|
TREAT FINGER FRACTURE EACH
|
Facility
|
OP
|
$201.63
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
4502672001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.30 |
| Max. Negotiated Rate |
$191.55 |
| Rate for Payer: Aetna of VT Commercial |
$191.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$180.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$89.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$180.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$121.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$171.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$163.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$90.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$160.30
|
| Rate for Payer: Cash Price |
$100.82
|
| Rate for Payer: Cigna Commercial |
$161.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$161.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$161.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$90.73
|
| Rate for Payer: Multiplan Commercial |
$187.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$171.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$90.73
|
| Rate for Payer: United Healthcare Commercial |
$191.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$90.73
|
| Rate for Payer: United Healthcare VA CCN |
$90.73
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$1,018.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
5102676501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$753.42 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Aetna of VT Commercial |
$967.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$753.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$753.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$865.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$855.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$814.40
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cigna Commercial |
$814.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$814.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$814.40
|
| Rate for Payer: Multiplan Commercial |
$946.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$865.30
|
| Rate for Payer: United Healthcare Commercial |
$967.10
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
OP
|
$1,259.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
9602672501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$557.61 |
| Max. Negotiated Rate |
$1,196.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,196.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,127.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$557.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,127.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$757.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,070.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,019.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$566.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,000.90
|
| Rate for Payer: Cash Price |
$629.50
|
| Rate for Payer: Cigna Commercial |
$1,007.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,007.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,007.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$566.55
|
| Rate for Payer: Multiplan Commercial |
$1,170.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,070.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$566.55
|
| Rate for Payer: United Healthcare Commercial |
$1,196.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$566.55
|
| Rate for Payer: United Healthcare VA CCN |
$566.55
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
OP
|
$1,085.00
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
9822674201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$480.55 |
| Max. Negotiated Rate |
$1,030.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,030.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$972.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$480.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$972.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$653.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$922.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$878.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$488.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$862.58
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cigna Commercial |
$868.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$868.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$868.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$488.25
|
| Rate for Payer: Multiplan Commercial |
$1,009.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$922.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$488.25
|
| Rate for Payer: United Healthcare Commercial |
$1,030.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$488.25
|
| Rate for Payer: United Healthcare VA CCN |
$488.25
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
OP
|
$1,418.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
9822676501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$628.03 |
| Max. Negotiated Rate |
$1,347.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,347.10
|
| 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 |
$628.03
|
| 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 |
$853.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,205.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,148.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$638.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,127.31
|
| Rate for Payer: Cash Price |
$709.00
|
| Rate for Payer: Cigna Commercial |
$1,134.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,134.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,134.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$638.10
|
| Rate for Payer: Multiplan Commercial |
$1,318.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,205.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$638.10
|
| Rate for Payer: United Healthcare Commercial |
$1,347.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$638.10
|
| Rate for Payer: United Healthcare VA CCN |
$638.10
|
|
|
TREAT FINGER FRACTURE EACH
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
5102675001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$181.87 |
| Max. Negotiated Rate |
$358.80 |
| Rate for Payer: Aetna of VT Commercial |
$190.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$181.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$196.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$181.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$267.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$264.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$264.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$219.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$264.91
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: Cigna Commercial |
$358.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$310.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$310.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$188.56
|
| Rate for Payer: Multiplan Commercial |
$188.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$270.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$190.81
|
| Rate for Payer: United Healthcare Commercial |
$293.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$190.81
|
| Rate for Payer: United Healthcare VA CCN |
$190.81
|
|
|
TREAT FINGER FRACTURE EACH
|
Professional
|
Both
|
$1,085.00
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
9822674201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$328.09 |
| Max. Negotiated Rate |
$1,019.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,019.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$972.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$337.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$972.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$459.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$625.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$625.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$377.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$625.65
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cigna Commercial |
$619.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$604.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$604.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$366.95
|
| Rate for Payer: Multiplan Commercial |
$1,009.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$465.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$328.09
|
| Rate for Payer: United Healthcare Commercial |
$504.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$328.09
|
| Rate for Payer: United Healthcare VA CCN |
$328.09
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$1,085.00
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
9812674202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$803.01 |
| Max. Negotiated Rate |
$1,030.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,030.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$803.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$803.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$922.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$911.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$868.00
