|
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
|
$1,364.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
9602556001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,009.50 |
| 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 |
$1,009.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,009.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,159.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,145.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,091.20
|
| 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: Multiplan Commercial |
$1,268.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,159.40
|
| Rate for Payer: United Healthcare Commercial |
$1,295.80
|
|
|
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
|
$1,653.00
|
|
|
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
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
9602560001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$555.84 |
| Max. Negotiated Rate |
$1,192.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,192.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,124.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$555.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,124.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$755.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,066.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,016.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$564.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$997.73
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cigna Commercial |
$1,004.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,004.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,004.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$564.75
|
| Rate for Payer: Multiplan Commercial |
$1,167.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,066.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$564.75
|
| Rate for Payer: United Healthcare Commercial |
$1,192.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$564.75
|
| Rate for Payer: United Healthcare VA CCN |
$564.75
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
OP
|
$889.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
9812560002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$393.74 |
| Max. Negotiated Rate |
$844.55 |
| Rate for Payer: Aetna of VT Commercial |
$844.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$796.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$393.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$796.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$535.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$755.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$720.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$400.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$706.75
|
| Rate for Payer: Cash Price |
$444.50
|
| Rate for Payer: Cigna Commercial |
$711.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$711.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$711.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$400.05
|
| Rate for Payer: Multiplan Commercial |
$826.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$755.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$400.05
|
| Rate for Payer: United Healthcare Commercial |
$844.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$400.05
|
| Rate for Payer: United Healthcare VA CCN |
$400.05
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
IP
|
$3,025.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
9602560501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,238.80 |
| Max. Negotiated Rate |
$2,873.75 |
| Rate for Payer: Aetna of VT Commercial |
$2,873.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,238.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,238.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,571.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,541.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,420.00
|
| Rate for Payer: Cash Price |
$1,512.50
|
| Rate for Payer: Cigna Commercial |
$2,420.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,420.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,420.00
|
| Rate for Payer: Multiplan Commercial |
$2,813.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,571.25
|
| Rate for Payer: United Healthcare Commercial |
$2,873.75
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Professional
|
Both
|
$3,025.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
9602560501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$493.57 |
| Max. Negotiated Rate |
$2,843.50 |
| Rate for Payer: Aetna of VT Commercial |
$2,843.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,710.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$508.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,710.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$691.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$848.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$848.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$567.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$848.62
|
| Rate for Payer: Cash Price |
$1,512.50
|
| Rate for Payer: Cash Price |
$1,512.50
|
| Rate for Payer: Cigna Commercial |
$936.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$868.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$868.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$524.41
|
| Rate for Payer: Multiplan Commercial |
$2,813.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$700.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$493.57
|
| Rate for Payer: United Healthcare Commercial |
$759.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$493.57
|
| Rate for Payer: United Healthcare VA CCN |
$493.57
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
OP
|
$1,398.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
9812560502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$619.17 |
| Max. Negotiated Rate |
$1,328.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,328.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,252.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$619.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,252.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$841.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,188.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,132.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$629.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,111.41
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$1,118.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,118.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,118.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$629.10
|
| Rate for Payer: Multiplan Commercial |
$1,300.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,188.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$629.10
|
| Rate for Payer: United Healthcare Commercial |
$1,328.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$629.10
|
| Rate for Payer: United Healthcare VA CCN |
$629.10
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
IP
|
$889.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
9602560002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$657.95 |
| Max. Negotiated Rate |
$844.55 |
| Rate for Payer: Aetna of VT Commercial |
$844.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$657.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$657.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$755.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$746.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$711.20
|
| Rate for Payer: Cash Price |
$444.50
|
| Rate for Payer: Cigna Commercial |
$711.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$711.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$711.20
|
| Rate for Payer: Multiplan Commercial |
$826.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$755.65
|
| Rate for Payer: United Healthcare Commercial |
$844.55
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
IP
|
$889.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
9812560002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$657.95 |
| Max. Negotiated Rate |
$844.55 |
| Rate for Payer: Aetna of VT Commercial |
