|
TREAT FINGER FRACTURE EACH
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
9812675002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$116.93 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Aetna of VT Commercial |
$250.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$236.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$236.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$158.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$224.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$213.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$209.88
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$211.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$211.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$211.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$118.80
|
| Rate for Payer: Multiplan Commercial |
$245.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$224.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$118.80
|
| Rate for Payer: United Healthcare Commercial |
$250.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.80
|
| Rate for Payer: United Healthcare VA CCN |
$118.80
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
OP
|
$1,209.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
9812672501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$535.47 |
| Max. Negotiated Rate |
$1,148.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,148.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,083.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$535.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,083.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$727.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,027.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$979.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$544.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$961.15
|
| Rate for Payer: Cash Price |
$604.50
|
| Rate for Payer: Cigna Commercial |
$967.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$967.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$967.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$544.05
|
| Rate for Payer: Multiplan Commercial |
$1,124.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,027.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$544.05
|
| Rate for Payer: United Healthcare Commercial |
$1,148.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$544.05
|
| Rate for Payer: United Healthcare VA CCN |
$544.05
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
9602675502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$555.82 |
| Max. Negotiated Rate |
$713.45 |
| Rate for Payer: Aetna of VT Commercial |
$713.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$555.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$555.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$638.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$630.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$600.80
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cigna Commercial |
$600.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$600.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$600.80
|
| Rate for Payer: Multiplan Commercial |
$698.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$638.35
|
| Rate for Payer: United Healthcare Commercial |
$713.45
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$860.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
9602672502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$636.49 |
| Max. Negotiated Rate |
$817.00 |
| Rate for Payer: Aetna of VT Commercial |
$817.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$636.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$636.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$731.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$722.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$688.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$688.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$688.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$688.00
|
| Rate for Payer: Multiplan Commercial |
$799.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$731.00
|
| Rate for Payer: United Healthcare Commercial |
$817.00
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
9602672001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$307.37 |
| Max. Negotiated Rate |
$659.30 |
| Rate for Payer: Aetna of VT Commercial |
$659.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$621.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$307.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$621.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$417.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$589.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$562.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$312.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$551.73
|
| Rate for Payer: Cash Price |
$347.00
|
| Rate for Payer: Cigna Commercial |
$555.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$555.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$555.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$312.30
|
| Rate for Payer: Multiplan Commercial |
$645.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$589.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$312.30
|
| Rate for Payer: United Healthcare Commercial |
$659.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$312.30
|
| Rate for Payer: United Healthcare VA CCN |
$312.30
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
OP
|
$3,130.00
|
|
|
Service Code
|
CPT 26735
|
| Hospital Charge Code |
9602673501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,386.28 |
| Max. Negotiated Rate |
$2,973.50 |
| Rate for Payer: Aetna of VT Commercial |
$2,973.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,804.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,386.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,804.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,884.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,660.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,535.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,408.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,488.35
|
| Rate for Payer: Cash Price |
$1,565.00
|
| Rate for Payer: Cigna Commercial |
$2,504.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,504.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,504.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,408.50
|
| Rate for Payer: Multiplan Commercial |
$2,910.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,660.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,408.50
|
| Rate for Payer: United Healthcare Commercial |
$2,973.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,408.50
|
| Rate for Payer: United Healthcare VA CCN |
$1,408.50
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
5102672501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$177.16 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna of VT Commercial |
$380.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$358.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$177.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$358.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$240.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$340.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$324.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$318.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$320.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$320.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$320.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$340.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$180.00
|
| Rate for Payer: United Healthcare Commercial |
$380.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.00
|
| Rate for Payer: United Healthcare VA CCN |
$180.00
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
CPT 26746
|
| Hospital Charge Code |
9822674601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,497.96 |
| Max. Negotiated Rate |
$1,922.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,922.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,497.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,497.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,720.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,700.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,619.20
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$1,619.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,619.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,619.20
|
| Rate for Payer: Multiplan Commercial |
$1,882.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,720.40
|
