|
TREAT FRACTURE OF ULNA
|
Facility
|
IP
|
$1,283.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
9812553502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$949.55 |
| Max. Negotiated Rate |
$1,218.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,218.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$949.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$949.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,090.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,077.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,026.40
|
| Rate for Payer: Cash Price |
$641.50
|
| Rate for Payer: Cigna Commercial |
$1,026.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,026.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,026.40
|
| Rate for Payer: Multiplan Commercial |
$1,193.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,090.55
|
| Rate for Payer: United Healthcare Commercial |
$1,218.85
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
OP
|
$1,283.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
9812553501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$568.24 |
| Max. Negotiated Rate |
$1,218.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,218.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,149.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$568.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,149.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$772.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,090.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,039.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$577.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,019.99
|
| Rate for Payer: Cash Price |
$641.50
|
| Rate for Payer: Cigna Commercial |
$1,026.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,026.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,026.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$577.35
|
| Rate for Payer: Multiplan Commercial |
$1,193.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,090.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$577.35
|
| Rate for Payer: United Healthcare Commercial |
$1,218.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$577.35
|
| Rate for Payer: United Healthcare VA CCN |
$577.35
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
OP
|
$3,913.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
9602553501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,733.07 |
| Max. Negotiated Rate |
$3,717.35 |
| Rate for Payer: Aetna of VT Commercial |
$3,717.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,505.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,733.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,505.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,355.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,326.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,169.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,760.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,110.84
|
| Rate for Payer: Cash Price |
$1,956.50
|
| Rate for Payer: Cigna Commercial |
$3,130.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,130.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,130.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,760.85
|
| Rate for Payer: Multiplan Commercial |
$3,639.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,326.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,760.85
|
| Rate for Payer: United Healthcare Commercial |
$3,717.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,760.85
|
| Rate for Payer: United Healthcare VA CCN |
$1,760.85
|
|
|
TREAT FRACTURE OF ULNA
|
Professional
|
Both
|
$3,913.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
9602553501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$444.23 |
| Max. Negotiated Rate |
$3,678.22 |
| Rate for Payer: Aetna of VT Commercial |
$3,678.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,505.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$457.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,505.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$621.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$722.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$722.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$510.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$722.51
|
| Rate for Payer: Cash Price |
$1,956.50
|
| Rate for Payer: Cash Price |
$1,956.50
|
| Rate for Payer: Cigna Commercial |
$842.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$796.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$796.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$482.78
|
| Rate for Payer: Multiplan Commercial |
$3,639.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$630.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$444.23
|
| Rate for Payer: United Healthcare Commercial |
$683.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$444.23
|
| Rate for Payer: United Healthcare VA CCN |
$444.23
|
|
|
TREAT FRACTURE OF ULNA
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
9812553001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$232.04 |
| Max. Negotiated Rate |
$457.92 |
| Rate for Payer: Aetna of VT Commercial |
$243.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$250.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$341.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$363.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$363.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$280.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$363.22
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$457.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$435.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$435.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$265.48
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$345.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$243.64
|
| Rate for Payer: United Healthcare Commercial |
$374.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$243.64
|
| Rate for Payer: United Healthcare VA CCN |
$243.64
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
9602553001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$262.20 |
| Max. Negotiated Rate |
$562.40 |
| Rate for Payer: Aetna of VT Commercial |
$562.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$530.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$262.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$530.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$356.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$503.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$479.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$266.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$470.64
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cigna Commercial |
$473.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$473.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$473.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$266.40
|
| Rate for Payer: Multiplan Commercial |
$550.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$503.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$266.40
|
| Rate for Payer: United Healthcare Commercial |
$562.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$266.40
|
| Rate for Payer: United Healthcare VA CCN |
$266.40
|
|
|
TREAT FRACTURE OF ULNA
|
Professional
|
Both
|
$1,283.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
9812553501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$444.23 |
| Max. Negotiated Rate |
$1,206.02 |
| Rate for Payer: Aetna of VT Commercial |
$1,206.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,149.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$457.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,149.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$621.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$722.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$722.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$510.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$722.51
|
| Rate for Payer: Cash Price |
$641.50
|
| Rate for Payer: Cash Price |
$641.50
|
| Rate for Payer: Cigna Commercial |
$842.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$796.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$796.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$482.78
|
| Rate for Payer: Multiplan Commercial |
$1,193.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$630.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$444.23
|
| Rate for Payer: United Healthcare Commercial |
$683.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$444.23
|
| Rate for Payer: United Healthcare VA CCN |
$444.23
|
|
|
TREAT FRACTURE OF ULNA
|
Professional
|
Both
|
$1,283.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
9812553502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$444.23 |
| Max. Negotiated Rate |
$1,206.02 |
| Rate for Payer: Aetna of VT Commercial |
$1,206.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,149.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$457.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,149.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$621.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$722.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$722.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$510.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$722.51