$844.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$657.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$657.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$755.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$746.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$711.20
|
| Rate for Payer: Cash Price |
$444.50
|
| Rate for Payer: Cigna Commercial |
$711.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$711.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$711.20
|
| Rate for Payer: Multiplan Commercial |
$826.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$755.65
|
| Rate for Payer: United Healthcare Commercial |
$844.55
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
IP
|
$1,626.48
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
4502560501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,203.76 |
| Max. Negotiated Rate |
$1,545.16 |
| Rate for Payer: Aetna of VT Commercial |
$1,545.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,203.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,203.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,382.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,366.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,301.18
|
| Rate for Payer: Cash Price |
$813.24
|
| Rate for Payer: Cigna Commercial |
$1,301.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,301.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,301.18
|
| Rate for Payer: Multiplan Commercial |
$1,512.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,382.51
|
| Rate for Payer: United Healthcare Commercial |
$1,545.16
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
IP
|
$366.04
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
4502560001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$270.91 |
| Max. Negotiated Rate |
$347.74 |
| Rate for Payer: Aetna of VT Commercial |
$347.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$270.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$270.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$311.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$307.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$292.83
|
| Rate for Payer: Cash Price |
$183.02
|
| Rate for Payer: Cigna Commercial |
$292.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$292.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$292.83
|
| Rate for Payer: Multiplan Commercial |
$340.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$311.13
|
| Rate for Payer: United Healthcare Commercial |
$347.74
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
OP
|
$1,398.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
9602560502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$619.17 |
| Max. Negotiated Rate |
$1,328.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,328.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,252.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$619.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,252.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$841.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,188.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,132.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$629.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,111.41
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$1,118.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,118.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,118.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$629.10
|
| Rate for Payer: Multiplan Commercial |
$1,300.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,188.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$629.10
|
| Rate for Payer: United Healthcare Commercial |
$1,328.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$629.10
|
| Rate for Payer: United Healthcare VA CCN |
$629.10
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Professional
|
Both
|
$1,255.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
9602560001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$324.13 |
| Max. Negotiated Rate |
$1,179.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,179.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,124.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$333.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,124.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$453.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$452.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$452.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$372.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$452.90
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cigna Commercial |
$610.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$553.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$553.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$338.26
|
| Rate for Payer: Multiplan Commercial |
$1,167.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$460.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$324.13
|
| Rate for Payer: United Healthcare Commercial |
$498.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.13
|
| Rate for Payer: United Healthcare VA CCN |
$324.13
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Professional
|
Both
|
$889.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
9812560002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$324.13 |
| Max. Negotiated Rate |
$835.66 |
| Rate for Payer: Aetna of VT Commercial |
$835.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$796.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$333.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$796.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$453.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$452.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$452.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$372.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$452.90
|
| Rate for Payer: Cash Price |
$444.50
|
| Rate for Payer: Cash Price |
$444.50
|
| Rate for Payer: Cigna Commercial |
$610.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$553.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$553.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$338.26
|
| Rate for Payer: Multiplan Commercial |
$826.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$460.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$324.13
|
| Rate for Payer: United Healthcare Commercial |
$498.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.13
|
| Rate for Payer: United Healthcare VA CCN |
$324.13
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
IP
|
$1,398.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
9812560502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,034.66 |
| Max. Negotiated Rate |
$1,328.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,328.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,034.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,034.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,188.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,174.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,118.40
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$1,118.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,118.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,118.40
|
| Rate for Payer: Multiplan Commercial |
$1,300.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,188.30
|
| Rate for Payer: United Healthcare Commercial |
$1,328.10
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
IP
|
$1,772.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
9812560501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,311.46 |
| Max. Negotiated Rate |
$1,683.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,683.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,311.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,311.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,506.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,488.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,417.60
|
| Rate for Payer: Cash Price |
$886.00
|
| Rate for Payer: Cigna Commercial |
$1,417.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,417.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,417.60
|
| Rate for Payer: Multiplan Commercial |
$1,647.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,506.20
|
| Rate for Payer: United Healthcare Commercial |
$1,683.40
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Professional
|
Both
|
