|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
9812453001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$215.69 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Aetna of VT Commercial |
$462.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$436.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$215.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$436.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$293.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$413.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$394.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$219.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$387.17
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cigna Commercial |
$389.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$389.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$389.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$219.15
|
| Rate for Payer: Multiplan Commercial |
$452.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$413.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$219.15
|
| Rate for Payer: United Healthcare Commercial |
$462.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$219.15
|
| Rate for Payer: United Healthcare VA CCN |
$219.15
|
|
|
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 |
9812360002
|
|
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
|
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
|
$854.00
|
|
|
Service Code
|
CPT 24576
|
| Hospital Charge Code |
9602457602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$632.05 |
| Max. Negotiated Rate |
$811.30 |
| Rate for Payer: Aetna of VT Commercial |
$811.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$632.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$632.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$725.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$717.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$683.20
|
| Rate for Payer: Cash Price |
$427.00
|
| Rate for Payer: Cigna Commercial |
$683.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$683.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$683.20
|
| Rate for Payer: Multiplan Commercial |
$794.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$725.90
|
| Rate for Payer: United Healthcare Commercial |
$811.30
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
9812453002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$360.43 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Aetna of VT Commercial |
$462.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$360.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$360.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$413.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$409.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$389.60
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cigna Commercial |
$389.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$389.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$389.60
|
| Rate for Payer: Multiplan Commercial |
$452.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$413.95
|
| Rate for Payer: United Healthcare Commercial |
$462.65
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
9812450002
|
|
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
|
OP
|
$627.00
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
9812360002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$277.70 |
| 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 |
$561.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$277.70
|
| 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 |
$377.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$532.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$507.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$282.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$498.46
|
| 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: Martins Point Health Care Commercial |
$282.15
|
| Rate for Payer: Multiplan Commercial |
$583.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$532.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$282.15
|
| Rate for Payer: United Healthcare Commercial |
$595.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$282.15
|
| Rate for Payer: United Healthcare VA CCN |
$282.15
|
|
|
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
|
$15,357.00
|
|
|
Service Code
|
CPT 24516
|
| Hospital Charge Code |
9602451601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$807.78 |
| Max. Negotiated Rate |
$14,435.58 |
| Rate for Payer: Aetna of VT Commercial |
$14,435.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$13,758.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$832.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$13,758.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,130.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,548.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,548.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$928.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,548.78
|
| Rate for Payer: Cash Price |
$7,678.50
|
| Rate for Payer: Cash Price |
$7,678.50
|
| Rate for Payer: Cigna Commercial |
$1,530.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,349.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,349.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$807.78
|
| Rate for Payer: Multiplan Commercial |
$14,282.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,147.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$807.78
|
| Rate for Payer: United Healthcare Commercial |
$1,242.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$807.78
|
| Rate for Payer: United Healthcare VA CCN |
$807.78
|
|
|
TREAT HUMERUS FRACTURE
|
Professional
|
Both
|
$2,303.00
|
|
|
Service Code
|
CPT 24575
|
| Hospital Charge Code |
9822457501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$698.12 |
| Max. Negotiated Rate |
$2,164.82 |
| Rate for Payer: Aetna of VT Commercial |
$2,164.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,063.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$719.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,063.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$977.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,162.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,162.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$802.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,162.80
|
| Rate for Payer: Cash Price |
$1,151.50
|
| Rate for Payer: Cash Price |
$1,151.50
|
| Rate for Payer: Cigna Commercial |
$1,318.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,161.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,161.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$698.12
|
| Rate for Payer: Multiplan Commercial |
$2,141.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$991.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$698.12
|
| Rate for Payer: United Healthcare Commercial |
$1,073.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$698.12
|
| Rate for Payer: United Healthcare VA CCN |
$698.12
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
9602360001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$688.29 |
| Max. Negotiated Rate |
$883.50 |
| Rate for Payer: Aetna of VT Commercial |
$883.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$688.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$688.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$790.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$781.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$744.00
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna Commercial |
$744.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$744.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$744.00
|
| Rate for Payer: Multiplan Commercial |
$864.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$790.50
|
| Rate for Payer: United Healthcare Commercial |
$883.50
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
9812453001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$360.43 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Aetna of VT Commercial |
$462.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$360.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$360.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$413.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$409.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$389.60
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cigna Commercial |
$389.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$389.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$389.60
|
| Rate for Payer: Multiplan Commercial |
$452.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$413.95
|
| Rate for Payer: United Healthcare Commercial |
$462.65
|
|
|
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
|
$304.00
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
5102360001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$272.35 |
| Max. Negotiated Rate |
$592.27 |
| Rate for Payer: Aetna of VT Commercial |
$285.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$272.35
|
| 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 |
$272.35
|