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cigna Commercial |
$868.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$868.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$868.00
|
| Rate for Payer: Multiplan Commercial |
$1,009.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$922.25
|
| Rate for Payer: United Healthcare Commercial |
$1,030.75
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
9602676501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,802.88 |
| Max. Negotiated Rate |
$2,314.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,314.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,802.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,802.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,070.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,046.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,948.80
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cigna Commercial |
$1,948.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,948.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,948.80
|
| Rate for Payer: Multiplan Commercial |
$2,265.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,070.60
|
| Rate for Payer: United Healthcare Commercial |
$2,314.20
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
OP
|
$1,018.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
5102676501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$450.87 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Aetna of VT Commercial |
$967.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$912.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$450.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$912.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$612.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$865.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$824.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$458.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$809.31
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cigna Commercial |
$814.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$814.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$814.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$458.10
|
| Rate for Payer: Multiplan Commercial |
$946.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$865.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$458.10
|
| Rate for Payer: United Healthcare Commercial |
$967.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$458.10
|
| Rate for Payer: United Healthcare VA CCN |
$458.10
|
|
|
TREAT FINGER FRACTURE EACH
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
9812675002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$188.56 |
| Max. Negotiated Rate |
$358.80 |
| Rate for Payer: Aetna of VT Commercial |
$248.16
|
| 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 |
$196.53
|
| 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 |
$267.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$264.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$264.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$219.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$264.91
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$358.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$310.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$310.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$188.56
|
| Rate for Payer: Multiplan Commercial |
$245.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$270.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$190.81
|
| Rate for Payer: United Healthcare Commercial |
$293.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$190.81
|
| Rate for Payer: United Healthcare VA CCN |
$190.81
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$492.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
9812672002
|
|
Hospital Revenue Code
|
981
|
| 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
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
5102675501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$218.35 |
| 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 |
$441.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$218.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$441.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$296.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$419.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$399.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$221.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.94
|
| 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: Martins Point Health Care Commercial |
$221.85
|
| Rate for Payer: Multiplan Commercial |
$458.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$419.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$221.85
|
| Rate for Payer: United Healthcare Commercial |
$468.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$221.85
|
| Rate for Payer: United Healthcare VA CCN |
$221.85
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
OP
|
$492.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
9812672002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$217.91 |
| 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 |
$440.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$217.91
|
| 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 |
$296.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$418.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$398.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$221.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.14
|
| 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: Martins Point Health Care Commercial |
$221.40
|
| Rate for Payer: Multiplan Commercial |
$457.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$418.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$221.40
|
| Rate for Payer: United Healthcare Commercial |
$467.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$221.40
|
| Rate for Payer: United Healthcare VA CCN |
$221.40
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$202.66
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
4502675001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.99 |
| Max. Negotiated Rate |
$192.53 |
| Rate for Payer: Aetna of VT Commercial |
$192.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$149.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$149.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$172.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$170.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$162.13
|
| Rate for Payer: Cash Price |
$101.33
|
| Rate for Payer: Cigna Commercial |
$162.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$162.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$162.13
|
| Rate for Payer: Multiplan Commercial |
$188.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$172.26
|
| Rate for Payer: United Healthcare Commercial |
$192.53
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$1,259.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
9602672501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$931.79 |
| Max. Negotiated Rate |
$1,196.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,196.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$931.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$931.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,070.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,057.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,007.20
|
| Rate for Payer: Cash Price |
$629.50
|
| Rate for Payer: Cigna Commercial |
$1,007.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,007.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,007.20
|
| Rate for Payer: Multiplan Commercial |
$1,170.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,070.15
|
| Rate for Payer: United Healthcare Commercial |
$1,196.05
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
OP
|
$1,418.00
|
|
|
Service Code
|
CPT 26727
|
| Hospital Charge Code |
9822672701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$628.03 |
| Max. Negotiated Rate |
$1,347.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,347.10
|
| 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 |
$628.03
|
| 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 |
$853.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,205.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,148.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$638.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,127.31
|
| Rate for Payer: Cash Price |
$709.00
|
| Rate for Payer: Cigna Commercial |
$1,134.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,134.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,134.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$638.10
|
| Rate for Payer: Multiplan Commercial |
$1,318.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,205.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$638.10
|
| Rate for Payer: United Healthcare Commercial |
$1,347.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$638.10
|
| Rate for Payer: United Healthcare VA CCN |
$638.10
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$1,292.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
