|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
9812550002
|
|
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
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
9812550002
|
|
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
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
9602550002
|
|
Hospital Revenue Code
|
960
|
| 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
|
$1,292.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
9812550501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$956.21 |
| 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 |
$956.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$956.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,098.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,085.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,033.60
|
| 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: Multiplan Commercial |
$1,201.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,098.20
|
| Rate for Payer: United Healthcare Commercial |
$1,227.40
|
|
|
TREAT FRACTURE OF RADIUS
|
Professional
|
Both
|
$953.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
5102552001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$527.57 |
| Max. Negotiated Rate |
$997.14 |
| Rate for Payer: Aetna of VT Commercial |
$895.82
|
| 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 |
$543.40
|
| 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 |
$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 |
$476.50
|
| Rate for Payer: Cash Price |
$476.50
|
| 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 |
$886.29
|
| 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
|
$604.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
5102550001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$447.02 |
| Max. Negotiated Rate |
$573.80 |
| Rate for Payer: Aetna of VT Commercial |
$573.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$447.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$447.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$513.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$507.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$483.20
|
| Rate for Payer: Cash Price |
$302.00
|
| Rate for Payer: Cigna Commercial |
$483.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$483.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$483.20
|
| Rate for Payer: Multiplan Commercial |
$561.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$513.40
|
| Rate for Payer: United Healthcare Commercial |
$573.80
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$1,549.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
9812552002
|
|
Hospital Revenue Code
|
981
|
| 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
|
OP
|
$3,056.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
9602550501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,353.50 |
| Max. Negotiated Rate |
$2,903.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,903.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,737.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,353.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,737.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,839.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,597.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,475.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,375.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,429.52
|
| Rate for Payer: Cash Price |
$1,528.00
|
| Rate for Payer: Cigna Commercial |
$2,444.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,444.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,444.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,375.20
|
| Rate for Payer: Multiplan Commercial |
$2,842.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,597.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,375.20
|
| Rate for Payer: United Healthcare Commercial |
$2,903.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,375.20
|
| Rate for Payer: United Healthcare VA CCN |
$1,375.20
|
|
|
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
|
|
|
TREAT FRACTURE OF RADIUS
|
Professional
|
Both
|
$869.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
9602550001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$256.93 |
| Max. Negotiated Rate |
$816.86 |
| Rate for Payer: Aetna of VT Commercial |
$816.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$778.54
|
| 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 |
$778.54
|
| 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 |
$434.50
|
| Rate for Payer: Cash Price |
$434.50
|
| 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 |
$808.17
|
| 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
|
$869.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
9602550001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$384.88 |
| 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 |
$778.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$384.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$778.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$523.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$738.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$703.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$391.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$690.86
|
| 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: Martins Point Health Care Commercial |
$391.05
|
| Rate for Payer: Multiplan Commercial |
$808.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$738.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$391.05
|
| Rate for Payer: United Healthcare Commercial |
$825.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$391.05
|
| Rate for Payer: United Healthcare VA CCN |
$391.05
|
|
|
TREAT FRACTURE OF RADIUS
|
Professional
|
Both
|
$2,502.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
9602552001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$527.57 |
| Max. Negotiated Rate |
$2,351.88 |
| Rate for Payer: Aetna of VT Commercial |
$2,351.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,241.54
|
| 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 |
$2,241.54
|
| 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 |
$1,251.00
|
| Rate for Payer: Cash Price |
$1,251.00
|
| 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 |
$2,326.86
|
| 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
|
$265.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
9812550001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$117.37 |
| 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 |
$237.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$117.37
|
| 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 |
$159.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$225.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$214.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$210.68
|
| 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: Martins Point Health Care Commercial |
$119.25
|
| Rate for Payer: Multiplan Commercial |
$246.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$225.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$119.25
|
| Rate for Payer: United Healthcare Commercial |
$251.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.25
|
| Rate for Payer: United Healthcare VA CCN |
$119.25
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$2,502.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
9602552001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,108.14 |
| 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 |
$2,241.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,108.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,241.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,506.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,126.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,026.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,125.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,989.09
|
| 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: Martins Point Health Care Commercial |
$1,125.90
|
| Rate for Payer: Multiplan Commercial |
$2,326.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,126.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,125.90
|
| Rate for Payer: United Healthcare Commercial |
$2,376.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,125.90
|
| Rate for Payer: United Healthcare VA CCN |
$1,125.90
|
|
|
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 |
9822552001
|
|
Hospital Revenue Code
|
982
|
| 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
|
$1,265.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
9602550502
|
|
Hospital Revenue Code
|
960
|
| 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
|
OP
|
$1,549.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
9822552001
|
|
Hospital Revenue Code
|
982
|
| 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
|
$265.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
9602550002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$117.37 |
| 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 |
$237.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$117.37
|
| 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 |
$159.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$225.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$214.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$210.68
|
| 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: Martins Point Health Care Commercial |
$119.25
|
| Rate for Payer: Multiplan Commercial |
$246.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$225.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$119.25
|
| Rate for Payer: United Healthcare Commercial |
$251.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.25
|
| Rate for Payer: United Healthcare VA CCN |
$119.25
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$3,056.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
9602550501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,261.75 |
| Max. Negotiated Rate |
$2,903.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,903.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,261.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,261.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,597.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,567.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,444.80
|
| Rate for Payer: Cash Price |
$1,528.00
|
| Rate for Payer: Cigna Commercial |
$2,444.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,444.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,444.80
|
| Rate for Payer: Multiplan Commercial |
$2,842.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,597.60
|
| Rate for Payer: United Healthcare Commercial |
$2,903.20
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$1,549.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
9602552002
|
|
Hospital Revenue Code
|
960
|
| 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
|
$2,504.00
|
|
|
Service Code
|
CPT 25525
|
| Hospital Charge Code |
9822552501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,853.21 |
| Max. Negotiated Rate |
$2,378.80 |
| Rate for Payer: Aetna of VT Commercial |
$2,378.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,853.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,853.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,128.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,103.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,003.20
|
| Rate for Payer: Cash Price |
$1,252.00
|
| Rate for Payer: Cigna Commercial |
$2,003.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,003.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,003.20
|
| Rate for Payer: Multiplan Commercial |
$2,328.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,128.40
|
| Rate for Payer: United Healthcare Commercial |
$2,378.80
|
|
|
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
|
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
|
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
|
|
