|
TREAT HUMERUS FRACTURE
|
Professional
|
Both
|
$2,018.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
9602450501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$437.85 |
| Max. Negotiated Rate |
$1,896.92 |
| Rate for Payer: Aetna of VT Commercial |
$1,896.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,807.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$450.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,807.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$612.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$865.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$865.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$503.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$865.54
|
| Rate for Payer: Cash Price |
$1,009.00
|
| Rate for Payer: Cash Price |
$1,009.00
|
| Rate for Payer: Cigna Commercial |
$830.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$812.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$812.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$491.49
|
| Rate for Payer: Multiplan Commercial |
$1,876.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$621.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$437.85
|
| Rate for Payer: United Healthcare Commercial |
$673.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$437.85
|
| Rate for Payer: United Healthcare VA CCN |
$437.85
|
|
|
TREAT HUMERUS FRACTURE
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
9812362002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$257.89 |
| Max. Negotiated Rate |
$659.88 |
| Rate for Payer: Aetna of VT Commercial |
$659.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$628.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$265.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$628.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$361.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$433.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$433.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$296.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$433.93
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$486.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$443.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$443.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$269.77
|
| Rate for Payer: Multiplan Commercial |
$652.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$257.89
|
| Rate for Payer: United Healthcare Commercial |
$396.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.89
|
| Rate for Payer: United Healthcare VA CCN |
$257.89
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$303.04
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
4502360001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.22 |
| Max. Negotiated Rate |
$287.89 |
| Rate for Payer: Aetna of VT Commercial |
$287.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$271.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$134.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$271.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$182.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$257.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$245.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$136.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$240.92
|
| Rate for Payer: Cash Price |
$151.52
|
| Rate for Payer: Cigna Commercial |
$242.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$242.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$242.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$136.37
|
| Rate for Payer: Multiplan Commercial |
$281.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$257.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$136.37
|
| Rate for Payer: United Healthcare Commercial |
$287.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.37
|
| Rate for Payer: United Healthcare VA CCN |
$136.37
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
5102453001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.58 |
| Max. Negotiated Rate |
$231.80 |
| Rate for Payer: Aetna of VT Commercial |
$231.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$180.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$180.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$207.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$204.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$195.20
|
| Rate for Payer: Cash Price |
$122.00
|
| Rate for Payer: Cigna Commercial |
$195.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$195.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$195.20
|
| Rate for Payer: Multiplan Commercial |
$226.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$207.40
|
| Rate for Payer: United Healthcare Commercial |
$231.80
|
|
|
TREAT HUMERUS FRACTURE
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
9812456002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$285.79 |
| Max. Negotiated Rate |
$551.14 |
| Rate for Payer: Aetna of VT Commercial |
$299.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$285.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$300.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$285.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$408.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$530.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$530.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$335.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$530.87
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna Commercial |
$551.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$542.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$542.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$330.00
|
| Rate for Payer: Multiplan Commercial |
$296.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$413.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$291.46
|
| Rate for Payer: United Healthcare Commercial |
$448.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$291.46
|
| Rate for Payer: United Healthcare VA CCN |
$291.46
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
9602450002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$403.48 |
| Max. Negotiated Rate |
$865.45 |
| Rate for Payer: Aetna of VT Commercial |
$865.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$816.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$403.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$816.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$548.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$774.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$737.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$409.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$724.25
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$728.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$728.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$728.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$409.95
|
| Rate for Payer: Multiplan Commercial |
$847.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$774.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$409.95
|
| Rate for Payer: United Healthcare Commercial |
$865.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$409.95
|
| Rate for Payer: United Healthcare VA CCN |
$409.95
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
9812360001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$464.04 |
| Max. Negotiated Rate |
$595.65 |
| Rate for Payer: Aetna of VT Commercial |
$595.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$464.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$464.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$532.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$526.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$501.60
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cigna Commercial |
$501.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$501.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$501.60
|
| Rate for Payer: Multiplan Commercial |
$583.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$532.95
|
| Rate for Payer: United Healthcare Commercial |
$595.65
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$647.28
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
4502456001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$479.05 |
| Max. Negotiated Rate |
$614.92 |
| Rate for Payer: Aetna of VT Commercial |
$614.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$479.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$479.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$550.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$543.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$517.82
|
| Rate for Payer: Cash Price |
$323.64
|
| Rate for Payer: Cigna Commercial |
$517.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$517.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$517.82
|
| Rate for Payer: Multiplan Commercial |
$601.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$550.19
|
| Rate for Payer: United Healthcare Commercial |
$614.92
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
9812450001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$403.48 |
| Max. Negotiated Rate |
$865.45 |
| Rate for Payer: Aetna of VT Commercial |
$865.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$816.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$403.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$816.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$548.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$774.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$737.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$409.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$724.25
