|
TREAT FRACTURE RADIUS & ULNA
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
5102556001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$258.06 |
| Max. Negotiated Rate |
$601.60 |
| Rate for Payer: Aetna of VT Commercial |
$601.60
|
| 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 |
$265.80
|
| 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 |
$361.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$387.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$387.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$296.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$387.31
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$486.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$475.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$475.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$289.54
|
| Rate for Payer: Multiplan Commercial |
$595.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$258.06
|
| Rate for Payer: United Healthcare Commercial |
$396.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$258.06
|
| Rate for Payer: United Healthcare VA CCN |
$258.06
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
9812556001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$321.10 |
| 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 |
$649.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$321.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$649.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$436.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$616.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$587.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$326.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$576.38
|
| 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: Martins Point Health Care Commercial |
$326.25
|
| Rate for Payer: Multiplan Commercial |
$674.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$616.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$326.25
|
| Rate for Payer: United Healthcare Commercial |
$688.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$326.25
|
| Rate for Payer: United Healthcare VA CCN |
$326.25
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
9812556002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$321.10 |
| 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 |
$649.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$321.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$649.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$436.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$616.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$587.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$326.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$576.38
|
| 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: Martins Point Health Care Commercial |
$326.25
|
| Rate for Payer: Multiplan Commercial |
$674.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$616.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$326.25
|
| Rate for Payer: United Healthcare Commercial |
$688.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$326.25
|
| Rate for Payer: United Healthcare VA CCN |
$326.25
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
IP
|
$1,244.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
9602556502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$920.68 |
| 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 |
$920.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$920.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,057.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,044.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$995.20
|
| 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: Multiplan Commercial |
$1,156.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,057.40
|
| Rate for Payer: United Healthcare Commercial |
$1,181.80
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
5102556501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$302.70 |
| 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 |
$302.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$302.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$347.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$343.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$327.20
|
| 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: Multiplan Commercial |
$380.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$347.65
|
| Rate for Payer: United Healthcare Commercial |
$388.55
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
OP
|
$639.01
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
4502556001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$283.02 |
| Max. Negotiated Rate |
$607.06 |
| Rate for Payer: Aetna of VT Commercial |
$607.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$572.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$283.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$572.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$384.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$543.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$517.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$287.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$508.01
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna Commercial |
$511.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$511.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$511.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$287.55
|
| Rate for Payer: Multiplan Commercial |
$594.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$543.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$287.55
|
| Rate for Payer: United Healthcare Commercial |
$607.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$287.55
|
| Rate for Payer: United Healthcare VA CCN |
$287.55
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Professional
|
Both
|
$1,653.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
9602556501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$448.45 |
| Max. Negotiated Rate |
$1,553.82 |
| Rate for Payer: Aetna of VT Commercial |
$1,553.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,480.92
|
| 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 |
$1,480.92
|
| 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 |
$826.50
|
| Rate for Payer: Cash Price |
$826.50
|
| 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 |
$1,537.29
|
| 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
|
Professional
|
Both
|
$725.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
9812556001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$258.06 |
| Max. Negotiated Rate |
$681.50 |
| Rate for Payer: Aetna of VT Commercial |
$681.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$649.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$265.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$649.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$361.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$387.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$387.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$296.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$387.31
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$486.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$475.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$475.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$289.54
|
| Rate for Payer: Multiplan Commercial |
$674.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$258.06
|
| Rate for Payer: United Healthcare Commercial |
$396.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$258.06
|
| Rate for Payer: United Healthcare VA CCN |
$258.06
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
OP
|
$1,244.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
9812556501
|
|
Hospital Revenue Code
|
981
|
| 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
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
9812556002
|
|
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
|
Professional
|
Both
|
$1,244.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
9812556502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$448.45 |
| Max. Negotiated Rate |
$1,169.36 |
| Rate for Payer: Aetna of VT Commercial |
$1,169.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,114.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$461.90
|
| 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 |
$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 |
$622.00
|
| Rate for Payer: Cash Price |
$622.00
|
| 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 |
$1,156.92
|
| 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
|
$1,364.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
9602556001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$604.12 |
| Max. Negotiated Rate |
$1,295.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,295.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,222.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$604.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,222.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$821.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,159.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,104.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$613.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,084.38
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cigna Commercial |
$1,091.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,091.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,091.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$613.80
|
| Rate for Payer: Multiplan Commercial |
$1,268.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,159.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$613.80
|
| Rate for Payer: United Healthcare Commercial |
$1,295.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$613.80
|
| Rate for Payer: United Healthcare VA CCN |
$613.80
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
9602556002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$321.10 |
| 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 |
$649.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$321.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$649.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$436.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$616.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$587.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$326.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$576.38
|
| 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: Martins Point Health Care Commercial |
$326.25
|
| Rate for Payer: Multiplan Commercial |
$674.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$616.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$326.25
|
| Rate for Payer: United Healthcare Commercial |
$688.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$326.25
|
| Rate for Payer: United Healthcare VA CCN |
$326.25
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Professional
|
Both
|
$725.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
9602556002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$258.06 |