| Rate for Payer: United Healthcare Commercial |
$1,922.80
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$1,182.00
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
9812675501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$874.80 |
| Max. Negotiated Rate |
$1,122.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,122.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$874.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$874.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,004.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$945.60
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cigna Commercial |
$945.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$945.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$945.60
|
| Rate for Payer: Multiplan Commercial |
$1,099.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,004.70
|
| Rate for Payer: United Healthcare Commercial |
$1,122.90
|
|
|
TREAT FINGER FRACTURE EACH
|
Professional
|
Both
|
$1,418.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
9602676502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$485.99 |
| Max. Negotiated Rate |
$1,332.92 |
| Rate for Payer: Aetna of VT Commercial |
$1,332.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,270.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$500.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,270.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$680.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$603.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$603.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$558.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$603.75
|
| Rate for Payer: Cash Price |
$709.00
|
| Rate for Payer: Cash Price |
$709.00
|
| Rate for Payer: Cigna Commercial |
$919.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$803.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$803.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$485.99
|
| Rate for Payer: Multiplan Commercial |
$1,318.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$690.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$485.99
|
| Rate for Payer: United Healthcare Commercial |
$747.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$485.99
|
| Rate for Payer: United Healthcare VA CCN |
$485.99
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$492.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
9602672002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$364.13 |
| Max. Negotiated Rate |
$467.40 |
| Rate for Payer: Aetna of VT Commercial |
$467.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$364.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$364.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$418.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$413.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$393.60
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$393.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$393.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$393.60
|
| Rate for Payer: Multiplan Commercial |
$457.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$418.20
|
| Rate for Payer: United Healthcare Commercial |
$467.40
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
9602672001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$513.63 |
| Max. Negotiated Rate |
$659.30 |
| Rate for Payer: Aetna of VT Commercial |
$659.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$513.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$513.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$589.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$582.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$555.20
|
| Rate for Payer: Cash Price |
$347.00
|
| Rate for Payer: Cigna Commercial |
$555.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$555.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$555.20
|
| Rate for Payer: Multiplan Commercial |
$645.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$589.90
|
| Rate for Payer: United Healthcare Commercial |
$659.30
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$654.01
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
4502674201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$484.03 |
| Max. Negotiated Rate |
$621.31 |
| Rate for Payer: Aetna of VT Commercial |
$621.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$484.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$484.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$555.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$549.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$523.21
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cigna Commercial |
$523.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$523.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$523.21
|
| Rate for Payer: Multiplan Commercial |
$608.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$555.91
|
| Rate for Payer: United Healthcare Commercial |
$621.31
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
9812674201
|
|
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 FINGER FRACTURE EACH
|
Facility
|
OP
|
$654.01
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
4502674201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$289.66 |
| Max. Negotiated Rate |
$621.31 |
| Rate for Payer: Aetna of VT Commercial |
$621.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$585.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$289.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$585.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$393.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$555.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$529.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$294.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$519.94
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cigna Commercial |
$523.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$523.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$523.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$294.30
|
| Rate for Payer: Multiplan Commercial |
$608.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$555.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$294.30
|
| Rate for Payer: United Healthcare Commercial |
$621.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$294.30
|
| Rate for Payer: United Healthcare VA CCN |
$294.30
|
|
|
TREAT FINGER FRACTURE EACH
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
9812675502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$271.31 |
| Max. Negotiated Rate |
$705.94 |
| Rate for Payer: Aetna of VT Commercial |
$705.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$672.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$279.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$672.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$379.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$406.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$406.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$312.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$406.45
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cigna Commercial |
$508.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$524.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$524.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$318.52
|
| Rate for Payer: Multiplan Commercial |
$698.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$385.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$271.31
|
| Rate for Payer: United Healthcare Commercial |
$417.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$271.31
|
| Rate for Payer: United Healthcare VA CCN |
$271.31
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
9602675002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$116.93 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Aetna of VT Commercial |
$250.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$236.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$236.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$158.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$224.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$213.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$209.88
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$211.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$211.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$211.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$118.80
|
| Rate for Payer: Multiplan Commercial |
$245.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$224.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$118.80
|
| Rate for Payer: United Healthcare Commercial |
$250.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.80
|