9812550501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$572.23 |
| Max. Negotiated Rate |
$1,227.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,227.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,157.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$572.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,157.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$777.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,098.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,046.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$581.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,027.14
|
| Rate for Payer: Cash Price |
$646.00
|
| Rate for Payer: Cigna Commercial |
$1,033.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,033.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,033.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$581.40
|
| Rate for Payer: Multiplan Commercial |
$1,201.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,098.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$581.40
|
| Rate for Payer: United Healthcare Commercial |
$1,227.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.40
|
| Rate for Payer: United Healthcare VA CCN |
$581.40
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$1,549.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
9822552001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,146.41 |
| Max. Negotiated Rate |
$1,471.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,471.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,146.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,146.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,316.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,301.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,239.20
|
| Rate for Payer: Cash Price |
$774.50
|
| Rate for Payer: Cigna Commercial |
$1,239.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,239.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,239.20
|
| Rate for Payer: Multiplan Commercial |
$1,440.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,316.65
|
| Rate for Payer: United Healthcare Commercial |
$1,471.55
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$2,502.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
9602552001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,851.73 |
| Max. Negotiated Rate |
$2,376.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,376.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,851.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,851.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,126.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,101.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,001.60
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$2,001.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,001.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,001.60
|
| Rate for Payer: Multiplan Commercial |
$2,326.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,126.70
|
| Rate for Payer: United Healthcare Commercial |
$2,376.90
|
|
|
TREAT FRACTURE OF RADIUS
|
Professional
|
Both
|
$1,549.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
9812552002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$527.57 |
| Max. Negotiated Rate |
$1,456.06 |
| Rate for Payer: Aetna of VT Commercial |
$1,456.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,387.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$543.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,387.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$738.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$968.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$968.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$606.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$968.40
|
| Rate for Payer: Cash Price |
$774.50
|
| Rate for Payer: Cash Price |
$774.50
|
| Rate for Payer: Cigna Commercial |
$997.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$928.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$928.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$560.65
|
| Rate for Payer: Multiplan Commercial |
$1,440.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$749.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$527.57
|
| Rate for Payer: United Healthcare Commercial |
$811.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$527.57
|
| Rate for Payer: United Healthcare VA CCN |
$527.57
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$953.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
5102552001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$705.32 |
| Max. Negotiated Rate |
$905.35 |
| Rate for Payer: Aetna of VT Commercial |
$905.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$705.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$705.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$810.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$800.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$762.40
|
| Rate for Payer: Cash Price |
$476.50
|
| Rate for Payer: Cigna Commercial |
$762.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$762.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$762.40
|
| Rate for Payer: Multiplan Commercial |
$886.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$810.05
|
| Rate for Payer: United Healthcare Commercial |
$905.35
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
9812550502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$560.27 |
| Max. Negotiated Rate |
$1,201.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,201.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,133.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$560.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,133.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$761.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,075.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,024.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$569.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,005.67
|
| Rate for Payer: Cash Price |
$632.50
|
| Rate for Payer: Cigna Commercial |
$1,012.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,012.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,012.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$569.25
|
| Rate for Payer: Multiplan Commercial |
$1,176.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,075.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$569.25
|
| Rate for Payer: United Healthcare Commercial |
$1,201.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$569.25
|
| Rate for Payer: United Healthcare VA CCN |
$569.25
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$1,790.89
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
4502550501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$793.19 |
| Max. Negotiated Rate |
$1,701.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,701.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,604.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$793.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,604.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,078.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,522.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,450.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$805.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,423.76
|
| Rate for Payer: Cash Price |
$895.44
|
| Rate for Payer: Cigna Commercial |
$1,432.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,432.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,432.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$805.90
|
| Rate for Payer: Multiplan Commercial |
$1,665.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,522.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$805.90
|
| Rate for Payer: United Healthcare Commercial |
$1,701.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$805.90
|
| Rate for Payer: United Healthcare VA CCN |
$805.90
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$952.83
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
4502552001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$422.01 |
| Max. Negotiated Rate |
$905.19 |
| Rate for Payer: Aetna of VT Commercial |
$905.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$853.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$422.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$853.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$573.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$809.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$771.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$428.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$757.50
|
| Rate for Payer: Cash Price |
$476.42
|
| Rate for Payer: Cigna Commercial |
$762.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$762.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$762.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$428.77
|
| Rate for Payer: Multiplan Commercial |
$886.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$809.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$428.77
|
| Rate for Payer: United Healthcare Commercial |
$905.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$428.77
|
| Rate for Payer: United Healthcare VA CCN |
$428.77
|
|