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$728.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$728.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$728.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$409.95
|
| Rate for Payer: Multiplan Commercial |
$847.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$774.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$409.95
|
| Rate for Payer: United Healthcare Commercial |
$865.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$409.95
|
| Rate for Payer: United Healthcare VA CCN |
$409.95
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$721.00
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
9602456001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$533.61 |
| Max. Negotiated Rate |
$684.95 |
| Rate for Payer: Aetna of VT Commercial |
$684.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$533.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$533.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$612.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$605.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$576.80
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: Cigna Commercial |
$576.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$576.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$576.80
|
| Rate for Payer: Multiplan Commercial |
$670.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$612.85
|
| Rate for Payer: United Healthcare Commercial |
$684.95
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$2,768.00
|
|
|
Service Code
|
CPT 24579
|
| Hospital Charge Code |
9822457901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,225.95 |
| Max. Negotiated Rate |
$2,629.60 |
| Rate for Payer: Aetna of VT Commercial |
$2,629.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,479.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,225.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,479.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,666.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,352.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,242.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,245.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,200.56
|
| Rate for Payer: Cash Price |
$1,384.00
|
| Rate for Payer: Cigna Commercial |
$2,214.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,214.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,214.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,245.60
|
| Rate for Payer: Multiplan Commercial |
$2,574.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,352.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,245.60
|
| Rate for Payer: United Healthcare Commercial |
$2,629.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,245.60
|
| Rate for Payer: United Healthcare VA CCN |
$1,245.60
|
|
|
TREAT HUMERUS FRACTURE
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
9812362001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$257.89 |
| Max. Negotiated Rate |
$659.88 |
| Rate for Payer: Aetna of VT Commercial |
$659.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$628.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$265.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$628.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$361.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$433.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$433.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$296.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$433.93
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$486.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$443.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$443.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$269.77
|
| Rate for Payer: Multiplan Commercial |
$652.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$257.89
|
| Rate for Payer: United Healthcare Commercial |
$396.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.89
|
| Rate for Payer: United Healthcare VA CCN |
$257.89
|
|
|
TREAT HUMERUS FRACTURE
|
Professional
|
Both
|
$627.00
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
9812360001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$313.95 |
| Max. Negotiated Rate |
$592.27 |
| Rate for Payer: Aetna of VT Commercial |
$589.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$561.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$323.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$561.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$439.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$475.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$475.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$361.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$475.54
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cigna Commercial |
$592.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$544.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$544.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$331.61
|
| Rate for Payer: Multiplan Commercial |
$583.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$445.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$313.95
|
| Rate for Payer: United Healthcare Commercial |
$482.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.95
|
| Rate for Payer: United Healthcare VA CCN |
$313.95
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$1,670.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
9602450001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$739.64 |
| Max. Negotiated Rate |
$1,586.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,586.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,496.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$739.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,496.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,005.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,419.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,352.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$751.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,327.65
|
| Rate for Payer: Cash Price |
$835.00
|
| Rate for Payer: Cigna Commercial |
$1,336.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,336.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,336.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$751.50
|
| Rate for Payer: Multiplan Commercial |
$1,553.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,419.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$751.50
|
| Rate for Payer: United Healthcare Commercial |
$1,586.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$751.50
|
| Rate for Payer: United Healthcare VA CCN |
$751.50
|
|
|
TREAT HUMERUS FRACTURE
|
Professional
|
Both
|
$854.00
|
|
|
Service Code
|
CPT 24576
|
| Hospital Charge Code |
9602457602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$310.59 |
| Max. Negotiated Rate |
$802.76 |
| Rate for Payer: Aetna of VT Commercial |
$802.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$765.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$319.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$765.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$434.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$469.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$469.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$357.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$469.97
|
| Rate for Payer: Cash Price |
$427.00
|
| Rate for Payer: Cash Price |
$427.00
|
| Rate for Payer: Cigna Commercial |
$588.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$573.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$573.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$349.46
|
| Rate for Payer: Multiplan Commercial |
$794.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$441.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$310.59
|
| Rate for Payer: United Healthcare Commercial |
$477.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.59
|
| Rate for Payer: United Healthcare VA CCN |
$310.59
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$279.18
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
4502362001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$206.62 |
| Max. Negotiated Rate |
$265.22 |
| Rate for Payer: Aetna of VT Commercial |
$265.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$206.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$206.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$237.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$234.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$223.34
|
| Rate for Payer: Cash Price |
$139.59
|
| Rate for Payer: Cigna Commercial |
$223.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$223.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$223.34
|
| Rate for Payer: Multiplan Commercial |
$259.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$237.30
|
| Rate for Payer: United Healthcare Commercial |
$265.22
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$2,322.00
|
|
|
Service Code
|
CPT 24516
|
| Hospital Charge Code |
9602451602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,718.51 |
| Max. Negotiated Rate |
$2,205.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,205.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,718.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,718.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,973.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,950.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,857.60
|
| Rate for Payer: Cash Price |
$1,161.00
|
| Rate for Payer: Cigna Commercial |
