|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$869.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
9602550001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$643.15 |
| Max. Negotiated Rate |
$825.55 |
| Rate for Payer: Aetna of VT Commercial |
$825.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$643.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$643.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$738.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$729.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$695.20
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cigna Commercial |
$695.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$695.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$695.20
|
| Rate for Payer: Multiplan Commercial |
$808.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$738.65
|
| Rate for Payer: United Healthcare Commercial |
$825.55
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$953.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
5102552001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$422.08 |
| 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 |
$853.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$422.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$853.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$573.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$810.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$771.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$428.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$757.63
|
| 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: Martins Point Health Care Commercial |
$428.85
|
| Rate for Payer: Multiplan Commercial |
$886.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$810.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$428.85
|
| Rate for Payer: United Healthcare Commercial |
$905.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$428.85
|
| Rate for Payer: United Healthcare VA CCN |
$428.85
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$1,790.89
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
4502550501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,325.44 |
| 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 |
$1,325.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,325.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,522.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,504.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,432.71
|
| 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: Multiplan Commercial |
$1,665.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,522.26
|
| Rate for Payer: United Healthcare Commercial |
$1,701.35
|
|
|
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
|
Professional
|
Both
|
$1,791.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
5102550501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$447.35 |
| Max. Negotiated Rate |
$1,683.54 |
| Rate for Payer: Aetna of VT Commercial |
$1,683.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,604.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$460.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,604.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$626.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$739.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$739.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$514.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$739.10
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cigna Commercial |
$848.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$819.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$819.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$495.85
|
| Rate for Payer: Multiplan Commercial |
$1,665.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$635.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$447.35
|
| Rate for Payer: United Healthcare Commercial |
$688.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$447.35
|
| Rate for Payer: United Healthcare VA CCN |
$447.35
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$1,791.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
5102550501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$793.23 |
| Max. Negotiated Rate |
$1,701.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,701.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,604.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$793.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,604.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,078.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,522.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,450.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$805.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,423.85
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cigna Commercial |
$1,432.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,432.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,432.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$805.95
|
| Rate for Payer: Multiplan Commercial |
$1,665.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,522.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$805.95
|
| Rate for Payer: United Healthcare Commercial |
$1,701.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$805.95
|
| Rate for Payer: United Healthcare VA CCN |
$805.95
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$1,791.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
5102550501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,325.52 |
| Max. Negotiated Rate |
$1,701.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,701.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,325.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,325.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,522.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,504.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,432.80
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cigna Commercial |
$1,432.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,432.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,432.80
|
| Rate for Payer: Multiplan Commercial |
$1,665.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,522.35
|
| Rate for Payer: United Healthcare Commercial |
$1,701.45
|
|
|
TREAT FRACTURE OF RADIUS
|
Professional
|
Both
|
$1,549.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
9602552002
|
|
Hospital Revenue Code
|
960
|
| 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
|
Professional
|
Both
|
$604.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
5102550001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$256.93 |
| Max. Negotiated Rate |
$567.76 |
| Rate for Payer: Aetna of VT Commercial |
$567.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$541.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$264.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$541.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$359.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$388.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$388.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$295.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$388.26
|
| Rate for Payer: Cash Price |
$302.00
|
| Rate for Payer: Cash Price |
$302.00
|
| Rate for Payer: Cigna Commercial |
$484.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$466.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$466.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$284.23
|
| Rate for Payer: Multiplan Commercial |
$561.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$364.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$256.93
|
| Rate for Payer: United Healthcare Commercial |
$395.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$256.93
|
| Rate for Payer: United Healthcare VA CCN |
$256.93
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$1,549.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
9812552001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$686.05 |
| 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 |
$1,387.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$686.05
|
| 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 |
$932.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,316.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,254.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$697.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,231.45
|
| 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: Martins Point Health Care Commercial |
$697.05
|
| Rate for Payer: Multiplan Commercial |
$1,440.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,316.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$697.05
|
| Rate for Payer: United Healthcare Commercial |
$1,471.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$697.05
|
| Rate for Payer: United Healthcare VA CCN |
$697.05
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
9602550502
|
|
Hospital Revenue Code
|
960
|
| 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
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
9812550001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$196.13 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Aetna of VT Commercial |
$251.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$196.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$196.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$225.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$222.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$212.00
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cigna Commercial |
$212.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$212.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$212.00
|
| Rate for Payer: Multiplan Commercial |
$246.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$225.25
|
| Rate for Payer: United Healthcare Commercial |
$251.75
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$603.86
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
4502550001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$446.92 |
| Max. Negotiated Rate |
$573.67 |
| Rate for Payer: Aetna of VT Commercial |
$573.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$446.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$446.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$513.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$507.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$483.09
|
| Rate for Payer: Cash Price |
$301.93
|
| Rate for Payer: Cigna Commercial |
$483.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$483.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$483.09
|
| Rate for Payer: Multiplan Commercial |
$561.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$513.28
|
| Rate for Payer: United Healthcare Commercial |
$573.67
|
|
|
TREAT FRACTURE OF RADIUS
|
Professional
|
Both
|
$2,504.00
|
|
|
Service Code
|
CPT 25525
|
| Hospital Charge Code |