|
| Rate for Payer: Cash Price |
$641.50
|
| Rate for Payer: Cash Price |
$641.50
|
| Rate for Payer: Cigna Commercial |
$842.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$796.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$796.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$482.78
|
| Rate for Payer: Multiplan Commercial |
$1,193.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$630.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$444.23
|
| Rate for Payer: United Healthcare Commercial |
$683.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$444.23
|
| Rate for Payer: United Healthcare VA CCN |
$444.23
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
9812553002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$191.69 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Aetna of VT Commercial |
$246.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.20
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.20
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.15
|
| Rate for Payer: United Healthcare Commercial |
$246.05
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
9602553501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,896.01 |
| Max. Negotiated Rate |
$3,717.35 |
| Rate for Payer: Aetna of VT Commercial |
$3,717.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,896.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,896.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,326.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,286.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,130.40
|
| Rate for Payer: Cash Price |
$1,956.50
|
| Rate for Payer: Cigna Commercial |
$3,130.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,130.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,130.40
|
| Rate for Payer: Multiplan Commercial |
$3,639.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,326.05
|
| Rate for Payer: United Healthcare Commercial |
$3,717.35
|
|
|
TREAT FRACTURE OF ULNA
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
9602553002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$232.04 |
| Max. Negotiated Rate |
$457.92 |
| Rate for Payer: Aetna of VT Commercial |
$243.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$250.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$341.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$363.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$363.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$280.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$363.22
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$457.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$435.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$435.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$265.48
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$345.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$243.64
|
| Rate for Payer: United Healthcare Commercial |
$374.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$243.64
|
| Rate for Payer: United Healthcare VA CCN |
$243.64
|
|
|
TREAT FRACTURE OF ULNA
|
Professional
|
Both
|
$592.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
9602553001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$243.64 |
| Max. Negotiated Rate |
$556.48 |
| Rate for Payer: Aetna of VT Commercial |
$556.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$530.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$250.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$530.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$341.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$363.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$363.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$280.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$363.22
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cigna Commercial |
$457.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$435.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$435.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$265.48
|
| Rate for Payer: Multiplan Commercial |
$550.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$345.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$243.64
|
| Rate for Payer: United Healthcare Commercial |
$374.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$243.64
|
| Rate for Payer: United Healthcare VA CCN |
$243.64
|
|
|
TREAT FRACTURE OF ULNA
|
Professional
|
Both
|
$1,283.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
9602553502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$444.23 |
| Max. Negotiated Rate |
$1,206.02 |
| Rate for Payer: Aetna of VT Commercial |
$1,206.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,149.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$457.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,149.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$621.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$722.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$722.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$510.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$722.51
|
| Rate for Payer: Cash Price |
$641.50
|
| Rate for Payer: Cash Price |
$641.50
|
| Rate for Payer: Cigna Commercial |
$842.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$796.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$796.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$482.78
|
| Rate for Payer: Multiplan Commercial |
$1,193.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$630.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$444.23
|
| Rate for Payer: United Healthcare Commercial |
$683.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$444.23
|
| Rate for Payer: United Healthcare VA CCN |
$444.23
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
OP
|
$1,283.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
9602553502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$568.24 |
| Max. Negotiated Rate |
$1,218.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,218.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,149.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$568.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,149.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$772.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,090.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,039.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$577.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,019.99
|
| Rate for Payer: Cash Price |
$641.50
|
| Rate for Payer: Cigna Commercial |
$1,026.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,026.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,026.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$577.35
|
| Rate for Payer: Multiplan Commercial |
$1,193.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,090.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$577.35
|
| Rate for Payer: United Healthcare Commercial |
$1,218.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$577.35
|
| Rate for Payer: United Healthcare VA CCN |
$577.35
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
9602553002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$191.69 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Aetna of VT Commercial |
$246.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.20
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.20
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.15
|
| Rate for Payer: United Healthcare Commercial |
$246.05
|
|
|
TREAT FRACTURE OF ULNA
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
5102553001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$243.64 |
| Max. Negotiated Rate |
$457.92 |
| Rate for Payer: Aetna of VT Commercial |
$313.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$299.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$250.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$299.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$341.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$363.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$363.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$280.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$363.22
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$457.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$435.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$435.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$265.48
|
| Rate for Payer: Multiplan Commercial |
$310.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$345.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$243.64
|
| Rate for Payer: United Healthcare Commercial |
$374.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$243.64
|
| Rate for Payer: United Healthcare VA CCN |
$243.64
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
IP
|
$2,629.51
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
4502553501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,946.10 |
| Max. Negotiated Rate |
$2,498.03 |
| Rate for Payer: Aetna of VT Commercial |