$1,857.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,857.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,857.60
|
| Rate for Payer: Multiplan Commercial |
$2,159.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,973.70
|
| Rate for Payer: United Healthcare Commercial |
$2,205.90
|
|
|
TREAT HUMERUS FRACTURE
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
5102450001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$329.99 |
| Max. Negotiated Rate |
$714.40 |
| Rate for Payer: Aetna of VT Commercial |
$714.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$680.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$339.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$680.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$461.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$491.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$491.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$379.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$491.35
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$624.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$590.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$590.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$359.22
|
| Rate for Payer: Multiplan Commercial |
$706.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$468.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$329.99
|
| Rate for Payer: United Healthcare Commercial |
$507.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$329.99
|
| Rate for Payer: United Healthcare VA CCN |
$329.99
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 24576
|
| Hospital Charge Code |
5102457601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$469.22 |
| Max. Negotiated Rate |
$602.30 |
| Rate for Payer: Aetna of VT Commercial |
$602.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$469.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$469.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$538.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$532.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$507.20
|
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Cigna Commercial |
$507.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$507.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$507.20
|
| Rate for Payer: Multiplan Commercial |
$589.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$538.90
|
| Rate for Payer: United Healthcare Commercial |
$602.30
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$13,035.00
|
|
|
Service Code
|
CPT 24516
|
| Hospital Charge Code |
5102451601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9,647.20 |
| Max. Negotiated Rate |
$12,383.25 |
| Rate for Payer: Aetna of VT Commercial |
$12,383.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$9,647.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$9,647.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11,079.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$10,949.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$10,428.00
|
| Rate for Payer: Cash Price |
$6,517.50
|
| Rate for Payer: Cigna Commercial |
$10,428.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$10,428.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$10,428.00
|
| Rate for Payer: Multiplan Commercial |
$12,122.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11,079.75
|
| Rate for Payer: United Healthcare Commercial |
$12,383.25
|
|
|
TREAT HUMERUS FRACTURE
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
5102453001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$218.60 |
| Max. Negotiated Rate |
$654.46 |
| Rate for Payer: Aetna of VT Commercial |
$229.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$218.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$356.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$218.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$483.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$535.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$535.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$397.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$535.42
|
| Rate for Payer: Cash Price |
$122.00
|
| Rate for Payer: Cash Price |
$122.00
|
| Rate for Payer: Cigna Commercial |
$654.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$622.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$622.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$378.75
|
| Rate for Payer: Multiplan Commercial |
$226.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$490.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$345.66
|
| Rate for Payer: United Healthcare Commercial |
$531.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$345.66
|
| Rate for Payer: United Healthcare VA CCN |
$345.66
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$1,345.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
9812450501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$595.70 |
| Max. Negotiated Rate |
$1,277.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,277.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,204.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$595.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,204.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$809.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,143.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,089.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$605.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,069.28
|
| Rate for Payer: Cash Price |
$672.50
|
| Rate for Payer: Cigna Commercial |
$1,076.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,076.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,076.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$605.25
|
| Rate for Payer: Multiplan Commercial |
$1,250.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,143.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$605.25
|
| Rate for Payer: United Healthcare Commercial |
$1,277.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$605.25
|
| Rate for Payer: United Healthcare VA CCN |
$605.25
|
|
|
TREAT HUMERUS FRACTURE
|
Professional
|
Both
|
$854.00
|
|
|
Service Code
|
CPT 24576
|
| Hospital Charge Code |
9812457602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$310.59 |
| Max. Negotiated Rate |
$802.76 |
| Rate for Payer: Aetna of VT Commercial |
$802.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$765.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$319.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$765.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$434.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$469.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$469.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$357.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$469.97
|
| Rate for Payer: Cash Price |
$427.00
|
| Rate for Payer: Cash Price |
$427.00
|
| Rate for Payer: Cigna Commercial |
$588.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$573.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$573.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$349.46
|
| Rate for Payer: Multiplan Commercial |
$794.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$441.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$310.59
|
| Rate for Payer: United Healthcare Commercial |
$477.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.59
|
| Rate for Payer: United Healthcare VA CCN |
$310.59
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
9812360002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$464.04 |
| Max. Negotiated Rate |
$595.65 |
| Rate for Payer: Aetna of VT Commercial |
$595.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$464.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$464.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$532.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$526.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$501.60
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cigna Commercial |
$501.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$501.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$501.60
|
| Rate for Payer: Multiplan Commercial |
$583.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$532.95
|
| Rate for Payer: United Healthcare Commercial |
$595.65
|
|
|
TREAT HUMERUS FRACTURE
|
Professional
|
Both
|
$2,741.00
|
|
|
Service Code
|
CPT 24582
|
| Hospital Charge Code |
9822458201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$778.64 |
| Max. Negotiated Rate |
$2,576.54 |
| Rate for Payer: Aetna of VT Commercial |
$2,576.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,455.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$802.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,455.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,090.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,307.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,307.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$895.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,307.54
|
| Rate for Payer: Cash Price |
$1,370.50
|
| Rate for Payer: Cash Price |
$1,370.50
|
| Rate for Payer: Cigna Commercial |
$1,473.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,294.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,294.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$778.64
|
| Rate for Payer: Multiplan Commercial |
$2,549.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,105.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$778.65
|
| Rate for Payer: United Healthcare Commercial |
$1,197.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$778.65
|
| Rate for Payer: United Healthcare VA CCN |
$778.65
|
|
