25
|
|
|
TREAT BIG TOE FRACTURE
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
9602849002
|
|
Hospital Revenue Code
|
960
|
| 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
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
9602849002
|
|
Hospital Revenue Code
|
960
|
| 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
|
$180.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
5102849001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$133.22 |
| 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 |
$133.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$133.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$151.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.00
|
| 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: Multiplan Commercial |
$167.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.00
|
| Rate for Payer: United Healthcare Commercial |
$171.00
|
|
|
TREAT BIG TOE FRACTURE
|
Professional
|
Both
|
$1,441.00
|
|
|
Service Code
|
CPT 28505
|
| Hospital Charge Code |
9822850501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$474.31 |
| Max. Negotiated Rate |
$1,354.54 |
| Rate for Payer: Aetna of VT Commercial |
$1,354.54
|
| 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 |
$488.54
|
| 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 |
$664.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$880.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$880.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$545.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$880.05
|
| Rate for Payer: Cash Price |
$720.50
|
| Rate for Payer: Cash Price |
$720.50
|
| Rate for Payer: Cigna Commercial |
$900.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,004.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,004.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$615.64
|
| Rate for Payer: Multiplan Commercial |
$1,340.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$673.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$474.31
|
| Rate for Payer: United Healthcare Commercial |
$729.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$474.31
|
| Rate for Payer: United Healthcare VA CCN |
$474.31
|
|
|
TREAT BIG TOE FRACTURE
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
CPT 28505
|
| Hospital Charge Code |
9822850501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,066.48 |
| 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 |
$1,066.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,066.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,224.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,210.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,152.80
|
| 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: Multiplan Commercial |
$1,340.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,224.85
|
| Rate for Payer: United Healthcare Commercial |
$1,368.95
|
|
|
TREAT BIG TOE FRACTURE
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
9812849002
|
|
Hospital Revenue Code
|
981
|
| 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 CLAVICLE FRACTURE
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
9812350002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$79.28 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Aetna of VT Commercial |
$170.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$142.31
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$143.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.55
|
| Rate for Payer: Multiplan Commercial |
$166.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.55
|
| Rate for Payer: United Healthcare Commercial |
$170.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.55
|
| Rate for Payer: United Healthcare VA CCN |
$80.55
|
|
|
TREAT CLAVICLE FRACTURE
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
9812350002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$160.37 |
| Max. Negotiated Rate |
$428.76 |
| Rate for Payer: Aetna of VT Commercial |
$168.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$234.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$318.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$342.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$342.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$261.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$342.06
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$428.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$366.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$366.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$222.29
|
| Rate for Payer: Multiplan Commercial |
$166.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$323.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$227.76
|
| Rate for Payer: United Healthcare Commercial |
$350.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.76
|
| Rate for Payer: United Healthcare VA CCN |
$227.76
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
9812350001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$132.48 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Aetna of VT Commercial |
$170.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$132.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$132.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.20
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$143.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.20
|
| Rate for Payer: Multiplan Commercial |
$166.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.15
|
| Rate for Payer: United Healthcare Commercial |
$170.05
|
|
|
TREAT CLAVICLE FRACTURE
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
9812350001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$160.37 |
| Max. Negotiated Rate |
$428.76 |
| Rate for Payer: Aetna of VT Commercial |
$168.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$234.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$318.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$342.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$342.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$261.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$342.06
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$428.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$366.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$366.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$222.29
|
| Rate for Payer: Multiplan Commercial |
$166.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$323.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$227.76
|
| Rate for Payer: United Healthcare Commercial |
$350.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.76
|
| Rate for Payer: United Healthcare VA CCN |
$227.76
|
|