9822552501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$750.49 |
| Max. Negotiated Rate |
$2,353.76 |
| Rate for Payer: Aetna of VT Commercial |
$2,353.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,243.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$773.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,243.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,050.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,370.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,370.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$863.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,370.25
|
| Rate for Payer: Cash Price |
$1,252.00
|
| Rate for Payer: Cash Price |
$1,252.00
|
| Rate for Payer: Cigna Commercial |
$1,420.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,249.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,249.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$750.49
|
| Rate for Payer: Multiplan Commercial |
$2,328.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,065.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$750.49
|
| Rate for Payer: United Healthcare Commercial |
$1,154.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$750.49
|
| Rate for Payer: United Healthcare VA CCN |
$750.49
|
|
|
TREAT FRACTURE OF RADIUS
|
Professional
|
Both
|
$1,549.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
9812552001
|
|
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
|
OP
|
$1,549.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
9602552002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$686.05 |
| 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 |
$1,387.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$686.05
|
| 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 |
$932.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,316.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,254.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$697.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,231.45
|
| 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: Martins Point Health Care Commercial |
$697.05
|
| Rate for Payer: Multiplan Commercial |
$1,440.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,316.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$697.05
|
| Rate for Payer: United Healthcare Commercial |
$1,471.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$697.05
|
| Rate for Payer: United Healthcare VA CCN |
$697.05
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$1,549.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
9812552002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$686.05 |
| 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 |
$1,387.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$686.05
|
| 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 |
$932.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,316.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,254.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$697.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,231.45
|
| 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: Martins Point Health Care Commercial |
$697.05
|
| Rate for Payer: Multiplan Commercial |
$1,440.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,316.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$697.05
|
| Rate for Payer: United Healthcare Commercial |
$1,471.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$697.05
|
| Rate for Payer: United Healthcare VA CCN |
$697.05
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$952.83
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
4502552001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$705.19 |
| 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 |
$705.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$705.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$809.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$800.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$762.26
|
| 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: Multiplan Commercial |
$886.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$809.91
|
| Rate for Payer: United Healthcare Commercial |
$905.19
|
|
|
TREAT FRACTURE OF RADIUS
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
9812550001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$237.41 |
| Max. Negotiated Rate |
$484.25 |
| Rate for Payer: Aetna of VT Commercial |
$249.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$237.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$264.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$237.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$359.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$388.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$388.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$295.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$388.26
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cigna Commercial |
$484.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$466.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$466.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$284.23
|
| Rate for Payer: Multiplan Commercial |
$246.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$364.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$256.93
|
| Rate for Payer: United Healthcare Commercial |
$395.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$256.93
|
| Rate for Payer: United Healthcare VA CCN |
$256.93
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
9812550502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$936.23 |
| 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 |
$936.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$936.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,075.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,062.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,012.00
|
| 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: Multiplan Commercial |
$1,176.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,075.25
|
| Rate for Payer: United Healthcare Commercial |
$1,201.75
|
|
|
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
|
$603.86
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
4502550001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$267.45 |
| Max. Negotiated Rate |
$573.67 |
| Rate for Payer: Aetna of VT Commercial |
$573.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$541.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$267.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$541.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$363.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$513.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$489.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$271.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$480.07
|
| Rate for Payer: Cash Price |
$301.93
|
| Rate for Payer: Cigna Commercial |
$483.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$483.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$483.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$271.74
|
| Rate for Payer: Multiplan Commercial |
$561.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$513.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$271.74
|
| Rate for Payer: United Healthcare Commercial |
$573.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$271.74
|
| Rate for Payer: United Healthcare VA CCN |
$271.74
|
|
|
TREAT FRACTURE OF RADIUS
|
Professional
|
Both
|
$1,265.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
9812550502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$447.35 |
| Max. Negotiated Rate |
$1,189.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,189.10
|
| 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 |
$460.77
|
| 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 |
$626.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$739.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$739.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$514.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$739.10
|
| Rate for Payer: Cash Price |
$632.50
|
| Rate for Payer: Cash Price |
$632.50
|
| Rate for Payer: Cigna Commercial |
$848.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$819.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$819.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$495.85
|
| Rate for Payer: Multiplan Commercial |
$1,176.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$635.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$447.35
|
| Rate for Payer: United Healthcare Commercial |
$688.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$447.35
|
| Rate for Payer: United Healthcare VA CCN |
$447.35
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$2,096.00
|
|
|
Service Code
|
CPT 25515
|
| Hospital Charge Code |
9822551501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,551.25 |
| Max. Negotiated Rate |
$1,991.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,991.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,551.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,551.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,781.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,760.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,676.80
|
| Rate for Payer: Cash Price |
$1,048.00
|
| Rate for Payer: Cigna Commercial |
$1,676.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,676.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,676.80
|
| Rate for Payer: Multiplan Commercial |
$1,949.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,781.60
|
| Rate for Payer: United Healthcare Commercial |
$1,991.20
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$2,096.00
|
|
|
Service Code
|
CPT 25515
|
| Hospital Charge Code |
9822551501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$928.32 |
| Max. Negotiated Rate |
$1,991.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,991.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,877.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$928.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,877.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,261.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,781.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,697.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$943.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,666.32
|
| Rate for Payer: Cash Price |
$1,048.00
|
| Rate for Payer: Cigna Commercial |
$1,676.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,676.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,676.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$943.20
|
| Rate for Payer: Multiplan Commercial |
$1,949.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,781.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$943.20
|
| Rate for Payer: United Healthcare Commercial |
$1,991.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$943.20
|
| Rate for Payer: United Healthcare VA CCN |
$943.20
|
|
