|
TREAT HUMERUS FRACTURE
|
Professional
|
Both
|
$731.00
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
9602453001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$345.66 |
| Max. Negotiated Rate |
$687.14 |
| Rate for Payer: Aetna of VT Commercial |
$687.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$654.90
|
| 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 |
$654.90
|
| 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 |
$365.50
|
| Rate for Payer: Cash Price |
$365.50
|
| 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 |
$679.83
|
| 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
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
CPT 24576
|
| Hospital Charge Code |
5102457601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$310.59 |
| Max. Negotiated Rate |
$595.96 |
| Rate for Payer: Aetna of VT Commercial |
$595.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$568.00
|
| 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 |
$568.00
|
| 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 |
$317.00
|
| Rate for Payer: Cash Price |
$317.00
|
| 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 |
$589.62
|
| 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 |
9602360002
|
|
Hospital Revenue Code
|
960
|
| 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
|
$673.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
5102450501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$437.85 |
| Max. Negotiated Rate |
$865.54 |
| Rate for Payer: Aetna of VT Commercial |
$632.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$602.94
|
| 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 |
$602.94
|
| 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 |
$336.50
|
| Rate for Payer: Cash Price |
$336.50
|
| 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 |
$625.89
|
| 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
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
9812456002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$141.29 |
| Max. Negotiated Rate |
$303.05 |
| Rate for Payer: Aetna of VT Commercial |
$303.05
|
| 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 |
$141.29
|
| 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 |
$192.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$271.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$258.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$143.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$253.60
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna Commercial |
$255.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$255.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$255.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$143.55
|
| Rate for Payer: Multiplan Commercial |
$296.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$271.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$143.55
|
| Rate for Payer: United Healthcare Commercial |
$303.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$143.55
|
| Rate for Payer: United Healthcare VA CCN |
$143.55
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
9602453001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$323.76 |
| 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 |
$654.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$323.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$654.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$440.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$621.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$592.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$328.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$581.14
|
| 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: Martins Point Health Care Commercial |
$328.95
|
| Rate for Payer: Multiplan Commercial |
$679.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$621.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$328.95
|
| Rate for Payer: United Healthcare Commercial |
$694.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$328.95
|
| Rate for Payer: United Healthcare VA CCN |
$328.95
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
9812450001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$674.23 |
| 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 |
$674.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$674.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$774.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$765.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$728.80
|
| 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: Multiplan Commercial |
$847.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$774.35
|
| Rate for Payer: United Healthcare Commercial |
$865.45
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
9812450002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$674.23 |
| 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 |
$674.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$674.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$774.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$765.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$728.80
|
| 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: Multiplan Commercial |
$847.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$774.35
|
| Rate for Payer: United Healthcare Commercial |
$865.45
|
|
|
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
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
9812362002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$519.55 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Aetna of VT Commercial |
$666.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$519.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$519.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$596.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$589.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$561.60
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$561.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$561.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$561.60
|
| Rate for Payer: Multiplan Commercial |
$652.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$596.70
|
| Rate for Payer: United Healthcare Commercial |
$666.90
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$2,018.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
9602450501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,493.52 |
| Max. Negotiated Rate |
$1,917.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,917.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,493.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,493.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,715.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,695.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,614.40
|
| Rate for Payer: Cash Price |
$1,009.00
|
| Rate for Payer: Cigna Commercial |
$1,614.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,614.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,614.40
|
| Rate for Payer: Multiplan Commercial |
$1,876.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,715.30
|
| Rate for Payer: United Healthcare Commercial |
$1,917.10
|
|
|
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
|
$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
|
$760.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
5102450001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$562.48 |
| 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 |
$562.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$562.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$646.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$638.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$608.00
|
| 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: Multiplan Commercial |
$706.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$646.00
|
| Rate for Payer: United Healthcare Commercial |
$722.00
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$2,582.00
|
|
|
Service Code
|
CPT 24538
|
| Hospital Charge Code |
9822453801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,143.57 |
| Max. Negotiated Rate |
$2,452.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,452.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,313.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,143.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,313.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,554.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,194.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,091.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,161.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,052.69
|
| Rate for Payer: Cash Price |
$1,291.00
|
| Rate for Payer: Cigna Commercial |