$2,498.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,946.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,946.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,235.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,208.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,103.61
|
| Rate for Payer: Cash Price |
$1,314.76
|
| Rate for Payer: Cigna Commercial |
$2,103.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,103.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,103.61
|
| Rate for Payer: Multiplan Commercial |
$2,445.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,235.08
|
| Rate for Payer: United Healthcare Commercial |
$2,498.03
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
OP
|
$333.35
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
4502553001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$147.64 |
| Max. Negotiated Rate |
$316.68 |
| Rate for Payer: Aetna of VT Commercial |
$316.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$298.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$147.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$298.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$200.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$283.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$270.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$150.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$265.01
|
| Rate for Payer: Cash Price |
$166.68
|
| Rate for Payer: Cigna Commercial |
$266.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$266.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$266.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$150.01
|
| Rate for Payer: Multiplan Commercial |
$310.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$283.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$150.01
|
| Rate for Payer: United Healthcare Commercial |
$316.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.01
|
| Rate for Payer: United Healthcare VA CCN |
$150.01
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
9812553001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$191.69 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Aetna of VT Commercial |
$246.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.20
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.20
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.15
|
| Rate for Payer: United Healthcare Commercial |
$246.05
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
IP
|
$2,630.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
5102553501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,946.46 |
| Max. Negotiated Rate |
$2,498.50 |
| Rate for Payer: Aetna of VT Commercial |
$2,498.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,946.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,946.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,235.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,209.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,104.00
|
| Rate for Payer: Cash Price |
$1,315.00
|
| Rate for Payer: Cigna Commercial |
$2,104.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,104.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,104.00
|
| Rate for Payer: Multiplan Commercial |
$2,445.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,235.50
|
| Rate for Payer: United Healthcare Commercial |
$2,498.50
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
9812556001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$536.57 |
| Max. Negotiated Rate |
$688.75 |
| Rate for Payer: Aetna of VT Commercial |
$688.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$536.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$536.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$616.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$609.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$580.00
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$580.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$580.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$580.00
|
| Rate for Payer: Multiplan Commercial |
$674.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$616.25
|
| Rate for Payer: United Healthcare Commercial |
$688.75
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
OP
|
$1,244.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
9602556502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$550.97 |
| Max. Negotiated Rate |
$1,181.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,181.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,114.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$550.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,114.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$748.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,057.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,007.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$559.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$988.98
|
| Rate for Payer: Cash Price |
$622.00
|
| Rate for Payer: Cigna Commercial |
$995.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$995.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$995.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$559.80
|
| Rate for Payer: Multiplan Commercial |
$1,156.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,057.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$559.80
|
| Rate for Payer: United Healthcare Commercial |
$1,181.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$559.80
|
| Rate for Payer: United Healthcare VA CCN |
$559.80
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Professional
|
Both
|
$409.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
5102556501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$366.42 |
| Max. Negotiated Rate |
$851.52 |
| Rate for Payer: Aetna of VT Commercial |
$384.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$366.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$461.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$366.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$627.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$776.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$776.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$515.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$776.87
|
| Rate for Payer: Cash Price |
$204.50
|
| Rate for Payer: Cash Price |
$204.50
|
| Rate for Payer: Cigna Commercial |
$851.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$836.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$836.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$505.62
|
| Rate for Payer: Multiplan Commercial |
$380.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$636.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$448.45
|
| Rate for Payer: United Healthcare Commercial |
$689.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$448.45
|
| Rate for Payer: United Healthcare VA CCN |
$448.45
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
5102556501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$181.15 |
| Max. Negotiated Rate |
$388.55 |
| Rate for Payer: Aetna of VT Commercial |
$388.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$366.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$181.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$366.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$246.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$347.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$331.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$184.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$325.15
|
| Rate for Payer: Cash Price |
$204.50
|
| Rate for Payer: Cigna Commercial |
$327.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$327.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$327.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$184.05
|
| Rate for Payer: Multiplan Commercial |
$380.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$347.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$184.05
|
| Rate for Payer: United Healthcare Commercial |
$388.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.05
|
| Rate for Payer: United Healthcare VA CCN |
$184.05
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
5102556001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$283.46 |
| Max. Negotiated Rate |
$608.00 |
| Rate for Payer: Aetna of VT Commercial |
$608.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$573.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$283.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$573.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$385.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$544.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$518.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$288.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$508.80
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$512.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$512.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$512.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$288.00
|
| Rate for Payer: Multiplan Commercial |
$595.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$544.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$288.00
|
| Rate for Payer: United Healthcare Commercial |
$608.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.00
|
| Rate for Payer: United Healthcare VA CCN |
$288.00
|
|