| Max. Negotiated Rate |
$681.50 |
| Rate for Payer: Aetna of VT Commercial |
$681.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$649.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$265.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$649.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$361.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$387.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$387.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$296.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$387.31
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$486.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$475.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$475.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$289.54
|
| Rate for Payer: Multiplan Commercial |
$674.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$258.06
|
| Rate for Payer: United Healthcare Commercial |
$396.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$258.06
|
| Rate for Payer: United Healthcare VA CCN |
$258.06
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
IP
|
$639.01
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
4502556001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$472.93 |
| Max. Negotiated Rate |
$607.06 |
| Rate for Payer: Aetna of VT Commercial |
$607.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$472.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$472.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$543.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$536.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$511.21
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna Commercial |
$511.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$511.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$511.21
|
| Rate for Payer: Multiplan Commercial |
$594.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$543.16
|
| Rate for Payer: United Healthcare Commercial |
$607.06
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
IP
|
$408.43
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
4502556501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.28 |
| Max. Negotiated Rate |
$388.01 |
| Rate for Payer: Aetna of VT Commercial |
$388.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$302.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$302.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$347.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$343.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$326.74
|
| Rate for Payer: Cash Price |
$204.22
|
| Rate for Payer: Cigna Commercial |
$326.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$326.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$326.74
|
| Rate for Payer: Multiplan Commercial |
$379.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$347.17
|
| Rate for Payer: United Healthcare Commercial |
$388.01
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
IP
|
$1,653.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
9602556501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,223.39 |
| Max. Negotiated Rate |
$1,570.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,570.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,223.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,223.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,405.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,388.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,322.40
|
| Rate for Payer: Cash Price |
$826.50
|
| Rate for Payer: Cigna Commercial |
$1,322.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,322.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,322.40
|
| Rate for Payer: Multiplan Commercial |
$1,537.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,405.05
|
| Rate for Payer: United Healthcare Commercial |
$1,570.35
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Professional
|
Both
|
$725.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
9812556002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$258.06 |
| Max. Negotiated Rate |
$681.50 |
| Rate for Payer: Aetna of VT Commercial |
$681.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$649.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$265.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$649.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$361.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$387.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$387.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$296.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$387.31
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$486.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$475.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$475.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$289.54
|
| Rate for Payer: Multiplan Commercial |
$674.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$258.06
|
| Rate for Payer: United Healthcare Commercial |
$396.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$258.06
|
| Rate for Payer: United Healthcare VA CCN |
$258.06
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Professional
|
Both
|
$1,244.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
9602556502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$448.45 |
| Max. Negotiated Rate |
$1,169.36 |
| Rate for Payer: Aetna of VT Commercial |
$1,169.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,114.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$461.90
|
| 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 |
$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 |
$622.00
|
| Rate for Payer: Cash Price |
$622.00
|
| 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 |
$1,156.92
|
| 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
|
Professional
|
Both
|
$1,364.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
9602556001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$258.06 |
| Max. Negotiated Rate |
$1,282.16 |
| Rate for Payer: Aetna of VT Commercial |
$1,282.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,222.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$265.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,222.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$361.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$387.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$387.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$296.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$387.31
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cigna Commercial |
$486.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$475.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$475.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$289.54
|
| Rate for Payer: Multiplan Commercial |
$1,268.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$258.06
|
| Rate for Payer: United Healthcare Commercial |
$396.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$258.06
|
| Rate for Payer: United Healthcare VA CCN |
$258.06
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
OP
|
$1,653.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
9602556501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$732.11 |
| Max. Negotiated Rate |
$1,570.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,570.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,480.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$732.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,480.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$995.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,405.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,338.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$743.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,314.13
|
| Rate for Payer: Cash Price |
$826.50
|
| Rate for Payer: Cigna Commercial |
$1,322.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,322.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,322.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$743.85
|
| Rate for Payer: Multiplan Commercial |
$1,537.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,405.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$743.85
|
| Rate for Payer: United Healthcare Commercial |
$1,570.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$743.85
|
| Rate for Payer: United Healthcare VA CCN |
$743.85
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
IP
|
$1,244.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
9812556501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$920.68 |
| 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 |
$920.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$920.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,057.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,044.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$995.20
|
| 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: Multiplan Commercial |
$1,156.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,057.40
|
| Rate for Payer: United Healthcare Commercial |
$1,181.80
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
OP
|
$408.43
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
4502556501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$180.89 |
| Max. Negotiated Rate |
$388.01 |
| Rate for Payer: Aetna of VT Commercial |
$388.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$365.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$180.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$365.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$245.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$347.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$330.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$183.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$324.70
|
| Rate for Payer: Cash Price |
$204.22
|
| Rate for Payer: Cigna Commercial |
$326.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$326.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$326.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$183.79
|
| Rate for Payer: Multiplan Commercial |
$379.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$347.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$183.79
|
| Rate for Payer: United Healthcare Commercial |
$388.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$183.79
|
| Rate for Payer: United Healthcare VA CCN |
$183.79
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
9602556002
|
|
Hospital Revenue Code
|
960
|
| 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
|
IP
|
$640.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
5102556001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$473.66 |
| 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 |
$473.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$473.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$544.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$537.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$512.00
|
| 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: Multiplan Commercial |
$595.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$544.00
|
| Rate for Payer: United Healthcare Commercial |
$608.00
|
|