$2,065.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,065.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,065.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,161.90
|
| Rate for Payer: Multiplan Commercial |
$2,401.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,194.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,161.90
|
| Rate for Payer: United Healthcare Commercial |
$2,452.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,161.90
|
| Rate for Payer: United Healthcare VA CCN |
$1,161.90
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$2,303.00
|
|
|
Service Code
|
CPT 24575
|
| Hospital Charge Code |
9822457501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$2,187.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,187.85
|
| 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 |
$1,020.00
|
| 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 |
$1,386.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,957.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,865.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,036.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,830.88
|
| Rate for Payer: Cash Price |
$1,151.50
|
| Rate for Payer: Cigna Commercial |
$1,842.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,842.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,842.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,036.35
|
| Rate for Payer: Multiplan Commercial |
$2,141.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,957.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,036.35
|
| Rate for Payer: United Healthcare Commercial |
$2,187.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,036.35
|
| Rate for Payer: United Healthcare VA CCN |
$1,036.35
|
|
|
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 KNEECAP DISLOCATION
|
Professional
|
Both
|
$486.00
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
9812756202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$435.41 |
| Max. Negotiated Rate |
$893.34 |
| Rate for Payer: Aetna of VT Commercial |
$456.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$435.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$487.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$435.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$662.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$784.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$784.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$543.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$784.20
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$893.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$785.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$785.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$472.93
|
| Rate for Payer: Multiplan Commercial |
$451.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$671.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$472.93
|
| Rate for Payer: United Healthcare Commercial |
$727.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$472.93
|
| Rate for Payer: United Healthcare VA CCN |
$472.93
|
|
|
TREAT KNEECAP DISLOCATION
|
Facility
|
IP
|
$576.66
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
4502756001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$426.79 |
| Max. Negotiated Rate |
$547.83 |
| Rate for Payer: Aetna of VT Commercial |
$547.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$426.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$426.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$490.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$484.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$461.33
|
| Rate for Payer: Cash Price |
$288.33
|
| Rate for Payer: Cigna Commercial |
$461.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$461.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$461.33
|
| Rate for Payer: Multiplan Commercial |
$536.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$490.16
|
| Rate for Payer: United Healthcare Commercial |
$547.83
|
|
|
TREAT KNEECAP DISLOCATION
|
Facility
|
OP
|
$576.66
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
4502756001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$255.40 |
| Max. Negotiated Rate |
$547.83 |
| Rate for Payer: Aetna of VT Commercial |
$547.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$516.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$255.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$516.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$347.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$490.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$467.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$259.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$458.44
|
| Rate for Payer: Cash Price |
$288.33
|
| Rate for Payer: Cigna Commercial |
$461.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$461.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$461.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$259.50
|
| Rate for Payer: Multiplan Commercial |
$536.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$490.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$259.50
|
| Rate for Payer: United Healthcare Commercial |
$547.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$259.50
|
| Rate for Payer: United Healthcare VA CCN |
$259.50
|
|
|
TREAT KNEECAP DISLOCATION
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
9812756001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
TREAT KNEECAP DISLOCATION
|
Facility
|
OP
|
$796.18
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
4502756201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$352.63 |
| Max. Negotiated Rate |
$756.37 |
| Rate for Payer: Aetna of VT Commercial |
$756.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$713.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$352.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$713.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$479.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$676.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$644.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$358.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$632.96
|
| Rate for Payer: Cash Price |
$398.09
|
| Rate for Payer: Cigna Commercial |
$636.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$636.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$636.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$358.28
|
| Rate for Payer: Multiplan Commercial |
$740.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$676.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$358.28
|
| Rate for Payer: United Healthcare Commercial |
$756.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$358.28
|
| Rate for Payer: United Healthcare VA CCN |
$358.28
|
|
|
TREAT KNEECAP DISLOCATION
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
9812756001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$630.76 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$342.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$465.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$536.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$536.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$382.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$536.74
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$630.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$603.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$603.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$365.40
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$471.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$332.31
|
| Rate for Payer: United Healthcare Commercial |
$511.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$332.31
|
| Rate for Payer: United Healthcare VA CCN |
$332.31
|
|
|
TREAT KNEECAP DISLOCATION
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
9812756001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
TREAT KNEECAP DISLOCATION
|
Facility
|
IP
|
$796.18
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
4502756201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$589.25 |
| Max. Negotiated Rate |
$756.37 |
| Rate for Payer: Aetna of VT Commercial |
$756.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$589.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$589.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$676.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$668.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$636.94
|
| Rate for Payer: Cash Price |
$398.09
|
| Rate for Payer: Cigna Commercial |
$636.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$636.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$636.94
|
| Rate for Payer: Multiplan Commercial |
$740.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$676.75
|
| Rate for Payer: United Healthcare Commercial |
$756.37
|
|