| Rate for Payer: United Healthcare VA CCN |
$118.80
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$492.96
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
4502675501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$364.84 |
| Max. Negotiated Rate |
$468.31 |
| Rate for Payer: Aetna of VT Commercial |
$468.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$364.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$364.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$419.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$414.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$394.37
|
| Rate for Payer: Cash Price |
$246.48
|
| Rate for Payer: Cigna Commercial |
$394.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$394.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$394.37
|
| Rate for Payer: Multiplan Commercial |
$458.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$419.02
|
| Rate for Payer: United Healthcare Commercial |
$468.31
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$1,712.00
|
|
|
Service Code
|
CPT 26735
|
| Hospital Charge Code |
5102673501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,267.05 |
| Max. Negotiated Rate |
$1,626.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,626.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,267.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,267.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,455.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,438.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,369.60
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cigna Commercial |
$1,369.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,369.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,369.60
|
| Rate for Payer: Multiplan Commercial |
$1,592.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,455.20
|
| Rate for Payer: United Healthcare Commercial |
$1,626.40
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
5102672001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$191.90 |
| Rate for Payer: Aetna of VT Commercial |
$191.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$149.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$149.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$171.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$161.60
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna Commercial |
$161.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$161.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$161.60
|
| Rate for Payer: Multiplan Commercial |
$187.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$171.70
|
| Rate for Payer: United Healthcare Commercial |
$191.90
|
|
|
TREAT FINGER FRACTURE EACH
|
Professional
|
Both
|
$1,244.00
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
9602675501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$271.31 |
| Max. Negotiated Rate |
$1,169.36 |
| Rate for Payer: Aetna of VT Commercial |
$1,169.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,114.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$279.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,114.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$379.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$406.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$406.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$312.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$406.45
|
| Rate for Payer: Cash Price |
$622.00
|
| Rate for Payer: Cash Price |
$622.00
|
| Rate for Payer: Cigna Commercial |
$508.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$524.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$524.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$318.52
|
| Rate for Payer: Multiplan Commercial |
$1,156.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$385.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$271.31
|
| Rate for Payer: United Healthcare Commercial |
$417.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$271.31
|
| Rate for Payer: United Healthcare VA CCN |
$271.31
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
CPT 26746
|
| Hospital Charge Code |
9822674601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$896.43 |
| Max. Negotiated Rate |
$1,922.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,922.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,813.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$896.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,813.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,218.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,720.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,639.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$910.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,609.08
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$1,619.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,619.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,619.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$910.80
|
| Rate for Payer: Multiplan Commercial |
$1,882.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,720.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$910.80
|
| Rate for Payer: United Healthcare Commercial |
$1,922.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$910.80
|
| Rate for Payer: United Healthcare VA CCN |
$910.80
|
|
|
TREAT FINGER FRACTURE EACH
|
Professional
|
Both
|
$1,712.00
|
|
|
Service Code
|
CPT 26735
|
| Hospital Charge Code |
5102673501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$571.03 |
| Max. Negotiated Rate |
$1,609.28 |
| Rate for Payer: Aetna of VT Commercial |
$1,609.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,533.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$588.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,533.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$799.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$712.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$712.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$656.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$712.16
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cigna Commercial |
$1,079.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$946.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$946.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$571.03
|
| Rate for Payer: Multiplan Commercial |
$1,592.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$810.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$571.03
|
| Rate for Payer: United Healthcare Commercial |
$878.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$571.03
|
| Rate for Payer: United Healthcare VA CCN |
$571.03
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
5102675501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$364.87 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Aetna of VT Commercial |
$468.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$364.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$364.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$419.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$414.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$394.40
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$394.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$394.40
|
| Rate for Payer: Multiplan Commercial |
$458.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$419.05
|
| Rate for Payer: United Healthcare Commercial |
$468.35
|
|
|
TREAT FINGER FRACTURE EACH
|
Professional
|
Both
|
$492.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
9812672002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$189.35 |
| Max. Negotiated Rate |
$462.48 |
| Rate for Payer: Aetna of VT Commercial |
$462.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$440.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$195.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$440.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$265.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$277.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$277.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$217.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$277.64
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$356.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$331.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$331.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$201.87
|
| Rate for Payer: Multiplan Commercial |
$457.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$268.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$189.35
|
| Rate for Payer: United Healthcare Commercial |
$291.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$189.35
|
| Rate for Payer: United Healthcare VA CCN |
$189.35
|
|