| 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 |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| 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 |
$282.72
|
| 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
|
$1,345.00
|
|
|
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
|
Facility
|
IP
|
$854.00
|
|
|
Service Code
|
CPT 24576
|
| Hospital Charge Code |
9812457601
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$632.05 |
| Max. Negotiated Rate |
$811.30 |
| Rate for Payer: Aetna of VT Commercial |
$811.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$632.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$632.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$725.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$717.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$683.20
|
| Rate for Payer: Cash Price |
$427.00
|
| Rate for Payer: Cigna Commercial |
$683.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$683.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$683.20
|
| Rate for Payer: Multiplan Commercial |
$794.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$725.90
|
| Rate for Payer: United Healthcare Commercial |
$811.30
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
9602453001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$541.01 |
| Max. Negotiated Rate |
$694.45 |
| Rate for Payer: Aetna of VT Commercial |
$694.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$541.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$541.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$621.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$614.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$584.80
|
| Rate for Payer: Cash Price |
$365.50
|
| Rate for Payer: Cigna Commercial |
$584.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$584.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$584.80
|
| Rate for Payer: Multiplan Commercial |
$679.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$621.35
|
| Rate for Payer: United Healthcare Commercial |
$694.45
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$303.04
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
4502360001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.28 |
| 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 |
$224.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$224.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$257.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$254.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$242.43
|
| 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: Multiplan Commercial |
$281.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$257.58
|
| Rate for Payer: United Healthcare Commercial |
$287.89
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$15,357.00
|
|
|
Service Code
|
CPT 24516
|
| Hospital Charge Code |
9602451601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$11,365.72 |
| Max. Negotiated Rate |
$14,589.15 |
| Rate for Payer: Aetna of VT Commercial |
$14,589.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$11,365.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$11,365.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13,053.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12,899.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$12,285.60
|
| Rate for Payer: Cash Price |
$7,678.50
|
| Rate for Payer: Cigna Commercial |
$12,285.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12,285.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12,285.60
|
| Rate for Payer: Multiplan Commercial |
$14,282.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13,053.45
|
| Rate for Payer: United Healthcare Commercial |
$14,589.15
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
5102450001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$722.00 |
| Rate for Payer: Aetna of VT Commercial |
$722.00
|
| 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 |
$336.60
|
| 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 |
$457.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$646.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$615.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$342.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$604.20
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$608.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$608.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$608.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$342.00
|
| Rate for Payer: Multiplan Commercial |
$706.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$646.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$342.00
|
| Rate for Payer: United Healthcare Commercial |
$722.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$342.00
|
| Rate for Payer: United Healthcare VA CCN |
$342.00
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$854.00
|
|
|
Service Code
|
CPT 24576
|
| Hospital Charge Code |
9812457602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$632.05 |
| Max. Negotiated Rate |
$811.30 |
| Rate for Payer: Aetna of VT Commercial |
$811.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$632.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$632.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$725.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$717.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$683.20
|
| Rate for Payer: Cash Price |
$427.00
|
| Rate for Payer: Cigna Commercial |
$683.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$683.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$683.20
|
| Rate for Payer: Multiplan Commercial |
$794.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$725.90
|
| Rate for Payer: United Healthcare Commercial |
$811.30
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$672.10
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
4502450501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$297.67 |
| Max. Negotiated Rate |
$638.50 |
| Rate for Payer: Aetna of VT Commercial |
$638.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$602.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$297.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$602.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$404.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$571.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$544.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$302.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$534.32
|
| Rate for Payer: Cash Price |
$336.05
|
| Rate for Payer: Cigna Commercial |
$537.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$537.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$537.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$302.44
|
| Rate for Payer: Multiplan Commercial |
$625.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$571.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$302.44
|
| Rate for Payer: United Healthcare Commercial |
$638.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$302.44
|
| Rate for Payer: United Healthcare VA CCN |
$302.44
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$243.77
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
4502453001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$180.41 |
| Max. Negotiated Rate |
$231.58 |
| Rate for Payer: Aetna of VT Commercial |
$231.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$180.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$180.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$207.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$204.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$195.02
|
| Rate for Payer: Cash Price |
$121.89
|
| Rate for Payer: Cigna Commercial |
$195.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$195.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$195.02
|
| Rate for Payer: Multiplan Commercial |
$226.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$207.20
|
| Rate for Payer: United Healthcare Commercial |
$231.58
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$633.84
|
|
|
Service Code
|
CPT 24576
|
| Hospital Charge Code |
4502457601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$280.73 |
| Max. Negotiated Rate |
$602.15 |
| Rate for Payer: Aetna of VT Commercial |
$602.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$567.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$280.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$567.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$381.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$538.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$513.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$285.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$503.90
|
| Rate for Payer: Cash Price |
$316.92
|
| Rate for Payer: Cigna Commercial |
$507.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$507.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$507.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$285.23
|
| Rate for Payer: Multiplan Commercial |
$589.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$538.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$285.23
|
| Rate for Payer: United Healthcare Commercial |
$602.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$285.23
|
| Rate for Payer: United Healthcare VA CCN |
$285.23
|
|