$889.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
9602560002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$324.13 |
| Max. Negotiated Rate |
$835.66 |
| Rate for Payer: Aetna of VT Commercial |
$835.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$796.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$333.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$796.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$453.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$452.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$452.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$372.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$452.90
|
| Rate for Payer: Cash Price |
$444.50
|
| Rate for Payer: Cash Price |
$444.50
|
| Rate for Payer: Cigna Commercial |
$610.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$553.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$553.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$338.26
|
| Rate for Payer: Multiplan Commercial |
$826.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$460.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$324.13
|
| Rate for Payer: United Healthcare Commercial |
$498.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.13
|
| Rate for Payer: United Healthcare VA CCN |
$324.13
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
IP
|
$1,627.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
5102560501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,204.14 |
| Max. Negotiated Rate |
$1,545.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,545.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,204.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,204.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,382.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,366.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,301.60
|
| Rate for Payer: Cash Price |
$813.50
|
| Rate for Payer: Cigna Commercial |
$1,301.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,301.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,301.60
|
| Rate for Payer: Multiplan Commercial |
$1,513.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,382.95
|
| Rate for Payer: United Healthcare Commercial |
$1,545.65
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
5102560001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$162.54 |
| Max. Negotiated Rate |
$348.65 |
| Rate for Payer: Aetna of VT Commercial |
$348.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$328.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$328.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$220.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$311.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$297.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$165.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$291.76
|
| Rate for Payer: Cash Price |
$183.50
|
| Rate for Payer: Cigna Commercial |
$293.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$293.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$293.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$165.15
|
| Rate for Payer: Multiplan Commercial |
$341.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$311.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$165.15
|
| Rate for Payer: United Healthcare Commercial |
$348.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.15
|
| Rate for Payer: United Healthcare VA CCN |
$165.15
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
5102560001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$271.62 |
| Max. Negotiated Rate |
$348.65 |
| Rate for Payer: Aetna of VT Commercial |
$348.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$271.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$271.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$311.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$308.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$293.60
|
| Rate for Payer: Cash Price |
$183.50
|
| Rate for Payer: Cigna Commercial |
$293.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$293.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$293.60
|
| Rate for Payer: Multiplan Commercial |
$341.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$311.95
|
| Rate for Payer: United Healthcare Commercial |
$348.65
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
OP
|
$1,627.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
5102560501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$720.60 |
| Max. Negotiated Rate |
$1,545.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,545.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,457.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$720.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,457.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$979.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,382.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,317.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$732.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,293.46
|
| Rate for Payer: Cash Price |
$813.50
|
| Rate for Payer: Cigna Commercial |
$1,301.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,301.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,301.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$732.15
|
| Rate for Payer: Multiplan Commercial |
$1,513.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,382.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$732.15
|
| Rate for Payer: United Healthcare Commercial |
$1,545.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$732.15
|
| Rate for Payer: United Healthcare VA CCN |
$732.15
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Professional
|
Both
|
$1,627.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
5102560501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$493.57 |
| Max. Negotiated Rate |
$1,529.38 |
| Rate for Payer: Aetna of VT Commercial |
$1,529.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,457.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$508.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,457.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$691.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$848.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$848.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$567.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$848.62
|
| Rate for Payer: Cash Price |
$813.50
|
| Rate for Payer: Cash Price |
$813.50
|
| Rate for Payer: Cigna Commercial |
$936.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$868.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$868.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$524.41
|
| Rate for Payer: Multiplan Commercial |
$1,513.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$700.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$493.57
|
| Rate for Payer: United Healthcare Commercial |
$759.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$493.57
|
| Rate for Payer: United Healthcare VA CCN |
$493.57
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
OP
|
$1,772.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
9812560501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$784.82 |
| Max. Negotiated Rate |
$1,683.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,683.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,587.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$784.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,587.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,066.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,506.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,435.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$797.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,408.74
|
| Rate for Payer: Cash Price |
$886.00
|
| Rate for Payer: Cigna Commercial |
$1,417.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,417.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,417.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$797.40
|
| Rate for Payer: Multiplan Commercial |
$1,647.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,506.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$797.40
|
| Rate for Payer: United Healthcare Commercial |
$1,683.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$797.40
|
| Rate for Payer: United Healthcare VA CCN |
$797.40
|
|
